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PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 401k Plan overview

Plan NamePETE LIEN & SONS, INC. GROUP INSURANCE PLAN
Plan identification number 501

PETE LIEN & SONS, INC. GROUP INSURANCE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Long-term disability cover

401k Sponsoring company profile

PETE LIEN & SONS, INC. has sponsored the creation of one or more 401k plans.

Company Name:PETE LIEN & SONS, INC.
Employer identification number (EIN):460271589
NAIC Classification:212310
NAIC Description: Stone Mining and Quarrying

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PETE LIEN & SONS, INC. GROUP INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-08-01
5012021-08-01
5012020-08-01
5012019-08-01
5012018-08-01
5012017-08-01GREGORY C. SCHWEISS
5012016-08-01GREGORY C. SCHWEISS
5012015-08-01GREGORY C. SCHWEISS
5012014-08-01GREGORY C. SCHWEISS
5012013-08-01
5012012-08-01GREGORY C SCHWEISS
5012011-08-01GREGORY C SCHWEISS
5012010-08-01GREGORY C SCHWEISS
5012009-08-01GREGORY C SCHWEISS

Plan Statistics for PETE LIEN & SONS, INC. GROUP INSURANCE PLAN

401k plan membership statisitcs for PETE LIEN & SONS, INC. GROUP INSURANCE PLAN

Measure Date Value
2022: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year2022-08-01305
Total number of active participants reported on line 7a of the Form 55002022-08-01320
Number of retired or separated participants receiving benefits2022-08-011
Number of other retired or separated participants entitled to future benefits2022-08-010
Total of all active and inactive participants2022-08-01321
2021: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year2021-08-01308
Total number of active participants reported on line 7a of the Form 55002021-08-01303
Number of retired or separated participants receiving benefits2021-08-012
Number of other retired or separated participants entitled to future benefits2021-08-010
Total of all active and inactive participants2021-08-01305
2020: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year2020-08-01304
Total number of active participants reported on line 7a of the Form 55002020-08-01305
Number of retired or separated participants receiving benefits2020-08-013
Number of other retired or separated participants entitled to future benefits2020-08-010
Total of all active and inactive participants2020-08-01308
2019: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-08-01322
Total number of active participants reported on line 7a of the Form 55002019-08-01299
Number of retired or separated participants receiving benefits2019-08-015
Number of other retired or separated participants entitled to future benefits2019-08-010
Total of all active and inactive participants2019-08-01304
2018: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-08-01338
Total number of active participants reported on line 7a of the Form 55002018-08-01318
Number of retired or separated participants receiving benefits2018-08-014
Number of other retired or separated participants entitled to future benefits2018-08-010
Total of all active and inactive participants2018-08-01322
2017: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-01349
Total number of active participants reported on line 7a of the Form 55002017-08-01331
Number of retired or separated participants receiving benefits2017-08-017
Number of other retired or separated participants entitled to future benefits2017-08-010
Total of all active and inactive participants2017-08-01338
2016: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-01334
Total number of active participants reported on line 7a of the Form 55002016-08-01345
Number of retired or separated participants receiving benefits2016-08-014
Number of other retired or separated participants entitled to future benefits2016-08-010
Total of all active and inactive participants2016-08-01349
2015: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-01340
Total number of active participants reported on line 7a of the Form 55002015-08-01332
Number of retired or separated participants receiving benefits2015-08-012
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-01334
2014: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-01349
Total number of active participants reported on line 7a of the Form 55002014-08-01336
Number of retired or separated participants receiving benefits2014-08-014
Number of other retired or separated participants entitled to future benefits2014-08-010
Total of all active and inactive participants2014-08-01340
2013: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-01354
Total number of active participants reported on line 7a of the Form 55002013-08-01342
Number of retired or separated participants receiving benefits2013-08-017
Total of all active and inactive participants2013-08-01349
2012: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-01332
Total number of active participants reported on line 7a of the Form 55002012-08-01348
Number of retired or separated participants receiving benefits2012-08-016
Total of all active and inactive participants2012-08-01354
Total participants2012-08-01354
2011: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-01329
Total number of active participants reported on line 7a of the Form 55002011-08-01328
Number of retired or separated participants receiving benefits2011-08-014
Total of all active and inactive participants2011-08-01332
Total participants2011-08-01332
2010: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year2010-08-01318
Total number of active participants reported on line 7a of the Form 55002010-08-01324
Number of retired or separated participants receiving benefits2010-08-015
Total of all active and inactive participants2010-08-01329
Total participants2010-08-01329
2009: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-01319
Total number of active participants reported on line 7a of the Form 55002009-08-01315
Number of retired or separated participants receiving benefits2009-08-013
Total of all active and inactive participants2009-08-01318
Total participants2009-08-01318

