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HOSPITAL AND HEALTH BENEFITS 401k Plan overview

Plan NameHOSPITAL AND HEALTH BENEFITS
Plan identification number 510

HOSPITAL AND HEALTH BENEFITS Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Vision

401k Sponsoring company profile

INTERNATIONAL UNION, UAW has sponsored the creation of one or more 401k plans.

Company Name:INTERNATIONAL UNION, UAW
Employer identification number (EIN):380679801
NAIC Classification:813930
NAIC Description:Labor Unions and Similar Labor Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOSPITAL AND HEALTH BENEFITS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102022-01-01MARGARET MOCK2023-07-28
5102021-01-01FRANK STUGLIN2022-06-29
5102020-01-01FRANK STUGLIN2021-07-12
5102019-01-01RAY CURRY2020-07-15
5102018-01-01GARY JONES
5102017-01-01GARY JONES
5102016-01-01GARY CASTEEL
5102015-01-01GARY CASTEEL
5102014-01-01GARY CASTEEL
5102013-01-01GARY CASTEEL
5102012-01-01DENNIS D. WILLIAMS DENNIS D. WILLIAMS2013-05-28
5102011-01-01DENNIS D. WILLIAMS
5102010-01-01DENNIS D. WILLIAMS DENNIS D. WILLIAMS2011-06-27
5102009-01-01DENNIS D. WILLIAMS

Plan Statistics for HOSPITAL AND HEALTH BENEFITS

401k plan membership statisitcs for HOSPITAL AND HEALTH BENEFITS

Measure Date Value
2022: HOSPITAL AND HEALTH BENEFITS 2022 401k membership
Total participants, beginning-of-year2022-01-01682
Total number of active participants reported on line 7a of the Form 55002022-01-01679
Number of retired or separated participants receiving benefits2022-01-0114
Total of all active and inactive participants2022-01-01693
2021: HOSPITAL AND HEALTH BENEFITS 2021 401k membership
Total participants, beginning-of-year2021-01-01625
Total number of active participants reported on line 7a of the Form 55002021-01-01670
Number of retired or separated participants receiving benefits2021-01-0112
Total of all active and inactive participants2021-01-01682
2020: HOSPITAL AND HEALTH BENEFITS 2020 401k membership
Total participants, beginning-of-year2020-01-01607
Total number of active participants reported on line 7a of the Form 55002020-01-01620
Number of retired or separated participants receiving benefits2020-01-015
Total of all active and inactive participants2020-01-01625
2019: HOSPITAL AND HEALTH BENEFITS 2019 401k membership
Total participants, beginning-of-year2019-01-01652
Total number of active participants reported on line 7a of the Form 55002019-01-01601
Number of retired or separated participants receiving benefits2019-01-016
Total of all active and inactive participants2019-01-01607
2018: HOSPITAL AND HEALTH BENEFITS 2018 401k membership
Total participants, beginning-of-year2018-01-01670
Total number of active participants reported on line 7a of the Form 55002018-01-01643
Number of retired or separated participants receiving benefits2018-01-019
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01652
2017: HOSPITAL AND HEALTH BENEFITS 2017 401k membership
Total participants, beginning-of-year2017-01-01664
Total number of active participants reported on line 7a of the Form 55002017-01-01667
Number of retired or separated participants receiving benefits2017-01-013
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01670
2016: HOSPITAL AND HEALTH BENEFITS 2016 401k membership
Total participants, beginning-of-year2016-01-012,158
Total number of active participants reported on line 7a of the Form 55002016-01-01657
Number of retired or separated participants receiving benefits2016-01-017
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01664
Total participants2016-01-01664
2015: HOSPITAL AND HEALTH BENEFITS 2015 401k membership
Total participants, beginning-of-year2015-01-012,144
Total number of active participants reported on line 7a of the Form 55002015-01-01624
Number of retired or separated participants receiving benefits2015-01-011,227
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-011,851
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-01307
Total participants2015-01-012,158
2014: HOSPITAL AND HEALTH BENEFITS 2014 401k membership
Total participants, beginning-of-year2014-01-012,164
Total number of active participants reported on line 7a of the Form 55002014-01-01582
Number of retired or separated participants receiving benefits2014-01-011,237
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,819
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-01325
Total participants2014-01-012,144
2013: HOSPITAL AND HEALTH BENEFITS 2013 401k membership
Total participants, beginning-of-year2013-01-012,537
Total number of active participants reported on line 7a of the Form 55002013-01-01642
Number of retired or separated participants receiving benefits2013-01-011,195
Total of all active and inactive participants2013-01-011,837
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-01327
Total participants2013-01-012,164
2012: HOSPITAL AND HEALTH BENEFITS 2012 401k membership
Total participants, beginning-of-year2012-01-012,599
Total number of active participants reported on line 7a of the Form 55002012-01-01754
Number of retired or separated participants receiving benefits2012-01-011,393
Total of all active and inactive participants2012-01-012,147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-01390
Total participants2012-01-012,537
2011: HOSPITAL AND HEALTH BENEFITS 2011 401k membership
Total participants, beginning-of-year2011-01-012,587
Total number of active participants reported on line 7a of the Form 55002011-01-01783
Number of retired or separated participants receiving benefits2011-01-011,429
Total of all active and inactive participants2011-01-012,212
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-01387
Total participants2011-01-012,599
2010: HOSPITAL AND HEALTH BENEFITS 2010 401k membership
Total participants, beginning-of-year2010-01-012,758
Total number of active participants reported on line 7a of the Form 55002010-01-01791
Number of retired or separated participants receiving benefits2010-01-011,417
Total of all active and inactive participants2010-01-012,208
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-01379
Total participants2010-01-012,587
2009: HOSPITAL AND HEALTH BENEFITS 2009 401k membership
Total participants, beginning-of-year2009-01-012,246
Total number of active participants reported on line 7a of the Form 55002009-01-01830
Number of retired or separated participants receiving benefits2009-01-011,525
Total of all active and inactive participants2009-01-012,355
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-01403
Total participants2009-01-012,758

