PAT MILLIKEN FORD, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2022: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-03-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 133 |
| Total of all active and inactive participants | 2022-03-01 | 133 |
| 2021: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-03-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 126 |
| Total of all active and inactive participants | 2021-03-01 | 126 |
| 2020: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-03-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 133 |
| Total of all active and inactive participants | 2020-03-01 | 133 |
| 2019: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-03-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-03-01 | 131 |
| Total of all active and inactive participants | 2019-03-01 | 131 |
| 2018: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-03-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 131 |
| Total of all active and inactive participants | 2018-03-01 | 131 |
| 2017: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-03-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 125 |
| Total of all active and inactive participants | 2017-03-01 | 125 |
| 2016: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-03-01 | 136 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 119 |
| Total of all active and inactive participants | 2016-03-01 | 119 |
| 2015: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-03-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 136 |
| Total of all active and inactive participants | 2015-03-01 | 136 |
| 2014: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-03-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 133 |
| Total of all active and inactive participants | 2014-03-01 | 133 |
| 2013: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-03-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 117 |
| Total of all active and inactive participants | 2013-03-01 | 117 |
| 2012: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-03-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 115 |
| Total of all active and inactive participants | 2012-03-01 | 115 |
| 2011: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-03-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-03-01 | 107 |
| Number of retired or separated participants receiving benefits | 2011-03-01 | 2 |
| Total of all active and inactive participants | 2011-03-01 | 109 |
| 2010: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-03-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-03-01 | 102 |
| Number of retired or separated participants receiving benefits | 2010-03-01 | 3 |
| Total of all active and inactive participants | 2010-03-01 | 105 |
| 2009: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-03-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-03-01 | 106 |
| Number of retired or separated participants receiving benefits | 2009-03-01 | 3 |
| Total of all active and inactive participants | 2009-03-01 | 109 |
| 2022: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-03-01 | Type of plan entity | Single employer plan |
| 2020-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-03-01 | Type of plan entity | Single employer plan |
| 2019-03-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2019-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2018 form 5500 responses |
|---|
| 2018-03-01 | Type of plan entity | Single employer plan |
| 2018-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2017 form 5500 responses |
|---|
| 2017-03-01 | Type of plan entity | Single employer plan |
| 2017-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2016 form 5500 responses |
|---|
| 2016-03-01 | Type of plan entity | Single employer plan |
| 2016-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2015 form 5500 responses |
|---|
| 2015-03-01 | Type of plan entity | Single employer plan |
| 2015-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2014 form 5500 responses |
|---|
| 2014-03-01 | Type of plan entity | Single employer plan |
| 2014-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2013 form 5500 responses |
|---|
| 2013-03-01 | Type of plan entity | Single employer plan |
| 2013-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2012 form 5500 responses |
|---|
| 2012-03-01 | Type of plan entity | Single employer plan |
| 2012-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2011 form 5500 responses |
|---|
| 2011-03-01 | Type of plan entity | Single employer plan |
| 2011-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2010 form 5500 responses |
|---|
| 2010-03-01 | Type of plan entity | Single employer plan |
| 2010-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: PAT MILLIKEN FORD FLEXIBLE BENEFIT PLAN 2009 form 5500 responses |
|---|
| 2009-03-01 | Type of plan entity | Single employer plan |
| 2009-03-01 | This submission is the final filing | No |
| 2009-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 302450 |
| Policy instance | 9 |
| Insurance contract or identification number | 302450 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $3,466 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL LONG TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $17,332 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,466 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 150802 |
| Policy instance | 1 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $24,669 | | Total amount of fees paid to insurance company | USD $605 | | 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 $24,669 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 605 | | Additional information about fees paid to insurance broker | INCENTIVE PAYMENTS |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1074230 |
| Policy instance | 2 |
| Insurance contract or identification number | 1074230 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $4,284 | | Total amount of fees paid to insurance company | USD $2,631 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,284 | | Amount paid for insurance broker fees | 2631 | | Additional information about fees paid to insurance broker | BONUS PAYMENTS | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 157410 |
| Policy instance | 3 |
| Insurance contract or identification number | 157410 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $5,261 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, DEPENDENT LIFE, SUPPL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $46,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,261 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 165505 |
| Policy instance | 4 |
| Insurance contract or identification number | 165505 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $6,409 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,409 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 128654 |
| Policy instance | 5 |
| Insurance contract or identification number | 128654 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $1,206 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,031 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,206 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 800861 |
| Policy instance | 6 |
| Insurance contract or identification number | 800861 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $5,720 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL CRIT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $22,881 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,720 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 825922 |
| Policy instance | 7 |
| Insurance contract or identification number | 825922 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $3,745 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,979 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,745 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 150802 |
| Policy instance | 8 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,059 | | Total amount of fees paid to insurance company | USD $15 | | 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 $1,059 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 15 | | Additional information about fees paid to insurance broker | INCENTIVE PAYMENTS |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 150802 |