Form 5500 Responses for PETE LIEN & SONS, INC. GROUP INSURANCE PLAN

2022: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2022 form 5500 responses
2022-08-01Type of plan entitySingle employer plan
2022-08-01Plan funding arrangement – InsuranceYes
2022-08-01Plan funding arrangement – General assets of the sponsorYes
2022-08-01Plan benefit arrangement – InsuranceYes
2022-08-01Plan benefit arrangement – General assets of the sponsorYes
2021: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan funding arrangement – General assets of the sponsorYes
2021-08-01Plan benefit arrangement – InsuranceYes
2021-08-01Plan benefit arrangement – General assets of the sponsorYes
2020: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2020 form 5500 responses
2020-08-01Type of plan entitySingle employer plan
2020-08-01Plan funding arrangement – InsuranceYes
2020-08-01Plan funding arrangement – General assets of the sponsorYes
2020-08-01Plan benefit arrangement – InsuranceYes
2020-08-01Plan benefit arrangement – General assets of the sponsorYes
2019: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2019 form 5500 responses
2019-08-01Type of plan entitySingle employer plan
2019-08-01Plan funding arrangement – InsuranceYes
2019-08-01Plan funding arrangement – General assets of the sponsorYes
2019-08-01Plan benefit arrangement – InsuranceYes
2019-08-01Plan benefit arrangement – General assets of the sponsorYes
2018: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2018 form 5500 responses
2018-08-01Type of plan entitySingle employer plan
2018-08-01Plan funding arrangement – InsuranceYes
2018-08-01Plan funding arrangement – General assets of the sponsorYes
2018-08-01Plan benefit arrangement – InsuranceYes
2018-08-01Plan benefit arrangement – General assets of the sponsorYes
2017: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan funding arrangement – General assets of the sponsorYes
2017-08-01Plan benefit arrangement – InsuranceYes
2017-08-01Plan benefit arrangement – General assets of the sponsorYes
2016: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan funding arrangement – General assets of the sponsorYes
2016-08-01Plan benefit arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – General assets of the sponsorYes
2015: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan funding arrangement – General assets of the sponsorYes
2015-08-01Plan benefit arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – General assets of the sponsorYes
2014: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan funding arrangement – General assets of the sponsorYes
2014-08-01Plan benefit arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – General assets of the sponsorYes
2013: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2013 form 5500 responses
2013-08-01Type of plan entityMulitple employer plan
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan funding arrangement – General assets of the sponsorYes
2013-08-01Plan benefit arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – General assets of the sponsorYes
2012: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2012 form 5500 responses
2012-08-01Type of plan entityMulitple employer plan
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan funding arrangement – General assets of the sponsorYes
2012-08-01Plan benefit arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – General assets of the sponsorYes
2011: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2011 form 5500 responses
2011-08-01Type of plan entityMulitple employer plan
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan funding arrangement – General assets of the sponsorYes
2011-08-01Plan benefit arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – General assets of the sponsorYes
2010: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2010 form 5500 responses
2010-08-01Type of plan entityMulitple employer plan
2010-08-01Plan funding arrangement – InsuranceYes
2010-08-01Plan funding arrangement – General assets of the sponsorYes
2010-08-01Plan benefit arrangement – InsuranceYes
2010-08-01Plan benefit arrangement – General assets of the sponsorYes
2009: PETE LIEN & SONS, INC. GROUP INSURANCE PLAN 2009 form 5500 responses
2009-08-01Type of plan entityMulitple employer plan
2009-08-01This submission is the final filingNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan funding arrangement – General assets of the sponsorYes
2009-08-01Plan benefit arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 2
Insurance contract or identification number000010032976
Number of Individuals Covered309
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $7,797
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,190
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,544
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number269
Policy instance 1
Insurance contract or identification number269
Number of Individuals Covered321
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Welfare Benefit Premiums Paid to CarrierUSD $707,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 2
Insurance contract or identification number000010032976
Number of Individuals Covered302
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $7,611
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,611
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number269
Policy instance 1
Insurance contract or identification number269
Number of Individuals Covered305
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Welfare Benefit Premiums Paid to CarrierUSD $637,360
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number269
Policy instance 1
Insurance contract or identification number269
Number of Individuals Covered308
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Welfare Benefit Premiums Paid to CarrierUSD $528,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 2
Insurance contract or identification number000010032976
Number of Individuals Covered296
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $7,609
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,609
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number269
Policy instance 1
Insurance contract or identification number269
Number of Individuals Covered304
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Welfare Benefit Premiums Paid to CarrierUSD $463,980
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 2
Insurance contract or identification number000010032976
Number of Individuals Covered295
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $7,757
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,757
Insurance broker organization code?3
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 2
Insurance contract or identification number000010032976
Number of Individuals Covered311
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $8,042
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,042
Insurance broker organization code?3
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number269
Policy instance 1
Insurance contract or identification number269
Number of Individuals Covered322
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Welfare Benefit Premiums Paid to CarrierUSD $420,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 2
Insurance contract or identification number000010032976
Number of Individuals Covered331
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $8,102
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number269
Policy instance 1
Insurance contract or identification number269
Number of Individuals Covered338
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Welfare Benefit Premiums Paid to CarrierUSD $424,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 2
Insurance contract or identification number000010032976
Number of Individuals Covered328
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $8,036
Total amount of fees paid to insurance companyUSD $668
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,036
Amount paid for insurance broker fees668
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameGROUP MARKETING SERVICES, INC.