Form 5500 Responses for HOSPITAL AND HEALTH BENEFITS

2022: HOSPITAL AND HEALTH BENEFITS 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: HOSPITAL AND HEALTH BENEFITS 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: HOSPITAL AND HEALTH BENEFITS 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: HOSPITAL AND HEALTH BENEFITS 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: HOSPITAL AND HEALTH BENEFITS 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: HOSPITAL AND HEALTH BENEFITS 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: HOSPITAL AND HEALTH BENEFITS 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: HOSPITAL AND HEALTH BENEFITS 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: HOSPITAL AND HEALTH BENEFITS 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: HOSPITAL AND HEALTH BENEFITS 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: HOSPITAL AND HEALTH BENEFITS 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: HOSPITAL AND HEALTH BENEFITS 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: HOSPITAL AND HEALTH BENEFITS 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: HOSPITAL AND HEALTH BENEFITS 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001,003,004
Policy instance 2
Insurance contract or identification numberUAW-001,003,004
Number of Individuals Covered620
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,714
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 number70605
Policy instance 1
Insurance contract or identification number70605
Number of Individuals Covered1650
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001,003,004
Policy instance 2
Insurance contract or identification numberUAW-001,003,004
Number of Individuals Covered609
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,088
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 number70605
Policy instance 1
Insurance contract or identification number70605
Number of Individuals Covered1651
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001,003,004
Policy instance 2
Insurance contract or identification numberUAW-001,003,004
Number of Individuals Covered561
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,436
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 number70605
Policy instance 1
Insurance contract or identification number70605
Number of Individuals Covered1584
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001,003,004
Policy instance 2
Insurance contract or identification numberUAW-001,003,004
Number of Individuals Covered590
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,347
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 number70605
Policy instance 1
Insurance contract or identification number70605
Number of Individuals Covered1623
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001,003,004
Policy instance 2
Insurance contract or identification numberUAW-001,003,004
Number of Individuals Covered600
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,404
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 number70605
Policy instance 1
Insurance contract or identification number70605
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001,003,004
Policy instance 2
Insurance contract or identification numberUAW-001,003,004
Number of Individuals Covered649
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameHM LIFE INSURANCE COMPANY
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number70605
Policy instance 1
Insurance contract or identification number70605
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
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 number70605
Policy instance 1
Insurance contract or identification number70605
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001,003,004
Policy instance 2
Insurance contract or identification numberUAW-001,003,004
Number of Individuals Covered1690
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameHM LIFE INSURANCE COMPANY
WISCONSIN VISION (National Association of Insurance Commissioners NAIC id number: )
Policy contract number
Policy instance 3
Number of Individuals Covered40
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Vision Insurance Welfare BenefitYes
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 number70605
Policy instance 1
Insurance contract or identification number70605
Number of Individuals Covered2216
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001
Policy instance 2
Insurance contract or identification numberUAW-001
Number of Individuals Covered1755
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker nameHM LIFE INSURANCE COMPANY
WISCONSIN VISION (National Association of Insurance Commissioners NAIC id number: )
Policy contract number
Policy instance 3
Number of Individuals Covered39
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001
Policy instance 2
Insurance contract or identification numberUAW-001
Number of Individuals Covered1822
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of fees paid to insurance companyUSD $6,048
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees6048
Insurance broker nameHM LIFE INSURANCE COMPANY
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number7163-33
Policy instance 1
Insurance contract or identification number7163-33
Number of Individuals Covered2164
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WISCONSIN VISION (National Association of Insurance Commissioners NAIC id number: )
Policy contract number
Policy instance 3
Number of Individuals Covered40
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Vision Insurance Welfare BenefitYes
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 number70605
Policy instance 1
Insurance contract or identification number70605
Number of Individuals Covered3186
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid in cash?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WISCONSIN VISION (National Association of Insurance Commissioners NAIC id number: )
Policy contract number
Policy instance 3
Number of Individuals Covered43
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001
Policy instance 2
Insurance contract or identification numberUAW-001
Number of Individuals Covered1990
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $148,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WISCONSIN VISION (National Association of Insurance Commissioners NAIC id number: )
Policy contract number
Policy instance 3
Number of Individuals Covered42
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001
Policy instance 2
Insurance contract or identification numberUAW-001
Number of Individuals Covered1948
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of fees paid to insurance companyUSD $6,202
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $137,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number70605
Policy instance 1
Insurance contract or identification number70605
Number of Individuals Covered3243
Insurance policy start date2011-01-01
Insurance policy end date2011-01-01
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
WISCONSIN VISION (National Association of Insurance Commissioners NAIC id number: )
Policy contract number
Policy instance 3
Number of Individuals Covered41
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberUAW-001
Policy instance 2
Insurance contract or identification numberUAW-001
Number of Individuals Covered1948
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of fees paid to insurance companyUSD $4,446
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Insurance broker nameHIGHMARK LIFE INSURANCE COMPANY
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number70605
Policy instance 1
Insurance contract or identification number70605
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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