Fidelity bond in place
Not reported
Filing
Hellermanntyton Corporation Health & Welfare Program
HellermannTyton • EIN 39-1154824 • Plan year 2019
Filing Insights
Participants
Down617 → 600
-17 • -2.76%
Assets
No comparison- → -
No earlier value available.
Investment Management Fee
-
Admin expenses - • Total expenses -
Filing Details
ContextNo event flags were generated for this filing.
Status Flags
Limited-scope audit performed
Not reported
Contributions transmitted on time
Not reported
Participant loans in default
Not reported
Leases in default
Not reported
Reportable party-in-interest issues
Not reported
Loss discovered during year
Not reported
Assets with undetermined value
Not reported
Non-cash contributions
Not reported
Assets held for investment
Not reported
5% transactions reported
Not reported
All plan assets distributed
Not reported
Benefits paid when due
Not reported
Plan blackout period
Not reported
Plan termination resolution adopted
Not reported
Counterparties
Known direct compensation$65,967
| Provider | Services | Location | Direct Compensation | Related |
|---|---|---|---|---|
| BLUE CROSS BLUE SHIELD OF WISCONSINEIN 39-0138065 | Appraisal, Service code 62, Auditing, Service code 49 | - | $54,897 | Blue Cross & Blue Shield United of Wisconsin |
| WAGEWORKSEIN 94-3351864 | Appraisal, Auditing | - | $11,070 | WageWorks |
| ASSOCIATED FINANCIAL GROUP LLC | Recordkeeping, Service code 53, Service code 55 | - | $0 | - |
Company Timeline
This filing is highlighted inside the broader sponsor history.
| Year / Filing | Filings | Participants | Assets | Contributions | Contrib./Participant |
|---|---|---|---|---|---|
| 2025 | 1 | 930 | $0 | $0 | - |
| Hellermanntyton Corporation Health & Welfare Program | - | 930 | - | - | - |
| 2024 | 2 | 907 | $100,500,878 | $8,434,750 | $9,300iApproximate average salary by contribution assumption: employee only about $232,490 at 4% or $154,994 at 6%; with 50% employer match about $154,994 at 4% or $103,329 at 6%; with 100% employer match about $116,245 at 4% or $77,497 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 785 | $100,500,878 | $8,434,750 | $10,745iApproximate average salary by contribution assumption: employee only about $268,623 at 4% or $179,082 at 6%; with 50% employer match about $179,082 at 4% or $119,388 at 6%; with 100% employer match about $134,311 at 4% or $89,541 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 907 | - | - | - |
| 2023 | 2 | 866 | $89,637,312 | $8,233,248 | $9,507iApproximate average salary by contribution assumption: employee only about $237,680 at 4% or $158,454 at 6%; with 50% employer match about $158,454 at 4% or $105,636 at 6%; with 100% employer match about $118,840 at 4% or $79,227 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 787 | $89,637,312 | $8,233,248 | $10,462iApproximate average salary by contribution assumption: employee only about $261,539 at 4% or $174,359 at 6%; with 50% employer match about $174,359 at 4% or $116,240 at 6%; with 100% employer match about $130,770 at 4% or $87,180 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 866 | - | - | - |
| 2022 | 2 | 791 | $79,021,074 | $6,905,428 | $8,730iApproximate average salary by contribution assumption: employee only about $218,250 at 4% or $145,500 at 6%; with 50% employer match about $145,500 at 4% or $97,000 at 6%; with 100% employer match about $109,125 at 4% or $72,750 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 720 | $79,021,074 | $6,905,428 | $9,591iApproximate average salary by contribution assumption: employee only about $239,772 at 4% or $159,848 at 6%; with 50% employer match about $159,848 at 4% or $106,565 at 6%; with 100% employer match about $119,886 at 4% or $79,924 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 791 | - | - | - |