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number269
Policy instance 1
Insurance contract or identification number269
Number of Individuals Covered332
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
Welfare Benefit Premiums Paid to CarrierUSD $366,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 2
Insurance contract or identification number000010032976
Number of Individuals Covered338
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $8,348
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,348
Insurance broker organization code?3
Insurance broker nameGROUP MARKETING SERVICES, INC.
WELLMARK BLUE CROSS AND BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 60128 )
Policy contract number269
Policy instance 1
Insurance contract or identification number269
Number of Individuals Covered336
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Welfare Benefit Premiums Paid to CarrierUSD $359,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010040496
Policy instance 4
Insurance contract or identification number000010040496
Number of Individuals Covered74
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,923
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 $23,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,923
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGROUP MARKETING SERVICES, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 3
Insurance contract or identification number000010032976
Number of Individuals Covered355
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $7,557
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
Welfare Benefit Premiums Paid to CarrierUSD $30,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,557
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameGROUP MARKETING SERVICES, INC.
ARCH INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 11150 )
Policy contract number54300
Policy instance 1
Insurance contract or identification number54300
Number of Individuals Covered349
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $10,203
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
Welfare Benefit Premiums Paid to CarrierUSD $401,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,203
Insurance broker organization code?5
Insurance broker nameFIRST ADMINISTRATORS, INC.
CELTIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80799 )
Policy contract numberCOS001998
Policy instance 2
Insurance contract or identification numberCOS001998
Number of Individuals Covered0
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $1
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
Other welfare benefits providedCONVERSION INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $4
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1
Insurance broker organization code?5
Insurance broker nameFIRST ADMINISTRATORS, INC.
CELTIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80799 )
Policy contract numberCOS001998
Policy instance 2
Insurance contract or identification numberCOS001998
Number of Individuals Covered359
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $655
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
Other welfare benefits providedCONVERSION INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $3,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $655
Insurance broker organization code?5
Insurance broker nameFIRST ADMINISTRATORS, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 3
Insurance contract or identification number000010032976
Number of Individuals Covered331
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $7,141
Total amount of fees paid to insurance companyUSD $558
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,563
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,141
Amount paid for insurance broker fees558
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameGROUP MARKETING SERVICES, INC.
ARCH INSURANCE GROUP (National Association of Insurance Commissioners NAIC id number: 11150 )
Policy contract number54300
Policy instance 1
Insurance contract or identification number54300
Number of Individuals Covered359
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $35,810
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
Welfare Benefit Premiums Paid to CarrierUSD $357,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,810
Insurance broker organization code?5
Insurance broker nameFIRST ADMINISTRATORS, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010040496
Policy instance 4
Insurance contract or identification number000010040496
Number of Individuals Covered69
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,543
Total amount of fees paid to insurance companyUSD $412
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 $22,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,543
Amount paid for insurance broker fees412
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameGROUP MARKETING SERVICES, INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010040496
Policy instance 4
Insurance contract or identification number000010040496
Number of Individuals Covered66
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,145
Total amount of fees paid to insurance companyUSD $443
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 $20,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number90000-9000Z
Policy instance 1
Insurance contract or identification number90000-9000Z
Number of Individuals Covered327
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $32,968
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
Welfare Benefit Premiums Paid to CarrierUSD $329,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CELTIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80799 )
Policy contract numberCOS001998
Policy instance 2
Insurance contract or identification numberCOS001998
Number of Individuals Covered326
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $613
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
Other welfare benefits providedCONVERSION INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $2,874
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 3
Insurance contract or identification number000010032976
Number of Individuals Covered317
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $6,979
Total amount of fees paid to insurance companyUSD $611
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010032976
Policy instance 3
Insurance contract or identification number000010032976
Number of Individuals Covered313
Insurance policy start date2009-12-01
Insurance policy end date2010-11-30
Total amount of commissions paid to insurance brokerUSD $6,786
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
Welfare Benefit Premiums Paid to CarrierUSD $27,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WELLMARK BLUE CROSS BLUE SHIELD OF SOUTH DAKOTA (National Association of Insurance Commissioners NAIC id number: 88848 )
Policy contract number90000-9000Z
Policy instance 1
Insurance contract or identification number90000-9000Z
Number of Individuals Covered318
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $31,382
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
Welfare Benefit Premiums Paid to CarrierUSD $313,972
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010040496
Policy instance 4
Insurance contract or identification number000010040496
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,918
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 $19,673
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CELTIC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80799 )
Policy contract numberCOS001998
Policy instance 2
Insurance contract or identification numberCOS001998
Number of Individuals Covered195
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $611
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
Other welfare benefits providedCONVERSION INSURANCE
Welfare Benefit Premiums Paid to CarrierUSD $2,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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