| Policy instance | 1 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $1,215 | | Total amount of fees paid to insurance company | USD $2 | | 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 $1,215 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2 | | Additional information about fees paid to insurance broker | AGENT FEES |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 150802 |
| Policy instance | 2 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $26,287 | | Total amount of fees paid to insurance company | USD $321 | | 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 $26,287 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 321 | | Additional information about fees paid to insurance broker | AGENT FEES |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1074230 |
| Policy instance | 3 |
| Insurance contract or identification number | 1074230 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $4,190 | | Total amount of fees paid to insurance company | USD $1,781 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,863 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,190 | | Amount paid for insurance broker fees | 1781 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 157410 |
| Policy instance | 4 |
| Insurance contract or identification number | 157410 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $5,252 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, DEPENDENT LIFE, SUPPL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $46,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,252 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 165505 |
| Policy instance | 5 |
| Insurance contract or identification number | 165505 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $6,225 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,416 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,225 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 128654 |
| Policy instance | 6 |
| Insurance contract or identification number | 128654 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $1,112 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,557 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,112 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 800861 |
| Policy instance | 7 |
| Insurance contract or identification number | 800861 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $5,685 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL CRIT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $22,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,685 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 825922 |
| Policy instance | 8 |
| Insurance contract or identification number | 825922 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $3,816 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $15,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,816 | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1074230 |
| Policy instance | 3 |
| Insurance contract or identification number | 1074230 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $4,379 | | Total amount of fees paid to insurance company | USD $4,501 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,379 | | Amount paid for insurance broker fees | 4501 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 157410 |
| Policy instance | 4 |
| Insurance contract or identification number | 157410 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $5,041 | | Total amount of fees paid to insurance company | USD $1,348 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, DEPENDENT LIFE, SUPPL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $44,343 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,041 | | Amount paid for insurance broker fees | 1348 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 165505 |
| Policy instance | 5 |
| Insurance contract or identification number | 165505 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $6,217 | | Total amount of fees paid to insurance company | USD $1,579 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,285 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,217 | | Amount paid for insurance broker fees | 1579 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 128654 |
| Policy instance | 6 |
| Insurance contract or identification number | 128654 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $1,069 | | Total amount of fees paid to insurance company | USD $79 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,346 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,069 | | Amount paid for insurance broker fees | 79 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 302450 |
| Policy instance | 7 |
| Insurance contract or identification number | 302450 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $3,635 | | Total amount of fees paid to insurance company | USD $252 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,635 | | Amount paid for insurance broker fees | 252 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 825922 |
| Policy instance | 9 |
| Insurance contract or identification number | 825922 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $4,152 | | Total amount of fees paid to insurance company | USD $208 | | Other welfare benefits provided | VOL GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $16,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,152 | | Amount paid for insurance broker fees | 208 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 150802 |
| Policy instance | 2 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $21,921 | | Total amount of fees paid to insurance company | USD $735 | | 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 $21,921 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 735 | | Additional information about fees paid to insurance broker | AGENT FEES |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 150802 |
| Policy instance | 1 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $298 | | Total amount of fees paid to insurance company | USD $4 | | 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 $298 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4 | | Additional information about fees paid to insurance broker | AGENT FEES |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 800861 |
| Policy instance | 8 |
| Insurance contract or identification number | 800861 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $6,455 | | Total amount of fees paid to insurance company | USD $566 | | Other welfare benefits provided | VOL CRIT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $25,820 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,455 | | Amount paid for insurance broker fees | 566 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 150802 |
| Policy instance | 1 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $386 | | Total amount of fees paid to insurance company | USD $11 | | Health Insurance Welfare Benefit | Yes | | Vision 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 $386 | | Amount paid for insurance broker fees | 11 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 150802 |
| Policy instance | 2 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $26,811 | | Total amount of fees paid to insurance company | USD $723 | | Health Insurance Welfare Benefit | Yes | | Vision 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 $26,811 | | Amount paid for insurance broker fees | 723 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1074230 |
| Policy instance | 3 |
| Insurance contract or identification number | 1074230 | | Number of Individuals Covered | 234 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $3,389 | | Total amount of fees paid to insurance company | USD $1,440 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,389 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1440 | | Additional information about fees paid to insurance broker | AGENT FEES |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 157410 |
| Policy instance | 4 |
