401k Plan data: NORTH AMERICAN BANCARD GROUP HEALTH PLAN plan

NORTH AMERICAN BANCARD GROUP HEALTH PLAN 401k Plan overview

Plan Name	NORTH AMERICAN BANCARD GROUP HEALTH PLAN
Plan identification number	501

NORTH AMERICAN BANCARD GROUP HEALTH PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Prepaid legal Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

NAB HOLDINGS, LLC has sponsored the creation of one or more 401k plans.

Company Name: NAB HOLDINGS, LLC

Employer identification number (EIN): 453514691

NAIC Classification: 522300
NAIC Description: Activities Related to Credit Intermediation

Additional information about NAB HOLDINGS, LLC

Jurisdiction of Incorporation: Michigan Secretary of State

Incorporation Date: 2011-09-14

Company Identification Number: D63759

Legal Registered Office Address: 250 STEPHENSON HWY TROY 480831117

United States of America (USA)

More information about NAB HOLDINGS, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH AMERICAN BANCARD GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2023-01-01
501 2022-01-01
501 2021-01-01
501 2020-01-01
501 2019-01-01
501 2018-01-01
501 2017-01-01 KIRK HAGGARTY
501 2016-01-01 KIRK HAGGARTY
501 2015-01-01 KIRK HAGGARTY
501 2014-01-01 KIRK HAGGARTY
501 2013-01-01 KIRK HAGGARTY

Plan Statistics for NORTH AMERICAN BANCARD GROUP HEALTH PLAN

401k plan membership statisitcs for NORTH AMERICAN BANCARD GROUP HEALTH PLAN

Measure Date Value
2023: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 1,105
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 1,157
Number of retired or separated participants receiving benefits 2023-01-01 12
Number of other retired or separated participants entitled to future benefits 2023-01-01 0
Total of all active and inactive participants 2023-01-01 1,169
2022: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 864
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 1,095
Number of retired or separated participants receiving benefits 2022-01-01 9
Number of other retired or separated participants entitled to future benefits 2022-01-01 0
Total of all active and inactive participants 2022-01-01 1,104
2021: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 855
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 854
Number of retired or separated participants receiving benefits 2021-01-01 10
Number of other retired or separated participants entitled to future benefits 2021-01-01 0
Total of all active and inactive participants 2021-01-01 864
2020: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 872
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 851
Number of retired or separated participants receiving benefits 2020-01-01 4
Number of other retired or separated participants entitled to future benefits 2020-01-01 0
Total of all active and inactive participants 2020-01-01 855
2019: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 790
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 871
Number of retired or separated participants receiving benefits 2019-01-01 1
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 872
2018: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 714
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 779
Number of retired or separated participants receiving benefits 2018-01-01 11
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 790
2017: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 708
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 709
Number of retired or separated participants receiving benefits 2017-01-01 8
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 717
2016: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 652
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 699
Number of retired or separated participants receiving benefits 2016-01-01 9
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 708
2015: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 504
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 652
Number of retired or separated participants receiving benefits 2015-01-01 0
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 652
2014: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 508
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 504
Number of retired or separated participants receiving benefits 2014-01-01 0
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 504
2013: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 500
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 508
Number of retired or separated participants receiving benefits 2013-01-01 0
Number of other retired or separated participants entitled to future benefits 2013-01-01 0
Total of all active and inactive participants 2013-01-01 508
Total participants 2013-01-01 508

