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MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 401k Plan overview

Plan NameMBT FINANCIAL CORP. MEDICAL INSURANCE PLAN
Plan identification number 501

MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN Benefits

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

401k Sponsoring company profile

MBT FINANCIAL CORP. has sponsored the creation of one or more 401k plans.

Company Name:MBT FINANCIAL CORP.
Employer identification number (EIN):380847680
NAIC Classification:522110
NAIC Description:Commercial Banking

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-01-01
5012018-01-01
5012017-01-01SPENCER BLUNT
5012016-01-01SPENCER BLUNT
5012015-01-01WENDY WARRINGTON
5012015-01-01SPENCER BLUNT
5012014-01-01WENDY WARRINGTON
5012014-01-01SPENCER BLUNT
5012013-01-01WENDY WARRINGTON
5012012-01-01WENDY WARRINGTON
5012011-01-01JAMES MORR
5012009-01-01JAMES MORR

Plan Statistics for MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN

401k plan membership statisitcs for MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN

Measure Date Value
2019: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01217
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-010
2018: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01239
Total number of active participants reported on line 7a of the Form 55002018-01-01217
Number of retired or separated participants receiving benefits2018-01-0112
Number of other retired or separated participants entitled to future benefits2018-01-013
Total of all active and inactive participants2018-01-01232
2017: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01225
Total number of active participants reported on line 7a of the Form 55002017-01-01212
Number of retired or separated participants receiving benefits2017-01-0114
Number of other retired or separated participants entitled to future benefits2017-01-0113
Total of all active and inactive participants2017-01-01239
2016: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01252
Total number of active participants reported on line 7a of the Form 55002016-01-01225
Number of retired or separated participants receiving benefits2016-01-0111
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01236
2015: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01674
Total number of active participants reported on line 7a of the Form 55002015-01-01587
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01587
2014: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01425
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-010
2013: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01279
Total number of active participants reported on line 7a of the Form 55002013-01-01425
Number of retired or separated participants receiving benefits2013-01-014
Total of all active and inactive participants2013-01-01429
2012: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01236
Total number of active participants reported on line 7a of the Form 55002012-01-01279
Number of retired or separated participants receiving benefits2012-01-014
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01283
2011: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01291
Total number of active participants reported on line 7a of the Form 55002011-01-01236
Number of retired or separated participants receiving benefits2011-01-0137
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01273
2009: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01303
Total number of active participants reported on line 7a of the Form 55002009-01-01322
Number of retired or separated participants receiving benefits2009-01-0111
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01333