| Insurance contract or identification number | 157410 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $5,103 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, DEPENDENT LIFE, SUPPL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $45,032 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,103 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 165505 |
| Policy instance | 5 |
| Insurance contract or identification number | 165505 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $6,056 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,562 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,056 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 128654 |
| Policy instance | 6 |
| Insurance contract or identification number | 128654 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $1,048 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,048 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 302450 |
| Policy instance | 7 |
| Insurance contract or identification number | 302450 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $3,377 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,886 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,377 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 800861 |
| Policy instance | 8 |
| Insurance contract or identification number | 800861 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $4,821 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL CRIT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $19,282 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,821 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 825922 |
| Policy instance | 9 |
| Insurance contract or identification number | 825922 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2019-03-01 | | Insurance policy end date | 2020-02-28 | | Total amount of commissions paid to insurance broker | USD $3,465 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | VOL GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $13,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,465 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 150802 |
| Policy instance | 1 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $1,264 | | Total amount of fees paid to insurance company | USD $16 | | Health Insurance Welfare Benefit | Yes | | Vision 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 $1,039 | | Amount paid for insurance broker fees | 16 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 150802 |
| Policy instance | 2 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $29,618 | | Total amount of fees paid to insurance company | USD $993 | | Health Insurance Welfare Benefit | Yes | | Vision 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 $24,690 | | Amount paid for insurance broker fees | 993 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1074230 |
| Policy instance | 3 |
| Insurance contract or identification number | 1074230 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $3,057 | | Total amount of fees paid to insurance company | USD $1,051 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,284 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,058 | | Amount paid for insurance broker fees | 1051 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 157410 |
| Policy instance | 4 |
| Insurance contract or identification number | 157410 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $4,299 | | Total amount of fees paid to insurance company | USD $1,152 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, DEPENDENT LIFE, SUPPL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $42,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,145 | | Amount paid for insurance broker fees | 1152 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 165505 |
| Policy instance | 5 |
| Insurance contract or identification number | 165505 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $5,454 | | Total amount of fees paid to insurance company | USD $1,694 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,866 | | Amount paid for insurance broker fees | 1694 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 128654 |
| Policy instance | 6 |
| Insurance contract or identification number | 128654 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $927 | | Total amount of fees paid to insurance company | USD $187 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,591 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $575 | | Amount paid for insurance broker fees | 187 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 302450 |
| Policy instance | 7 |
| Insurance contract or identification number | 302450 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $2,758 | | Total amount of fees paid to insurance company | USD $523 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,592 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,680 | | Amount paid for insurance broker fees | 523 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 800861 |
| Policy instance | 8 |
| Insurance contract or identification number | 800861 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $3,777 | | Total amount of fees paid to insurance company | USD $393 | | Other welfare benefits provided | VOL CRIT ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $17,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,334 | | Amount paid for insurance broker fees | 393 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 825922 |
| Policy instance | 9 |
| Insurance contract or identification number | 825922 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2019-02-28 | | Total amount of commissions paid to insurance broker | USD $3,065 | | Total amount of fees paid to insurance company | USD $393 | | Other welfare benefits provided | VOL GROUP ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,880 | | Amount paid for insurance broker fees | 393 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 165505 |
| Policy instance | 5 |
| Insurance contract or identification number | 165505 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $3,707 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,672 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,707 | | Insurance broker organization code? | 3 | | Insurance broker name | CORPORATE BENEFIT SOLUTIONS LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 157410 |
| Policy instance | 4 |
| Insurance contract or identification number | 157410 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $2,432 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, DEPENDENT LIFE, SUPPL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $34,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,432 | | Insurance broker organization code? | 3 | | Insurance broker name | CORPORATE BENEFIT SOLUTIONS LLC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1074230 |
| Policy instance | 3 |
| Insurance contract or identification number | 1074230 | | Number of Individuals Covered | 211 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $2,936 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,114 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,936 | | Insurance broker organization code? | 3 | | Insurance broker name | CORPORATE BENEFIT SOLUTIONS LLC |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 150802 |
| Policy instance | 2 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $29,177 | | Total amount of fees paid to insurance company | USD $1,405 | | Health Insurance Welfare Benefit | Yes | | Vision 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 $23,324 | | Amount paid for insurance broker fees | 1405 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 | | Insurance broker name | ACTION BENEFITS COMPANY |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 150802 |
| Policy instance | 1 |
| Insurance contract or identification number | 150802 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2017-03-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $1,492 | | Total amount of fees paid to insurance company | USD $69 | | Health Insurance Welfare Benefit | Yes | | Vision 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 $1,195 | | Amount paid for insurance broker fees | 69 | | Additional information about fees paid to insurance broker | AGENT FEES | | Insurance broker organization code? | 3 | | Insurance broker name | ACTION BENEFITS COMPANY |
|