Measure	Date	Value
2023: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	1,105
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	1,157
Number of retired or separated participants receiving benefits	2023-01-01	12
Number of other retired or separated participants entitled to future benefits	2023-01-01	0
Total of all active and inactive participants	2023-01-01	1,169
2022: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	864
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	1,095
Number of retired or separated participants receiving benefits	2022-01-01	9
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	1,104
2021: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	855
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	854
Number of retired or separated participants receiving benefits	2021-01-01	10
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	864
2020: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	872
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	851
Number of retired or separated participants receiving benefits	2020-01-01	4
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	855
2019: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	790
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	871
Number of retired or separated participants receiving benefits	2019-01-01	1
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	872
2018: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	714
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	779
Number of retired or separated participants receiving benefits	2018-01-01	11
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	790
2017: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	708
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	709
Number of retired or separated participants receiving benefits	2017-01-01	8
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	717
2016: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	652
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	699
Number of retired or separated participants receiving benefits	2016-01-01	9
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	708
2015: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	504
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	652
Number of retired or separated participants receiving benefits	2015-01-01	0
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	652
2014: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	508
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	504
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	504
2013: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	500
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	508
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	508
Total participants	2013-01-01	508

Form 5500 Responses for NORTH AMERICAN BANCARD GROUP HEALTH PLAN

2023: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Plan funding arrangement – Insurance	Yes
2023-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2023-01-01	Plan benefit arrangement – Insurance	Yes
2023-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2022: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2018: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2017: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: NORTH AMERICAN BANCARD GROUP HEALTH PLAN 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

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

280283

Policy instance

Insurance contract or identification number	280283
Number of Individuals Covered	1929
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $51,874
Total amount of fees paid to insurance company	USD $10,980
Welfare Benefit Premiums Paid to Carrier	USD $1,481,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

GROUP HEALTH COOPERATIVE (National Association of Insurance Commissioners NAIC id number: 95672 )

Policy contract number

2488400

Policy instance

Insurance contract or identification number	2488400
Number of Individuals Covered	3
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $633
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00939702

Policy instance

Insurance contract or identification number	00939702
Number of Individuals Covered	54
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $1,850
Total amount of fees paid to insurance company	USD $714
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $24,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

302207

Policy instance

Insurance contract or identification number	302207
Number of Individuals Covered	181
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $6,841
Other welfare benefits provided	LEGAL SERVICES PLAN MEMBERSHIPS
Welfare Benefit Premiums Paid to Carrier	USD $31,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	1157
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $50,322
Total amount of fees paid to insurance company	USD $33,252
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, ACCIDENT, VOLUNTARY: CI, HI
Welfare Benefit Premiums Paid to Carrier	USD $790,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

236079

Policy instance

Insurance contract or identification number	236079
Number of Individuals Covered	21
Insurance policy start date	2023-01-01
Insurance policy end date	2023-12-31
Total amount of commissions paid to insurance broker	USD $5,267
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $115,963
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	1095
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $25,414
Total amount of fees paid to insurance company	USD $45,287
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, ACCIDENT, VOLUNTARY: CI, HI
Welfare Benefit Premiums Paid to Carrier	USD $1,259,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $25,414
Amount paid for insurance broker fees	45287
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

302207

Policy instance

Insurance contract or identification number	302207
Number of Individuals Covered	128
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,924
Other welfare benefits provided	LEGAL SERVICES PLAN MEMBERSHIPS
Welfare Benefit Premiums Paid to Carrier	USD $20,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,103
Insurance broker organization code?	4

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00939702

Policy instance

Insurance contract or identification number	00939702
Number of Individuals Covered	53
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $613
Total amount of fees paid to insurance company	USD $53
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $13,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $613
Amount paid for insurance broker fees	53
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

280283

Policy instance

Insurance contract or identification number	280283
Number of Individuals Covered	1775
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $37,520
Total amount of fees paid to insurance company	USD $8,495
Welfare Benefit Premiums Paid to Carrier	USD $1,072,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,520
Amount paid for insurance broker fees	8495
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

PRE-PAID LEGAL SERVICES DBA LEGAL SHIELD (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

302207

Policy instance

Insurance contract or identification number	302207
Number of Individuals Covered	72
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $2,890
Other welfare benefits provided	LEGAL SERVICES PLAN MEMBERSHIPS
Welfare Benefit Premiums Paid to Carrier	USD $10,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,277
Insurance broker organization code?	4