| 2021 | 2 | 747 | $90,175,218 | $7,642,652 | $10,231iApproximate average salary by contribution assumption: employee only about $255,778 at 4% or $170,519 at 6%; with 50% employer match about $170,519 at 4% or $113,679 at 6%; with 100% employer match about $127,889 at 4% or $85,259 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 673 | $90,175,218 | $7,642,652 | $11,356iApproximate average salary by contribution assumption: employee only about $283,902 at 4% or $189,268 at 6%; with 50% employer match about $189,268 at 4% or $126,179 at 6%; with 100% employer match about $141,951 at 4% or $94,634 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 747 | - | - | - |
| 2020 | 2 | 653 | $77,193,407 | $7,053,860 | $10,802iApproximate average salary by contribution assumption: employee only about $270,056 at 4% or $180,037 at 6%; with 50% employer match about $180,037 at 4% or $120,025 at 6%; with 100% employer match about $135,028 at 4% or $90,019 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 653 | $77,193,407 | $7,053,860 | $10,802iApproximate average salary by contribution assumption: employee only about $270,056 at 4% or $180,037 at 6%; with 50% employer match about $180,037 at 4% or $120,025 at 6%; with 100% employer match about $135,028 at 4% or $90,019 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 596 | - | - | - |
| 2019 | 2 | 695 | $67,695,725 | $6,792,585 | $9,774iApproximate average salary by contribution assumption: employee only about $244,338 at 4% or $162,892 at 6%; with 50% employer match about $162,892 at 4% or $108,594 at 6%; with 100% employer match about $122,169 at 4% or $81,446 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 695 | $67,695,725 | $6,792,585 | $9,774iApproximate average salary by contribution assumption: employee only about $244,338 at 4% or $162,892 at 6%; with 50% employer match about $162,892 at 4% or $108,594 at 6%; with 100% employer match about $122,169 at 4% or $81,446 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | Current | 600 | - | - | - |
| 2018 | 1 | 712 | $53,473,437 | $7,029,974 | $9,874iApproximate average salary by contribution assumption: employee only about $246,839 at 4% or $164,559 at 6%; with 50% employer match about $164,559 at 4% or $109,706 at 6%; with 100% employer match about $123,419 at 4% or $82,280 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 712 | $53,473,437 | $7,029,974 | $9,874iApproximate average salary by contribution assumption: employee only about $246,839 at 4% or $164,559 at 6%; with 50% employer match about $164,559 at 4% or $109,706 at 6%; with 100% employer match about $123,419 at 4% or $82,280 at 6%. |
| 2017 | 1 | 618 | $52,151,139 | $6,546,990 | $10,594iApproximate average salary by contribution assumption: employee only about $264,846 at 4% or $176,564 at 6%; with 50% employer match about $176,564 at 4% or $117,709 at 6%; with 100% employer match about $132,423 at 4% or $88,282 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 618 | $52,151,139 | $6,546,990 | $10,594iApproximate average salary by contribution assumption: employee only about $264,846 at 4% or $176,564 at 6%; with 50% employer match about $176,564 at 4% or $117,709 at 6%; with 100% employer match about $132,423 at 4% or $88,282 at 6%. |
| 2016 | 2 | 542 | $43,560,973 | $4,885,428 | $9,014iApproximate average salary by contribution assumption: employee only about $225,343 at 4% or $150,228 at 6%; with 50% employer match about $150,228 at 4% or $100,152 at 6%; with 100% employer match about $112,671 at 4% or $75,114 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 542 | $43,560,973 | $4,885,428 | $9,014iApproximate average salary by contribution assumption: employee only about $225,343 at 4% or $150,228 at 6%; with 50% employer match about $150,228 at 4% or $100,152 at 6%; with 100% employer match about $112,671 at 4% or $75,114 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 490 | - | - | - |
