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G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 401k Plan overview

Plan NameG & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA
Plan identification number 504

G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA Benefits

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

401k Sponsoring company profile

G & T INDUSTRIES, INC has sponsored the creation of one or more 401k plans.

Company Name:G & T INDUSTRIES, INC
Employer identification number (EIN):381460927
NAIC Classification:326200

Additional information about G & T INDUSTRIES, INC

Jurisdiction of Incorporation: Michigan Secretary of State
Incorporation Date: 0000-00-00
Company Identification Number: 083456
Legal Registered Office Address: 1001 76TH STREET SW BYRON CENTER


United States of America (USA)
49315

More information about G & T INDUSTRIES, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042022-07-01DARRYL KRAGT2024-01-17 DARRYL KRAGT2024-01-17
5042021-07-01DARRYL KRAGT2023-01-10 DARRYL KRAGT2023-01-10
5042020-07-01DARRYL KRAGT2022-02-09 DARRYL KRAGT2022-02-09
5042019-07-01DARRYL KRAGT2021-03-22 DARRYL KRAGT2021-03-22
5042018-07-01DARRYL KRAGT2020-02-07
5042017-07-01
5042016-07-01
5042015-07-01
5042014-07-01
5042013-07-01
5042012-07-01DARRYL KRAGT
5042011-07-01DARRYL KRAGT
5042009-07-01DARRYL KRAGT

Plan Statistics for G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA

401k plan membership statisitcs for G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA

Measure Date Value
2022: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2022 401k membership
Total participants, beginning-of-year2022-07-01293
Total number of active participants reported on line 7a of the Form 55002022-07-01268
Total of all active and inactive participants2022-07-01268
2021: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2021 401k membership
Total participants, beginning-of-year2021-07-01285
Total number of active participants reported on line 7a of the Form 55002021-07-01289
Number of retired or separated participants receiving benefits2021-07-014
Total of all active and inactive participants2021-07-01293
2020: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2020 401k membership
Total participants, beginning-of-year2020-07-01350
Total number of active participants reported on line 7a of the Form 55002020-07-01284
Number of retired or separated participants receiving benefits2020-07-011
Total of all active and inactive participants2020-07-01285
2019: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2019 401k membership
Total participants, beginning-of-year2019-07-01442
Total number of active participants reported on line 7a of the Form 55002019-07-01348
Number of retired or separated participants receiving benefits2019-07-012
Total of all active and inactive participants2019-07-01350
2018: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2018 401k membership
Total participants, beginning-of-year2018-07-01301
Total number of active participants reported on line 7a of the Form 55002018-07-01441
Number of retired or separated participants receiving benefits2018-07-011
Total of all active and inactive participants2018-07-01442
2017: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2017 401k membership
Total participants, beginning-of-year2017-07-01192
Total number of active participants reported on line 7a of the Form 55002017-07-01299
Number of retired or separated participants receiving benefits2017-07-012
Total of all active and inactive participants2017-07-01301
2016: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2016 401k membership
Total participants, beginning-of-year2016-07-01170
Total number of active participants reported on line 7a of the Form 55002016-07-01187
Number of retired or separated participants receiving benefits2016-07-015
Total of all active and inactive participants2016-07-01192
2015: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2015 401k membership
Total participants, beginning-of-year2015-07-01138
Total number of active participants reported on line 7a of the Form 55002015-07-01164
Number of retired or separated participants receiving benefits2015-07-016
Total of all active and inactive participants2015-07-01170
2014: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2014 401k membership
Total participants, beginning-of-year2014-07-01143
Total number of active participants reported on line 7a of the Form 55002014-07-01134
Number of retired or separated participants receiving benefits2014-07-014
Total of all active and inactive participants2014-07-01138
2013: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2013 401k membership
Total participants, beginning-of-year2013-07-01122
Total number of active participants reported on line 7a of the Form 55002013-07-01140
Number of retired or separated participants receiving benefits2013-07-013
Total of all active and inactive participants2013-07-01143
2012: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2012 401k membership
Total participants, beginning-of-year2012-07-01132
Total number of active participants reported on line 7a of the Form 55002012-07-01119
Number of retired or separated participants receiving benefits2012-07-013
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01122
2011: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2011 401k membership
Total participants, beginning-of-year2011-07-01133
Total number of active participants reported on line 7a of the Form 55002011-07-01131
Number of retired or separated participants receiving benefits2011-07-011
Total of all active and inactive participants2011-07-01132
2009: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2009 401k membership
Total participants, beginning-of-year2009-07-01152
Total number of active participants reported on line 7a of the Form 55002009-07-01130
Number of retired or separated participants receiving benefits2009-07-0117
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01147

