CHRISTIAN REST HOME ASSOCIATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN
401k plan membership statisitcs for CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2020: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-12-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 54 |
| Number of retired or separated participants receiving benefits | 2020-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-12-01 | 0 |
| Total of all active and inactive participants | 2020-12-01 | 54 |
| Number of employers contributing to the scheme | 2020-12-01 | 0 |
| 2019: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-12-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 68 |
| Number of retired or separated participants receiving benefits | 2019-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-12-01 | 0 |
| Total of all active and inactive participants | 2019-12-01 | 68 |
| Number of employers contributing to the scheme | 2019-12-01 | 0 |
| 2018: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-12-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 106 |
| Number of retired or separated participants receiving benefits | 2018-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 0 |
| Total of all active and inactive participants | 2018-12-01 | 106 |
| Number of employers contributing to the scheme | 2018-12-01 | 0 |
| 2017: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-12-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 86 |
| Number of retired or separated participants receiving benefits | 2017-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-12-01 | 0 |
| Total of all active and inactive participants | 2017-12-01 | 86 |
| Number of employers contributing to the scheme | 2017-12-01 | 0 |
| 2016: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-12-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 100 |
| Number of retired or separated participants receiving benefits | 2016-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-12-01 | 0 |
| Total of all active and inactive participants | 2016-12-01 | 100 |
| 2015: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-12-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 96 |
| Number of retired or separated participants receiving benefits | 2015-12-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2015-12-01 | 0 |
| Total of all active and inactive participants | 2015-12-01 | 98 |
| 2014: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-12-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-12-01 | 70 |
| Number of retired or separated participants receiving benefits | 2014-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-12-01 | 0 |
| Total of all active and inactive participants | 2014-12-01 | 70 |
| 2013: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-12-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-12-01 | 92 |
| Number of retired or separated participants receiving benefits | 2013-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-12-01 | 0 |
| Total of all active and inactive participants | 2013-12-01 | 92 |
| 2012: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-12-01 | 201 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-12-01 | 118 |
| Number of retired or separated participants receiving benefits | 2012-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-12-01 | 0 |
| Total of all active and inactive participants | 2012-12-01 | 118 |
| 2011: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-12-01 | 228 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-12-01 | 201 |
| Total of all active and inactive participants | 2011-12-01 | 201 |
| Total participants | 2011-12-01 | 201 |
| 2010: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-12-01 | 213 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-12-01 | 228 |
| Total of all active and inactive participants | 2010-12-01 | 228 |
| Total participants | 2010-12-01 | 228 |
| 2009: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-12-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-12-01 | 213 |
| Total of all active and inactive participants | 2009-12-01 | 213 |
| Total participants | 2009-12-01 | 213 |
| 2008: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-12-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-12-01 | 134 |
| Total of all active and inactive participants | 2008-12-01 | 134 |
| Total participants | 2008-12-01 | 134 |
| 2007: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-12-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-12-01 | 133 |
| Total of all active and inactive participants | 2007-12-01 | 133 |
| Total participants | 2007-12-01 | 133 |
| 2006: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-12-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-12-01 | 141 |
| Total of all active and inactive participants | 2006-12-01 | 141 |
| Total participants | 2006-12-01 | 141 |
| 2005: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-12-01 | 34 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-12-01 | 112 |
| Total of all active and inactive participants | 2005-12-01 | 112 |
| Total participants | 2005-12-01 | 112 |
| 2004: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-12-01 | 46 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-12-01 | 34 |
| Total of all active and inactive participants | 2004-12-01 | 34 |
| Total participants | 2004-12-01 | 34 |
| 2003: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-12-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-12-01 | 46 |
| Total of all active and inactive participants | 2003-12-01 | 46 |
| Total participants | 2003-12-01 | 46 |
| 2002: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-12-01 | 63 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-12-01 | 78 |
| Total of all active and inactive participants | 2002-12-01 | 78 |
| Total participants | 2002-12-01 | 78 |
| 2001: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2001 401k membership |
|---|
| Total participants, beginning-of-year | 2001-12-01 | 63 |
| Total number of active participants reported on line 7a of the Form 5500 | 2001-12-01 | 63 |
| Total of all active and inactive participants | 2001-12-01 | 63 |
| Total participants | 2001-12-01 | 63 |