| 2015 | 2 | 465 | $39,013,072 | $4,694,667 | $10,096iApproximate average salary by contribution assumption: employee only about $252,401 at 4% or $168,268 at 6%; with 50% employer match about $168,268 at 4% or $112,178 at 6%; with 100% employer match about $126,201 at 4% or $84,134 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 465 | $39,013,072 | $4,694,667 | $10,096iApproximate average salary by contribution assumption: employee only about $252,401 at 4% or $168,268 at 6%; with 50% employer match about $168,268 at 4% or $112,178 at 6%; with 100% employer match about $126,201 at 4% or $84,134 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 402 | - | - | - |
| 2014 | 2 | 462 | $36,916,579 | $3,949,671 | $8,549iApproximate average salary by contribution assumption: employee only about $213,727 at 4% or $142,485 at 6%; with 50% employer match about $142,485 at 4% or $94,990 at 6%; with 100% employer match about $106,863 at 4% or $71,242 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 462 | $36,916,579 | $3,949,671 | $8,549iApproximate average salary by contribution assumption: employee only about $213,727 at 4% or $142,485 at 6%; with 50% employer match about $142,485 at 4% or $94,990 at 6%; with 100% employer match about $106,863 at 4% or $71,242 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 447 | - | - | - |
| 2013 | 2 | 403 | $32,761,778 | $3,460,541 | $8,587iApproximate average salary by contribution assumption: employee only about $214,674 at 4% or $143,116 at 6%; with 50% employer match about $143,116 at 4% or $95,411 at 6%; with 100% employer match about $107,337 at 4% or $71,558 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 403 | $32,761,778 | $3,460,541 | $8,587iApproximate average salary by contribution assumption: employee only about $214,674 at 4% or $143,116 at 6%; with 50% employer match about $143,116 at 4% or $95,411 at 6%; with 100% employer match about $107,337 at 4% or $71,558 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 393 | - | - | - |
| 2012 | 2 | 354 | $26,416,207 | $3,028,034 | $8,554iApproximate average salary by contribution assumption: employee only about $213,844 at 4% or $142,563 at 6%; with 50% employer match about $142,563 at 4% or $95,042 at 6%; with 100% employer match about $106,922 at 4% or $71,281 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 354 | $26,416,207 | $3,028,034 | $8,554iApproximate average salary by contribution assumption: employee only about $213,844 at 4% or $142,563 at 6%; with 50% employer match about $142,563 at 4% or $95,042 at 6%; with 100% employer match about $106,922 at 4% or $71,281 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 329 | - | - | - |
| 2011 | 2 | 302 | $22,185,820 | $2,710,517 | $8,975iApproximate average salary by contribution assumption: employee only about $224,381 at 4% or $149,587 at 6%; with 50% employer match about $149,587 at 4% or $99,725 at 6%; with 100% employer match about $112,190 at 4% or $74,794 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 302 | $22,185,820 | $2,710,517 | $8,975iApproximate average salary by contribution assumption: employee only about $224,381 at 4% or $149,587 at 6%; with 50% employer match about $149,587 at 4% or $99,725 at 6%; with 100% employer match about $112,190 at 4% or $74,794 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 300 | - | - | - |
| 2010 | 2 | 284 | $20,304,250 | $1,967,093 | $6,926iApproximate average salary by contribution assumption: employee only about $173,160 at 4% or $115,440 at 6%; with 50% employer match about $115,440 at 4% or $76,960 at 6%; with 100% employer match about $86,580 at 4% or $57,720 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 258 | $20,304,250 | $1,967,093 | $7,624iApproximate average salary by contribution assumption: employee only about $190,610 at 4% or $127,073 at 6%; with 50% employer match about $127,073 at 4% or $84,715 at 6%; with 100% employer match about $95,305 at 4% or $63,537 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 284 | - | - | - |
| 2009 | 2 | 293 | $0 | $0 | - |
