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WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 401k Plan overview

Plan NameWALBRIDGE ALDINGER PREMIUM CHOICE PLAN
Plan identification number 502

WALBRIDGE ALDINGER PREMIUM CHOICE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Other welfare benefit cover

401k Sponsoring company profile

WALBRIDGE/DIG/DFM WELFARE BENEFIT PLAN has sponsored the creation of one or more 401k plans.

Company Name:WALBRIDGE/DIG/DFM WELFARE BENEFIT PLAN
Employer identification number (EIN):381141440
NAIC Classification:236200

Additional information about WALBRIDGE/DIG/DFM WELFARE BENEFIT PLAN

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C0711371

More information about WALBRIDGE/DIG/DFM WELFARE BENEFIT PLAN

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WALBRIDGE ALDINGER PREMIUM CHOICE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-01-01PETER J. DARGA2022-04-05
5022020-01-01PETER J. DARGA2021-09-08
5022019-01-01PETER J. DARGA2020-07-20
5022018-01-01
5022017-01-01
5022016-01-01
5022015-01-01
5022014-01-01
5022013-01-01
5022012-01-01PETER J DARGA
5022012-01-01PETER J DARGA
5022011-01-01VINCENT DEANGELIS
5022009-01-01VINCENT DEANGELIS

Plan Statistics for WALBRIDGE ALDINGER PREMIUM CHOICE PLAN

401k plan membership statisitcs for WALBRIDGE ALDINGER PREMIUM CHOICE PLAN

Measure Date Value
2021: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01785
Total number of active participants reported on line 7a of the Form 55002021-01-01784
Number of retired or separated participants receiving benefits2021-01-0140
Total of all active and inactive participants2021-01-01824
2020: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01773
Total number of active participants reported on line 7a of the Form 55002020-01-01735
Number of retired or separated participants receiving benefits2020-01-0150
Total of all active and inactive participants2020-01-01785
2019: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01796
Total number of active participants reported on line 7a of the Form 55002019-01-01739
Number of retired or separated participants receiving benefits2019-01-0134
Total of all active and inactive participants2019-01-01773
2018: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01815
Total number of active participants reported on line 7a of the Form 55002018-01-01770
Number of retired or separated participants receiving benefits2018-01-0126
Total of all active and inactive participants2018-01-01796
2017: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01549
Total number of active participants reported on line 7a of the Form 55002017-01-01799
Number of retired or separated participants receiving benefits2017-01-0116
Total of all active and inactive participants2017-01-01815
2016: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01504
Total number of active participants reported on line 7a of the Form 55002016-01-01529
Number of retired or separated participants receiving benefits2016-01-0120
Total of all active and inactive participants2016-01-01549
2015: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01519
Total number of active participants reported on line 7a of the Form 55002015-01-01492
Number of retired or separated participants receiving benefits2015-01-0112
Total of all active and inactive participants2015-01-01504
2014: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01513
Total number of active participants reported on line 7a of the Form 55002014-01-01519
Number of retired or separated participants receiving benefits2014-01-010
Total of all active and inactive participants2014-01-01519
2013: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01511
Total number of active participants reported on line 7a of the Form 55002013-01-01505
Number of retired or separated participants receiving benefits2013-01-018
Total of all active and inactive participants2013-01-01513
2012: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01865
Total number of active participants reported on line 7a of the Form 55002012-01-011,164
Number of retired or separated participants receiving benefits2012-01-0110
Total of all active and inactive participants2012-01-011,174
2011: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01818
Total number of active participants reported on line 7a of the Form 55002011-01-01865
Total of all active and inactive participants2011-01-01865
2009: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01537
Total number of active participants reported on line 7a of the Form 55002009-01-01691
Total of all active and inactive participants2009-01-01691