| 2020: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2017 form 5500 responses |
|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2016 form 5500 responses |
|---|
| 2016-12-01 | Type of plan entity | Single employer plan |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-12-01 | Type of plan entity | Single employer plan |
| 2015-12-01 | Submission has been amended | No |
| 2015-12-01 | This submission is the final filing | No |
| 2015-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-12-01 | Plan is a collectively bargained plan | No |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-12-01 | Type of plan entity | Single employer plan |
| 2014-12-01 | Submission has been amended | No |
| 2014-12-01 | This submission is the final filing | No |
| 2014-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-12-01 | Plan is a collectively bargained plan | No |
| 2014-12-01 | Plan funding arrangement – Insurance | Yes |
| 2014-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-12-01 | Type of plan entity | Single employer plan |
| 2013-12-01 | Submission has been amended | No |
| 2013-12-01 | This submission is the final filing | No |
| 2013-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-12-01 | Plan is a collectively bargained plan | No |
| 2013-12-01 | Plan funding arrangement – Insurance | Yes |
| 2013-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-12-01 | Type of plan entity | Single employer plan |
| 2012-12-01 | Submission has been amended | No |
| 2012-12-01 | This submission is the final filing | No |
| 2012-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-12-01 | Plan is a collectively bargained plan | No |
| 2012-12-01 | Plan funding arrangement – Insurance | Yes |
| 2012-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2011 form 5500 responses |
|---|
| 2011-12-01 | Type of plan entity | Single employer plan |
| 2011-12-01 | First time form 5500 has been submitted | Yes |
| 2011-12-01 | Submission has been amended | No |
| 2011-12-01 | This submission is the final filing | No |
| 2011-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-12-01 | Plan is a collectively bargained plan | No |
| 2011-12-01 | Plan funding arrangement – Insurance | Yes |
| 2011-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2010 form 5500 responses |
|---|
| 2010-12-01 | Type of plan entity | Single employer plan |
| 2010-12-01 | First time form 5500 has been submitted | Yes |
| 2010-12-01 | Submission has been amended | No |
| 2010-12-01 | This submission is the final filing | No |
| 2010-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-12-01 | Plan is a collectively bargained plan | No |
| 2010-12-01 | Plan funding arrangement – Insurance | Yes |
| 2010-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2009 form 5500 responses |
|---|
| 2009-12-01 | Type of plan entity | Single employer plan |
| 2009-12-01 | First time form 5500 has been submitted | Yes |
| 2009-12-01 | Submission has been amended | No |
| 2009-12-01 | This submission is the final filing | No |
| 2009-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-12-01 | Plan is a collectively bargained plan | No |
| 2009-12-01 | Plan funding arrangement – Insurance | Yes |
| 2009-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2008 form 5500 responses |
|---|
| 2008-12-01 | Type of plan entity | Single employer plan |
| 2008-12-01 | First time form 5500 has been submitted | Yes |
| 2008-12-01 | Submission has been amended | No |
| 2008-12-01 | This submission is the final filing | No |
| 2008-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-12-01 | Plan is a collectively bargained plan | No |
| 2008-12-01 | Plan funding arrangement – Insurance | Yes |
| 2008-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2007 form 5500 responses |
|---|
| 2007-12-01 | Type of plan entity | Single employer plan |
| 2007-12-01 | First time form 5500 has been submitted | Yes |
| 2007-12-01 | Submission has been amended | No |
| 2007-12-01 | This submission is the final filing | No |
| 2007-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-12-01 | Plan is a collectively bargained plan | No |
| 2007-12-01 | Plan funding arrangement – Insurance | Yes |
| 2007-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2006 form 5500 responses |
|---|
| 2006-12-01 | Type of plan entity | Single employer plan |
| 2006-12-01 | First time form 5500 has been submitted | Yes |
| 2006-12-01 | Submission has been amended | No |
| 2006-12-01 | This submission is the final filing | No |
| 2006-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-12-01 | Plan is a collectively bargained plan | No |
| 2006-12-01 | Plan funding arrangement – Insurance | Yes |
| 2006-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2005 form 5500 responses |
|---|
| 2005-12-01 | Type of plan entity | Single employer plan |
| 2005-12-01 | First time form 5500 has been submitted | Yes |
| 2005-12-01 | Submission has been amended | No |
| 2005-12-01 | This submission is the final filing | No |
| 2005-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-12-01 | Plan is a collectively bargained plan | No |
| 2005-12-01 | Plan funding arrangement – Insurance | Yes |
| 2005-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2004 form 5500 responses |
|---|
| 2004-12-01 | Type of plan entity | Single employer plan |
| 2004-12-01 | First time form 5500 has been submitted | Yes |
| 2004-12-01 | Submission has been amended | No |
| 2004-12-01 | This submission is the final filing | No |
| 2004-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-12-01 | Plan is a collectively bargained plan | No |
| 2004-12-01 | Plan funding arrangement – Insurance | Yes |
| 2004-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2003 form 5500 responses |
|---|
| 2003-12-01 | Type of plan entity | Single employer plan |
| 2003-12-01 | First time form 5500 has been submitted | Yes |
| 2003-12-01 | Submission has been amended | No |
| 2003-12-01 | This submission is the final filing | No |
| 2003-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-12-01 | Plan is a collectively bargained plan | No |
| 2003-12-01 | Plan funding arrangement – Insurance | Yes |
| 2003-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2002 form 5500 responses |
|---|