| Hellermanntyton Corporation Health & Welfare Program | - | 293 | - | - | - |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | - | - | - | - |
| 2008 | 2 | 275 | $14,668,367 | $1,440,600 | $5,239iApproximate average salary by contribution assumption: employee only about $130,964 at 4% or $87,309 at 6%; with 50% employer match about $87,309 at 4% or $58,206 at 6%; with 100% employer match about $65,482 at 4% or $43,655 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 275 | $14,668,367 | $1,440,600 | $5,239iApproximate average salary by contribution assumption: employee only about $130,964 at 4% or $87,309 at 6%; with 50% employer match about $87,309 at 4% or $58,206 at 6%; with 100% employer match about $65,482 at 4% or $43,655 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 218 | - | - | - |
| 2007 | 2 | 285 | $19,871,204 | $1,445,053 | $5,070iApproximate average salary by contribution assumption: employee only about $126,759 at 4% or $84,506 at 6%; with 50% employer match about $84,506 at 4% or $56,337 at 6%; with 100% employer match about $63,380 at 4% or $42,253 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 249 | $19,871,204 | $1,445,053 | $5,803iApproximate average salary by contribution assumption: employee only about $145,086 at 4% or $96,724 at 6%; with 50% employer match about $96,724 at 4% or $64,483 at 6%; with 100% employer match about $72,543 at 4% or $48,362 at 6%. |
| Hellermanntyton Corporation Health & Welfare Program | - | 285 | - | - | - |
| 2006 | 3 | 395 | $17,871,493 | $1,376,519 | $3,485iApproximate average salary by contribution assumption: employee only about $87,121 at 4% or $58,081 at 6%; with 50% employer match about $58,081 at 4% or $38,721 at 6%; with 100% employer match about $43,561 at 4% or $29,040 at 6%. |
| Hellermanntyton Corporation 401(K) Retirement and Profit Sharing Plan | - | 277 | $17,871,493 | $1,376,519 | $4,969iApproximate average salary by contribution assumption: employee only about $124,235 at 4% or $82,823 at 6%; with 50% employer match about $82,823 at 4% or $55,215 at 6%; with 100% employer match about $62,117 at 4% or $41,412 at 6%. |
| HELLERMANNTYTON CORP. FLEXIBLE BENEFITS PLAN | - | 310 | - | - | - |
| Hellermanntyton Corporation Health & Welfare Program | - | 395 | - | - | - |
| 2005 | 1 | 306 | $0 | $0 | - |
| Hellermanntyton Corporation Health & Welfare Program | - | 306 | - | - | - |
| 2004 | 1 | 290 | $0 | $0 | - |
| Hellermanntyton Corporation Health & Welfare Program | - | 290 | - | - | - |
| 2003 | 1 | 288 | $0 | $0 | - |
| Hellermanntyton Corporation Health & Welfare Program | - | 288 | - | - | - |
| 2002 | 1 | 259 | $0 | $0 | - |
| Hellermanntyton Corporation Health & Welfare Program | - | 259 | - | - | - |
| 2001 | 1 | 281 | $0 | $0 | - |
| Hellermanntyton Corporation Health & Welfare Program | - | 281 | - | - | - |
| 2000 | 1 | 341 | $0 | $0 | - |
| Hellermanntyton Corporation Health & Welfare Program | - | 341 | - | - | - |
Schedule Details
Schedule A
- Row 1
- Form Id
- 4
- Ins Broker Name
- ASSOCIATED FINANCIAL GROUP LLC
- Ins Broker US Address1
- 711 EISENHOWER DRIVE
- Ins Broker US City
- KIMBERLY
- Ins Broker US State
- WI
- Ins Broker US ZIP
- 54136
- Ins Broker Comm Pd Amount
- $0
- Ins Broker Fees Pd Amount
- $488
- Ins Broker Fees Pd Text
- FEES PAID
- Ins Broker Code
- 3
- Row 2
- Form Id
- 3
- Ins Broker Name
- ASSOCIATED FINANCIAL GROUP LLC
- Ins Broker US Address1
- 711 EISENHOWER DRIVE
- Ins Broker US City
- KIMBERLY
- Ins Broker US State
- WI
- Ins Broker US ZIP
- 54136
- Ins Broker Comm Pd Amount
- $10,291
- Ins Broker Fees Pd Amount
- $2,680
- Ins Broker Fees Pd Text
- BROKER BONUS
- Ins Broker Code
- 3
- Row 3
- Form Id
- 1
- Ins Broker Name
- ASSOCIATED FINANCIAL GROUP LLC
- Ins Broker US Address1
- 711 EISENHOWER DRIVE
- Ins Broker US City
- KIMBERLY
- Ins Broker US State
- WI
- Ins Broker US ZIP
- 54136
- Ins Broker Comm Pd Amount
- $6,327
- Ins Broker Fees Pd Amount
- $1,595
