The insurance industry in Iowa grew directly from the needs of a region crossed by the Mississippi and Missouri rivers. As more people moved into Iowa frontier communities and businesses grew, so did the need for insurance coverage, especially in niche areas that existing companies wouldn’t cover.

Take a look at some of the ways Des Moines—and Iowa—became a center for the insurance industry:

Mutuals started by church congregations, immigrant groups and farmers’ organizations thrived in Iowa because their firms were small, locally owned and had relatively low fees. By 1920, 162 mutuals operated in Iowa, with many created to insure specific industries or hazards, such as grain mills (which were high risk for fire).

Events like the Civil War and Spanish Flu led to the rise of life insurance companies in Iowa, which hadn’t existed previously.

With the rise of accidental deaths due to the automobile, Iowa insurance companies developed safety standards that they also used as advertisements. For instance, the IMT Insurance Company taught children about traffic safety.

After Iowa passed workers’ compensation laws in 1913, employers had to buy liability insurance, leading to a new area of growth for companies.

Residents of the coal-mining town Muchakinock created one of the state’s earliest forms of health insurance in 1888 to provide burial expenses and prepaid medical care.

In the 1920s, Grinnell College began offering hospital care to students and faculty for a fixed monthly fee—one of the nation’s earliest forms of health insurance for hospital care.

Following the Great Depression, when many people had to go without medical care, companies like Blue Cross and Blue Shield of Iowa and South Dakota were formed to offer affordable health care and save hospitals from bankruptcy.