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

280283

Policy instance

Insurance contract or identification number	280283
Number of Individuals Covered	1405
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $29,822
Total amount of fees paid to insurance company	USD $4,146
Welfare Benefit Premiums Paid to Carrier	USD $832,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $29,822
Amount paid for insurance broker fees	4146
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	854
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $15,848
Total amount of fees paid to insurance company	USD $16,431
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D, ACCIDENT, VOLUNTARY CI
Welfare Benefit Premiums Paid to Carrier	USD $1,149,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $15,848
Amount paid for insurance broker fees	16431
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	851
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of fees paid to insurance company	USD $21,114
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $887,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	21114
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

280283

Policy instance

Insurance contract or identification number	280283
Number of Individuals Covered	1379
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $30,433
Total amount of fees paid to insurance company	USD $8,520
Welfare Benefit Premiums Paid to Carrier	USD $869,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $30,433
Amount paid for insurance broker fees	8520
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	871
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of fees paid to insurance company	USD $13,314
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $948,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	13314
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

GROUP 58670

Policy instance

Insurance contract or identification number	GROUP 58670
Number of Individuals Covered	713
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $26,547
Welfare Benefit Premiums Paid to Carrier	USD $757,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $26,547
Insurance broker organization code?	3

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

GROUP 58670

Policy instance

Insurance contract or identification number	GROUP 58670
Number of Individuals Covered	645
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $28,471
Total amount of fees paid to insurance company	USD $9,577
Welfare Benefit Premiums Paid to Carrier	USD $813,304
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,471
Amount paid for insurance broker fees	9577
Additional information about fees paid to insurance broker	FEES NON-MONETARY COMPENSATION
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX967014

Policy instance

Insurance contract or identification number	FLX967014
Number of Individuals Covered	910
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $1,526
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $88,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1526
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	667
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $12,340
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $585,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	12340
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 964817

Policy instance

Insurance contract or identification number	LK 964817
Number of Individuals Covered	779
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $1,137
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,518
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1137
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 968525

Policy instance

Insurance contract or identification number	OK 968525
Number of Individuals Covered	877
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $208
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $10,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	208
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751902

Policy instance

Insurance contract or identification number	LK 751902
Number of Individuals Covered	779
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of fees paid to insurance company	USD $1,418
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $76,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	1418
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 751902

Policy instance

Insurance contract or identification number	LK 751902
Number of Individuals Covered	691
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $73,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK 968525

Policy instance

Insurance contract or identification number	OK 968525
Number of Individuals Covered	799
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $10,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

00280283/0001

Policy instance

Insurance contract or identification number	00280283/0001
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $90,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

GROUP 58670

Policy instance

Insurance contract or identification number	GROUP 58670
Number of Individuals Covered	595
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $21,206
Total amount of fees paid to insurance company	USD $7,224
Welfare Benefit Premiums Paid to Carrier	USD $606,242
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21,206
Amount paid for insurance broker fees	7224
Additional information about fees paid to insurance broker	FEES NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX967014

Policy instance

Insurance contract or identification number	FLX967014
Number of Individuals Covered	829
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $78,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	595
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of fees paid to insurance company	USD $13,688
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $507,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	13688
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK 964817

Policy instance

Insurance contract or identification number	LK 964817
Number of Individuals Covered	691
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

211995

Policy instance

Insurance contract or identification number	211995
Number of Individuals Covered	69
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,707
Total amount of fees paid to insurance company	USD $361
Other welfare benefits provided	LIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $21,438
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,707
Amount paid for insurance broker fees	361
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

GROUP 58670

Policy instance

Insurance contract or identification number	GROUP 58670
Number of Individuals Covered	791
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $54,557
Total amount of fees paid to insurance company	USD $3,013
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $54,557
Insurance broker organization code?	3
Amount paid for insurance broker fees	3013
Additional information about fees paid to insurance broker	FEES
Insurance broker name	LSG INSURANCE PARTNERS

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

0280283/001

Policy instance

Insurance contract or identification number	0280283/001
Number of Individuals Covered	403
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $35,044
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $973,128
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $35,044
Insurance broker organization code?	3
Insurance broker name	JAY SCHREIBMAN