| 2002-12-01 | Type of plan entity | Single employer plan |
| 2002-12-01 | First time form 5500 has been submitted | Yes |
| 2002-12-01 | Submission has been amended | No |
| 2002-12-01 | This submission is the final filing | No |
| 2002-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-12-01 | Plan is a collectively bargained plan | No |
| 2002-12-01 | Plan funding arrangement – Insurance | Yes |
| 2002-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2001: CHRISTIAN REST HOME ASSOCIATION HEALTH AND WELFARE PLAN 2001 form 5500 responses |
|---|
| 2001-12-01 | Type of plan entity | Single employer plan |
| 2001-12-01 | First time form 5500 has been submitted | Yes |
| 2001-12-01 | Submission has been amended | No |
| 2001-12-01 | This submission is the final filing | No |
| 2001-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2001-12-01 | Plan is a collectively bargained plan | No |
| 2001-12-01 | Plan funding arrangement – Insurance | Yes |
| 2001-12-01 | Plan benefit arrangement – Insurance | Yes |
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10249131001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10249131001 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $1,460 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,915 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $487 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 7017063 |
| Policy instance | 3 |
| Insurance contract or identification number | 7017063 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $3,670 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,670 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 468215 |
| Policy instance | 2 |
| Insurance contract or identification number | 468215 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $1,254 | | Total amount of fees paid to insurance company | USD $113 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $9,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,254 | | Amount paid for insurance broker fees | 113 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 231536 |
| Policy instance | 1 |
| Insurance contract or identification number | 231536 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | Total amount of commissions paid to insurance broker | USD $25,628 | | Total amount of fees paid to insurance company | USD $1,030 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,628 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | FEES AND OTHER COMMISSIONS |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10249131001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10249131001 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $1,260 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $840 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 0 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 2203 |
| Policy instance | 3 |
| Insurance contract or identification number | 2203 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $3,093 | | Total amount of fees paid to insurance company | USD $126 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,093 | | Amount paid for insurance broker fees | 126 | | Additional information about fees paid to insurance broker | NEW BUSINESS BONUS RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 468215 |
| Policy instance | 2 |
| Insurance contract or identification number | 468215 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $1,273 | | Total amount of fees paid to insurance company | USD $115 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $8,515 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,273 | | Amount paid for insurance broker fees | 115 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 231536 |
| Policy instance | 1 |
| Insurance contract or identification number | 231536 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $23,885 | | Total amount of fees paid to insurance company | USD $1,308 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,885 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | FEES |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 2203 |
| Policy instance | 3 |
| Insurance contract or identification number | 2203 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $3,156 | | Total amount of fees paid to insurance company | USD $125 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,156 | | Amount paid for insurance broker fees | 125 | | Additional information about fees paid to insurance broker | RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 468215 |
| Policy instance | 2 |
| Insurance contract or identification number | 468215 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $1,305 | | Total amount of fees paid to insurance company | USD $117 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $9,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,305 | | Amount paid for insurance broker fees | 117 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 231536 |
| Policy instance | 1 |
| Insurance contract or identification number | 231536 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | Total amount of commissions paid to insurance broker | USD $25,184 | | Total amount of fees paid to insurance company | USD $630 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,184 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | FEES |
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| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 2203 |
| Policy instance | 3 |
| Insurance contract or identification number | 2203 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $3,222 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 468215 |
| Policy instance | 2 |
| Insurance contract or identification number | 468215 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $1,250 | | Total amount of fees paid to insurance company | USD $114 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $9,899 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 231536 |
| Policy instance | 1 |
| Insurance contract or identification number | 231536 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | Total amount of commissions paid to insurance broker | USD $1,166 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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