Form 5500 Responses for G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA

2022: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan funding arrangement – General assets of the sponsorYes
2022-07-01Plan benefit arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – General assets of the sponsorYes
2021: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan funding arrangement – General assets of the sponsorYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan funding arrangement – General assets of the sponsorYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – General assets of the sponsorYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – General assets of the sponsorYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – General assets of the sponsorYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – General assets of the sponsorYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – General assets of the sponsorYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – General assets of the sponsorYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes
2012: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – General assets of the sponsorYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2011: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – General assets of the sponsorYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – General assets of the sponsorYes
2009: G & T INDUSTRIES, INC. EMPLOYEE BENEFIT HEALTH PLA 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – General assets of the sponsorYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract number956415
Policy instance 1
Insurance contract or identification number956415
Number of Individuals Covered301
Insurance policy start date2021-08-01
Insurance policy end date2022-08-01
Total amount of commissions paid to insurance brokerUSD $2,164
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $28,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,164
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number240037
Policy instance 1
Insurance contract or identification number240037
Number of Individuals Covered549
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $38,102
Total amount of fees paid to insurance companyUSD $1,761
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,102
Amount paid for insurance broker fees1761
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number240037
Policy instance 1
Insurance contract or identification number240037
Number of Individuals Covered587
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $37,436
Total amount of fees paid to insurance companyUSD $4,154
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,436
Amount paid for insurance broker fees4154
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number125335
Policy instance 2
Insurance contract or identification number125335
Number of Individuals Covered156
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $40,724
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $828,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $43,064
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number240037
Policy instance 1
Insurance contract or identification number240037
Number of Individuals Covered551
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $38,011
Total amount of fees paid to insurance companyUSD $1,754
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,011
Amount paid for insurance broker fees1754
Insurance broker organization code?3
BLUECROSS BLUESHIELD OF TENNESSEE, INC. (National Association of Insurance Commissioners NAIC id number: 54518 )
Policy contract number125335
Policy instance 2
Insurance contract or identification number125335
Number of Individuals Covered114
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $24,754
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $396,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,754
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number240037
Policy instance 1
Insurance contract or identification number240037
Number of Individuals Covered355
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $38,623
Total amount of fees paid to insurance companyUSD $2,276
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,623
Amount paid for insurance broker fees2276
Insurance broker organization code?3
DELTA DENTAL OF TENNESSEE (National Association of Insurance Commissioners NAIC id number: 54526 )
Policy contract number7402
Policy instance 2
Insurance contract or identification number7402
Number of Individuals Covered117
Insurance policy start date2018-01-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $2,459
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
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number240037
Policy instance 1
Insurance contract or identification number240037
Number of Individuals Covered350
Insurance policy start date2016-08-01
Insurance policy end date2017-07-31
Total amount of commissions paid to insurance brokerUSD $42,043
Total amount of fees paid to insurance companyUSD $1,561
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0902525
Policy instance 1
Insurance contract or identification number0902525
Number of Individuals Covered396
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $6,247
Total amount of fees paid to insurance companyUSD $35,867
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,324,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,247
Amount paid for insurance broker fees35867
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameCOLDBROOK INSURANCE GROUP LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12253246
Policy instance 2
Insurance contract or identification number12253246
Number of Individuals Covered89
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $0
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,547
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 number45232
Policy instance 1
Insurance contract or identification number45232
Number of Individuals Covered72
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $34,818
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,468
Insurance broker organization code?3
Insurance broker namePINNACLE INSURANCE PARTNERS
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00240037/0001
Policy instance 3
Insurance contract or identification number00240037/0001
Number of Individuals Covered163
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $23,152
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 $493,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,152
Insurance broker organization code?3
Insurance broker nameCOLDBROOK INSURANCE GROUP
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number45232
Policy instance 1
Insurance contract or identification number45232
Number of Individuals Covered280
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $48,291
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,292
Insurance broker organization code?3
Insurance broker namePINNACLE INSURANCE PARTNERS
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12253246
Policy instance 2
Insurance contract or identification number12253246
Number of Individuals Covered82
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $0
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12253246
Policy instance 2
Insurance contract or identification number12253246
Number of Individuals Covered82
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $12,313
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 number45232
Policy instance 1
Insurance contract or identification number45232
Number of Individuals Covered298
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $45,876
Total amount of fees paid to insurance companyUSD $1,608
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,440
Amount paid for insurance broker fees1608
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameJAMES W WATSON
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12253246
Policy instance 2
Insurance contract or identification number12253246
Number of Individuals Covered89
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number782762
Policy instance 1
Insurance contract or identification number782762
Number of Individuals Covered213
Insurance policy start date2011-07-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $607
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $53,445
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12253246
Policy instance 2
Insurance contract or identification number12253246
Number of Individuals Covered91
Insurance policy start date2009-08-01
Insurance policy end date2010-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $13,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number782762
Policy instance 1
Insurance contract or identification number782762
Number of Individuals Covered134
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $17,246
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $862,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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