- Ins Broker Fees Pd Text
- BROKER BONUS
- Ins Broker Code
- 3
- Row 4
- Form Id
- 2
- Ins Broker Name
- ASSOCIATED FINANCIAL GROUP LLC
- Ins Broker US Address1
- 711 EISENHOWER DRIVE
- Ins Broker US City
- KIMBERLY
- Ins Broker US State
- WI
- Ins Broker US ZIP
- 54136
- Ins Broker Comm Pd Amount
- $11,128
- Ins Broker Fees Pd Amount
- $2,994
- Ins Broker Fees Pd Text
- BROKER BONUS
- Ins Broker Code
- 3
- Row 5
- Form Id
- 1
- Ins Broker Name
- NATIONAL BENEFIT CENTER
- Ins Broker US Address1
- 6830 COCHRAN RD
- Ins Broker US City
- SOLON
- Ins Broker US State
- OH
- Ins Broker US ZIP
- 44139
- Ins Broker Comm Pd Amount
- $0
- Ins Broker Fees Pd Amount
- $2,337
- Ins Broker Fees Pd Text
- FEES
- Ins Broker Code
- 3
- Row 6
- Form Id
- 3
- Ins Broker Name
- NATIONAL BENEFIT CENTER
- Ins Broker US Address1
- 6830 COCHRAN RD
- Ins Broker US City
- SOLON
- Ins Broker US State
- OH
- Ins Broker US ZIP
- 44139
- Ins Broker Comm Pd Amount
- $0
- Ins Broker Fees Pd Amount
- $3,767
- Ins Broker Fees Pd Text
- FEES
- Ins Broker Code
- 3
- Row 7
- Form Id
- 2
- Ins Broker Name
- NATIONAL BENEFIT CENTER
- Ins Broker US Address1
- 6830 COCHRAN RD
- Ins Broker US City
- SOLON
- Ins Broker US State
- OH
- Ins Broker US ZIP
- 44139
- Ins Broker Comm Pd Amount
- $0
- Ins Broker Fees Pd Amount
- $2,337
- Ins Broker Fees Pd Text
- FEES
- Ins Broker Code
- 3
- Row 8
- Ins Carrier Name: THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
- Form Id
- 1
- Schedule A Plan Year Begin Date
- 2019-01-01
- Schedule A Plan Year End Date
- 2019-12-31
- Schedule A Plan Num
- 501
- Schedule A EIN
- 39-1154824
- Ins Carrier Name
- THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 35-0472300
- Ins Carrier Naic Code
- 6576
- Ins Contract Num
- 000010235459
- Ins Prsn Covered End of year Count
- 285
- Ins Policy From Date
- 2019-01-01
- Ins Policy To Date
- 2019-12-31
- Ins Broker Comm Total Amount
- $6,327
- Ins Broker Fees Total Amount
- $3,932
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- Yes
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- No
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $63,273
- Ins Fail Provide Info Indicator
- No
- Row 9
- Ins Carrier Name: THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
- Form Id
- 2
- Schedule A Plan Year Begin Date
- 2019-01-01
- Schedule A Plan Year End Date
- 2019-12-31
- Schedule A Plan Num
- 501
- Schedule A EIN
- 39-1154824
- Ins Carrier Name
- THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 35-0472300
- Ins Carrier Naic Code
- 65676
- Ins Contract Num
- 000010235458
- Ins Prsn Covered End of year Count
- 678
- Ins Policy From Date
- 2019-01-01
- Ins Policy To Date
- 2019-12-31
- Ins Broker Comm Total Amount
- $11,128
- Ins Broker Fees Total Amount
- $5,331
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- Yes
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- AD&D
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $111,278
- Ins Fail Provide Info Indicator
- No
- Row 10
- Ins Carrier Name: THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
- Form Id
- 3
- Schedule A Plan Year Begin Date
- 2019-01-01
- Schedule A Plan Year End Date
- 2019-12-31
- Schedule A Plan Num
- 501
- Schedule A EIN
- 39-1154824
- Ins Carrier Name
- THE LINCOLN NATIONAL LIFE INSURANCE COMPANY
- Ins Carrier EIN
- 35-0472300
- Ins Carrier Naic Code
- 65676
- Ins Contract Num
- 000400235460
- Ins Prsn Covered End of year Count
- 314
- Ins Policy From Date
- 2019-01-01
- Ins Policy To Date
- 2019-12-31
- Ins Broker Comm Total Amount
- $10,291
- Ins Broker Fees Total Amount
- $6,447
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Bnft Health Indicator
- No
- Wlfr Bnft Dental Indicator
- No
- Wlfr Bnft Vision Indicator
- No
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- No
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- Yes
- Wlfr Type Bnft Oth Text
- VOL CHILD LIFE, VOL SPOUSE LIFE, VOL LIFE