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

211994

Policy instance

Insurance contract or identification number	211994
Number of Individuals Covered	652
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $9,638
Total amount of fees paid to insurance company	USD $2,753
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $137,758
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,638
Amount paid for insurance broker fees	2753
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	613
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $28,403
Total amount of fees paid to insurance company	USD $3,725
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $469,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,416
Insurance broker organization code?	3
Amount paid for insurance broker fees	3725
Insurance broker name	LOCKTON COMPANIES, LLC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

211995

Policy instance

Insurance contract or identification number	211995
Number of Individuals Covered	49
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,015
Total amount of fees paid to insurance company	USD $308
Other welfare benefits provided	LIFESTYLE LIFE AND AD&D
Welfare Benefit Premiums Paid to Carrier	USD $20,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,877
Amount paid for insurance broker fees	156
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

GROUP 58670

Policy instance

Insurance contract or identification number	GROUP 58670
Number of Individuals Covered	463
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $39,038
Total amount of fees paid to insurance company	USD $4,160
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,638
Insurance broker organization code?	3
Amount paid for insurance broker fees	4160
Additional information about fees paid to insurance broker	FEES
Insurance broker name	LSG INSURANCE PARTNERS

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

0280283/001

Policy instance

Insurance contract or identification number	0280283/001
Number of Individuals Covered	378
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $32,563
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $863,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $32,563
Insurance broker organization code?	3
Insurance broker name	JAY SCHREIBMAN

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

211994

Policy instance

Insurance contract or identification number	211994
Number of Individuals Covered	504
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $8,915
Total amount of fees paid to insurance company	USD $1,758
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $114,305
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,501
Amount paid for insurance broker fees	881
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	439
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $23,792
Total amount of fees paid to insurance company	USD $8,371
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $378,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,909
Amount paid for insurance broker fees	8371
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00481908

Policy instance

Insurance contract or identification number	00481908
Number of Individuals Covered	438
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $20,448
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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	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
Welfare Benefit Premiums Paid to Carrier	USD $317,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,448
Insurance broker organization code?	3
Insurance broker name	LUBIN SCHWARTZ & GOLDMAN INC

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

211995

Policy instance

Insurance contract or identification number	211995
Number of Individuals Covered	47
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $2,890
Total amount of fees paid to insurance company	USD $312
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	No
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 $16,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,890
Amount paid for insurance broker fees	312
Insurance broker organization code?	3
Insurance broker name	LUBIN SCHWARTZ & GOLDMAN

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

211994

Policy instance

Insurance contract or identification number	211994
Number of Individuals Covered	508
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $10,241
Total amount of fees paid to insurance company	USD $2,112
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	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
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 $111,466
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,241
Amount paid for insurance broker fees	2112
Insurance broker organization code?	3
Insurance broker name	LUBIN SCHWARTZ & GOLDMAN

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

0280283/002

Policy instance

Insurance contract or identification number	0280283/002
Number of Individuals Covered	17
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $1,604
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	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
Welfare Benefit Premiums Paid to Carrier	USD $64,591
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

0280283/001

Policy instance

Insurance contract or identification number	0280283/001
Number of Individuals Covered	394
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $35,527
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	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
Welfare Benefit Premiums Paid to Carrier	USD $1,380,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

GROUP 58670

Policy instance

Insurance contract or identification number	GROUP 58670
Number of Individuals Covered	367
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $38,041
Total amount of fees paid to insurance company	USD $422
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	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
Amount paid for insurance broker fees	422
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $38,041
Insurance broker name	JAY R SCHREIBMAN

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Company Name:	NAB HOLDINGS, LLC
Employer identification number (EIN):	453514691
NAIC Classification:	522300
NAIC Description:	Activities Related to Credit Intermediation

Jurisdiction of Incorporation:	Michigan Secretary of State
Incorporation Date:	2011-09-14
Company Identification Number:	D63759
Legal Registered Office Address:	250 STEPHENSON HWY TROY 480831117 United States of America (USA)