Form 5500 Responses for MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN

2019: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01This submission is the final filingYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: MBT FINANCIAL CORP. MEDICAL INSURANCE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number540693 0010DVIO
Policy instance 3
Insurance contract or identification number540693 0010DVIO
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $2,267
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,666
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,267
Insurance broker organization code?3
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number0007587
Policy instance 2
Insurance contract or identification number0007587
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,552
Total amount of fees paid to insurance companyUSD $303
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,552
Amount paid for insurance broker fees303
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number148755
Policy instance 1
Insurance contract or identification number148755
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $17,096
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,264
Insurance broker organization code?3
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00148755
Policy instance 4
Insurance contract or identification number00148755
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $12,916
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,074
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number540693 0010DVIO
Policy instance 3
Insurance contract or identification number540693 0010DVIO
Number of Individuals Covered203
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $2,304
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,044
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,155
Insurance broker organization code?3
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number0007587
Policy instance 2
Insurance contract or identification number0007587
Number of Individuals Covered511
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $7,575
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,555
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number148755
Policy instance 1
Insurance contract or identification number148755
Number of Individuals Covered224
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $15,643
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,456
Insurance broker organization code?3
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00148755
Policy instance 4
Insurance contract or identification number00148755
Number of Individuals Covered219
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $15,445
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,949
Insurance broker organization code?3
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00148755/C001
Policy instance 6
Insurance contract or identification number00148755/C001
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,476
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 number00148755/G001
Policy instance 5
Insurance contract or identification number00148755/G001
Number of Individuals Covered266
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $46,733
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,026,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,733
Insurance broker organization code?3
Insurance broker nameDALY-MERRITT INC
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number148755
Policy instance 1
Insurance contract or identification number148755
Number of Individuals Covered176
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $32,621
Total amount of fees paid to insurance companyUSD $2,801
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,133
Insurance broker organization code?3
Amount paid for insurance broker fees2801
Insurance broker nameGARY M MIKLOSOVIC
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number540693 0010DVIO
Policy instance 3
Insurance contract or identification number540693 0010DVIO
Number of Individuals Covered203
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,134
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,342
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,134
Insurance broker organization code?3
Insurance broker nameDALY-MERRITT INC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number0007587
Policy instance 2
Insurance contract or identification number0007587
Number of Individuals Covered543
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,587
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,587
Insurance broker organization code?3
Insurance broker nameMELISSA ARMATIS
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00148755/R001
Policy instance 4
Insurance contract or identification number00148755/R001
Number of Individuals Covered4
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $631
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $631
Insurance broker organization code?3
Insurance broker nameDALY-MERRITT INC
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number0007587
Policy instance 2
Insurance contract or identification number0007587
Number of Individuals Covered587
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $5,592
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,592
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number59198
Policy instance 1
Insurance contract or identification number59198
Number of Individuals Covered453
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $90,489
Total amount of fees paid to insurance companyUSD $4,187
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,080
Insurance broker organization code?3
Amount paid for insurance broker fees4187
Insurance broker nameMELISSA ARMATIS
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number0007587
Policy instance 2
Insurance contract or identification number0007587
Number of Individuals Covered674
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,839
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,839
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number68967-601
Policy instance 3
Insurance contract or identification number68967-601
Number of Individuals Covered36
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health 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 number42841-094
Policy instance 1
Insurance contract or identification number42841-094
Insurance policy start date2014-01-01
Insurance policy end date2014-11-30
Total amount of commissions paid to insurance brokerUSD $110,577
Total amount of fees paid to insurance companyUSD $597
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $110,577
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Amount paid for insurance broker fees597
Insurance broker nameDALY MERRITT INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number42841-096
Policy instance 6
Insurance contract or identification number42841-096
Number of Individuals Covered11
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,925
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,925
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameJOHN DALY
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number10002690
Policy instance 4
Insurance contract or identification number10002690
Number of Individuals Covered220
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $33,668
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $715,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,668
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDALY-MERRITT, INC.
PARAMOUNT CARE OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95189 )
Policy contract numberMA0454
Policy instance 3
Insurance contract or identification numberMA0454
Number of Individuals Covered229
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $40,813
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $816,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,813
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number0007587
Policy instance 2
Insurance contract or identification number0007587
Number of Individuals Covered721
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $5,710
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,710
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number42841-094
Policy instance 1
Insurance contract or identification number42841-094
Number of Individuals Covered37
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,925
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,925
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameJOHN L. DALY
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00148755/0001
Policy instance 5
Insurance contract or identification number00148755/0001
Number of Individuals Covered74
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $11,782
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $264,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,782
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number0007587
Policy instance 2
Insurance contract or identification number0007587
Number of Individuals Covered702
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,795
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,795
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
PARAMOUNT CARE OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95189 )
Policy contract numberMA0454
Policy instance 3
Insurance contract or identification numberMA0454
Number of Individuals Covered78
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $39,078
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $781,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,078
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number99131AA,991317A
Policy instance 4
Insurance contract or identification number99131AA,991317A
Number of Individuals Covered230
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $35,260
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $849,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,260
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDALY-MERRITT, INC.
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00148755/0001
Policy instance 5
Insurance contract or identification number00148755/0001
Number of Individuals Covered74
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $12,849
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $259,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,849
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number42841-094
Policy instance 1
Insurance contract or identification number42841-094
Number of Individuals Covered50
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameJOHN L. DALY
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number42841-096
Policy instance 6
Insurance contract or identification number42841-096
Number of Individuals Covered9
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameJOHN DALY
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number001487550001
Policy instance 5
Insurance contract or identification number001487550001
Number of Individuals Covered83
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $14,256
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $263,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number99131AA991317A
Policy instance 4
Insurance contract or identification number99131AA991317A
Number of Individuals Covered251
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $36,863
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $961,522
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 number42841-094
Policy instance 1
Insurance contract or identification number42841-094
Number of Individuals Covered58
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number0007587
Policy instance 2
Insurance contract or identification number0007587
Number of Individuals Covered701
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,904
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PARAMOUNT CARE OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95189 )
Policy contract numberMA0454
Policy instance 3
Insurance contract or identification numberMA0454
Number of Individuals Covered73
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $39,445
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $788,899
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 number42841-096
Policy instance 6
Insurance contract or identification number42841-096
Number of Individuals Covered8
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH ALLIANCE PLAN (National Association of Insurance Commissioners NAIC id number: 95844 )
Policy contract number99131AA991317A
Policy instance 4
Insurance contract or identification number99131AA991317A
Number of Individuals Covered174
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $27,848
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $692,571
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,848
Additional information about fees paid to insurance brokerNA
Insurance broker organization code?3
Insurance broker nameDALY-MERRITT, INC.
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number0007587
Policy instance 2
Insurance contract or identification number0007587
Number of Individuals Covered728
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,771
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,771
Additional information about fees paid to insurance brokerNA
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number68967
Policy instance 1
Insurance contract or identification number68967
Number of Individuals Covered129
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $23,064
Total amount of fees paid to insurance companyUSD $1,945
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,064
Amount paid for insurance broker fees1945
Additional information about fees paid to insurance brokerINSURANCE FEE
Insurance broker organization code?3
Insurance broker nameJOHN L. DALY
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number001487550001
Policy instance 5
Insurance contract or identification number001487550001
Number of Individuals Covered152
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $26,525
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $546,813
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,525
Additional information about fees paid to insurance brokerNA
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.
PARAMOUNT CARE OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95189 )
Policy contract numberM00156
Policy instance 3
Insurance contract or identification numberM00156
Number of Individuals Covered199
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $31,766
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $794,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,766
Additional information about fees paid to insurance brokerNA
Insurance broker organization code?3
Insurance broker nameDALY MERRITT, INC.

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