Form 5500 Responses for WALBRIDGE ALDINGER PREMIUM CHOICE PLAN

2021: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
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: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
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: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
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: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
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: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
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: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
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: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
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: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Submission has been amendedYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: WALBRIDGE ALDINGER PREMIUM CHOICE PLAN 2009 form 5500 responses
2009-01-01Type of plan entityMulitple employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract numberCID 159430
Policy instance 2
Insurance contract or identification numberCID 159430
Number of Individuals Covered1938
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $38,608
Total amount of fees paid to insurance companyUSD $10,719
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,061,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,608
Insurance broker organization code?3
Amount paid for insurance broker fees10719
Additional information about fees paid to insurance brokerADMIN FEES
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1969
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $18,127
Total amount of fees paid to insurance companyUSD $586
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 $18,127
Amount paid for insurance broker fees586
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION - RETENTION BONUS
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract numberCID 159430
Policy instance 2
Insurance contract or identification numberCID 159430
Number of Individuals Covered1825
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $35,200
Total amount of fees paid to insurance companyUSD $5,013
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $983,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,200
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1832
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $13,348
Total amount of fees paid to insurance companyUSD $1,242
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 $13,348
Amount paid for insurance broker fees1242
Additional information about fees paid to insurance brokerNEW BUSINESS BONUS, RETENTION BONUS
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number16834
Policy instance 2
Insurance contract or identification number16834
Number of Individuals Covered1866
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $32,839
Total amount of fees paid to insurance companyUSD $10,186
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $953,771
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,839
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1910
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $17,331
Total amount of fees paid to insurance companyUSD $1,414
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 $17,331
Amount paid for insurance broker fees1414
Additional information about fees paid to insurance brokerRETENTION BONUS
Insurance broker organization code?3
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1974
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $18,647
Total amount of fees paid to insurance companyUSD $0
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 $18,647
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number16834
Policy instance 2
Insurance contract or identification number16834
Number of Individuals Covered1937
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $31,412
Total amount of fees paid to insurance companyUSD $5,116
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $847,247
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,412
Amount paid for insurance broker fees5116
Additional information about fees paid to insurance brokerOTHER COMPENSATION FOR SERVICES TO CLIENT OR INSURANCE PROVIDER
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number16834
Policy instance 2
Insurance contract or identification number16834
Number of Individuals Covered1984
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $30,683
Total amount of fees paid to insurance companyUSD $8,574
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $900,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,683
Amount paid for insurance broker fees8574
Additional information about fees paid to insurance brokerSERVICES TO CLIENT OR INSURANCE COMPANY
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered2000
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $18,994
Total amount of fees paid to insurance companyUSD $0
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 $18,994
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1260
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $21,868
Total amount of fees paid to insurance companyUSD $0
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 $21,868
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number16834
Policy instance 2
Insurance contract or identification number16834
Number of Individuals Covered1275
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $20,559
Total amount of fees paid to insurance companyUSD $10,608
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $588,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,559
Amount paid for insurance broker fees10608
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number16834
Policy instance 2
Insurance contract or identification number16834
Number of Individuals Covered519
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $20,097
Total amount of fees paid to insurance companyUSD $6,231
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $576,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,097
Amount paid for insurance broker fees6231
Additional information about fees paid to insurance brokerFEES AND OTHER COMP
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1290
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $20,362
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 $20,362
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number16834
Policy instance 4
Insurance contract or identification number16834
Number of Individuals Covered619
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $93,923
Total amount of fees paid to insurance companyUSD $13,872
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $533,224
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 number47147
Policy instance 3
Insurance contract or identification number47147
Number of Individuals Covered1326
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $54,401
Total amount of fees paid to insurance companyUSD $10,636
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $596,455
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 number21
Policy instance 2
Insurance contract or identification number21
Number of Individuals Covered593
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,917
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental 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 number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1262
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $21,530
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 $21,530
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerFEES & OTHER COMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number16834
Policy instance 2
Insurance contract or identification number16834
Number of Individuals Covered619
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $93,923
Total amount of fees paid to insurance companyUSD $13,872
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $533,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $93,923
Amount paid for insurance broker fees13872
Additional information about fees paid to insurance brokerFEES & OTHER COMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1241
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $22,570
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 $22,570
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number47147
Policy instance 3
Insurance contract or identification number47147
Number of Individuals Covered1319
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $39,744
Total amount of fees paid to insurance companyUSD $5,452
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $494,937
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 number21
Policy instance 2
Insurance contract or identification number21
Number of Individuals Covered641
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,609
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental 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 number16834
Policy instance 4
Insurance contract or identification number16834
Number of Individuals Covered1296
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $52,716
Total amount of fees paid to insurance companyUSD $12,724
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $451,736
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 number16834
Policy instance 2
Insurance contract or identification number16834
Number of Individuals Covered1296
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $52,716
Total amount of fees paid to insurance companyUSD $12,724
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $451,736
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,716
Amount paid for insurance broker fees12724
Additional information about fees paid to insurance brokerFEES & OTHER COMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1483
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $24,535
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental 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 number21
Policy instance 2
Insurance contract or identification number21
Number of Individuals Covered583
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,939
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental 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 number47147
Policy instance 3
Insurance contract or identification number47147
Number of Individuals Covered572
Insurance policy start date2010-11-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $36,868
Total amount of fees paid to insurance companyUSD $966
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $264,991
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 number16834
Policy instance 4
Insurance contract or identification number16834
Number of Individuals Covered1508
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $78,813
Total amount of fees paid to insurance companyUSD $4,001
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $540,969
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 number9272
Policy instance 1
Insurance contract or identification number9272
Number of Individuals Covered1517
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $23,104
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 $23,104
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number16834
Policy instance 2
Insurance contract or identification number16834
Number of Individuals Covered1402
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $91,545
Total amount of fees paid to insurance companyUSD $2
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $284,615
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $91,545
Amount paid for insurance broker fees2
Additional information about fees paid to insurance brokerMISCELLANEOUS
Insurance broker organization code?3
Insurance broker nameKAPNICK INSURANCE GROUP
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number47147
Policy instance 4
Insurance contract or identification number47147
Number of Individuals Covered154
Insurance policy start date2009-11-01
Insurance policy end date2010-10-31
Total amount of commissions paid to insurance brokerUSD $34,416
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $160,102
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,416
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number16834
Policy instance 5
Insurance contract or identification number16834
Number of Individuals Covered1539
Insurance policy start date2010-07-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $42,995
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $196,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,995
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number21
Policy instance 3
Insurance contract or identification number21
Number of Individuals Covered377
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $3,286
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 $3,286
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameKAPNICK & COMPANY, INC.

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