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $102,908
- Ins Fail Provide Info Indicator
- No
- Row 11
- Ins Carrier Name: BLUE CROSS BLUE SHIELD OF WISCONSIN
- Form Id
- 4
- Schedule A Plan Year Begin Date
- 2019-01-01
- Schedule A Plan Year End Date
- 2019-12-31
- Schedule A Plan Num
- 501
- Schedule A EIN
- 39-1154824
- Ins Carrier Name
- BLUE CROSS BLUE SHIELD OF WISCONSIN
- Ins Carrier EIN
- 39-0138065
- Ins Carrier Naic Code
- 54003
- Ins Contract Num
- W80434
- Ins Prsn Covered End of year Count
- 1,375
- Ins Policy From Date
- 2019-01-01
- Ins Policy To Date
- 2019-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $488
- Alloc Contracts Indiv Indicator
- No
- Alloc Contracts Group Indicator
- No
- Alloc Contracts Other Indicator
- No
- Pens Distr Bnft Terminate Pln Indicator
- No
- Unalloc Contracts Dep Adm Indicator
- No
- Unal Contrac Imm Part Guar Indicator
- No
- Unal Contracts Guar Invest Indicator
- No
- Unalloc Contracts Other Indicator
- No
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Bnft Health Indicator
- Yes
- Wlfr Bnft Dental Indicator
- Yes
- Wlfr Bnft Vision Indicator
- Yes
- Wlfr Bnft Life Insur Indicator
- No
- Wlfr Bnft Temp Disab Indicator
- No
- Wlfr Bnft Long Terminate Disab Indicator
- No
- Wlfr Bnft Unemp Indicator
- No
- Wlfr Bnft Drug Indicator
- No
- Wlfr Bnft Stop Loss Indicator
- No
- Wlfr Bnft Hmo Indicator
- No
- Wlfr Bnft Ppo Indicator
- Yes
- Wlfr Bnft Indemnity Indicator
- No
- Wlfr Bnft Other Indicator
- No
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Cash Indicator
- No
- Wlfr Refund Credit Indicator
- No
- Wlfr Total Charges Paid Amount
- $6,318,645
- Ins Fail Provide Info Indicator
- No
Schedule C
Schedule C Provider
ASSOCIATED FINANCIAL GROUP LLC
INS AGENTS AND BROKERS
Direct compensation$0
RecordkeepingService code 53Service code 55
Indirect compensationYes
Formula-based compensationNo
Source fields
- Row 1
- Service code: Recordkeeping
- Service code
- Recordkeeping
- Row 2
- Service code: Service code 53
- Service code
- Service code 53
- Row 3
- Service code: Service code 55
- Service code
- Service code 55
- ASSOCIATED FINANCIAL GROUP LLC
- Other provider name
- ASSOCIATED FINANCIAL GROUP LLC
- Provider Other US Address1
- 711 EISENHOWER DR
- Provider Other US City
- KIMBERLY
- Provider Other US State
- WI
- Provider Other US ZIP
- 54136
- Relationship to employer or plan
- INS AGENTS AND BROKERS
- Direct compensation
- $0
- Indirect compensation reported
- Yes
- Provider Other Elig Indicator Comp Indicator
- No
- Provider Other Total Indicator Comp Amount
- $141,356
- Provider Other Amount Formula Indicator
- No
Schedule C Provider
BLUE CROSS BLUE SHIELD OF WISCONSIN
CLAIMS PROCESSING • EIN 39-0138065
Direct compensation$54,897
AppraisalService code 62AuditingService code 49
Indirect compensationNo
Source fields
- Row 5
- Service code: Appraisal
- Service code
- Appraisal
- Row 6
- Service code: Service code 62
- Service code
- Service code 62
- Row 7
- Service code: Auditing
- Service code
- Auditing
- Row 8
- Service code: Service code 49
- Service code
- Service code 49
- BLUE CROSS BLUE SHIELD OF WISCONSIN
- Other provider name
- BLUE CROSS BLUE SHIELD OF WISCONSIN
- Other provider EIN
- 39-0138065
- Relationship to employer or plan
- CLAIMS PROCESSING
- Direct compensation
- $54,897
- Indirect compensation reported
- No
Schedule C Provider
WAGEWORKS
CLAIMS PROCESSING • EIN 94-3351864
Direct compensation$11,070
AppraisalAuditing
Indirect compensationNo
Source fields
- Row 10
- Service code: Appraisal
- Service code
- Appraisal
- Row 11
- Service code: Auditing
- Service code
- Auditing
- WAGEWORKS
- Other provider name
- WAGEWORKS
- Other provider EIN
- 94-3351864
- Relationship to employer or plan
- CLAIMS PROCESSING
- Direct compensation
- $11,070
- Indirect compensation reported
- No
Schedule C Provider
Provider 4
Provider details
Source fields
- Row 13
- Excluded provider reported
- No
Filing received by DOL Oct 15, 2020