401k Plan data: MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN plan

MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN
Plan identification number	502

MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance) Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

MID-MICHIGAN INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name: MID-MICHIGAN INDUSTRIES, INC.

Employer identification number (EIN): 382001352

NAIC Classification: 624310
NAIC Description: Vocational Rehabilitation Services

Additional information about MID-MICHIGAN INDUSTRIES, INC.

Jurisdiction of Incorporation: Michigan Secretary of State

Incorporation Date: 0000-00-00

Company Identification Number: 738140

Legal Registered Office Address: 2426 PARKWAY DR MT PLEASANT

United States of America (USA)
48858

More information about MID-MICHIGAN INDUSTRIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2019-01-01 JEREMY MURPHY 2020-07-15
502 2019-01-01 JEREMY MURPHY 2021-06-02

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
502	2019-01-01	JEREMY MURPHY	2020-07-15
502	2019-01-01	JEREMY MURPHY	2021-06-02

Plan Statistics for MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN

401k plan membership statisitcs for MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN

Measure Date Value
2019: MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 108
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 108
Number of employers contributing to the scheme 2019-01-01 0

Measure	Date	Value
2019: MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	108
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	108
Number of employers contributing to the scheme	2019-01-01	0

Form 5500 Responses for MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN

2019: MID-MICHIGAN INDUSTRIES WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	First time form 5500 has been submitted	Yes
2019-01-01	Submission has been amended	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

266102

Policy instance

Insurance contract or identification number	266102
Number of Individuals Covered	55
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $19,265
Total amount of fees paid to insurance company	USD $373
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 $16,141
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSIONS

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

266102

Policy instance

Insurance contract or identification number	266102
Number of Individuals Covered	52
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $14,304
Total amount of fees paid to insurance company	USD $407
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,984
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	FEES AND OTHER COMMISSIONS

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

4191

Policy instance

Insurance contract or identification number	4191
Number of Individuals Covered	110
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,864
Total amount of fees paid to insurance company	USD $93
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 $6,864
Amount paid for insurance broker fees	93
Additional information about fees paid to insurance broker	NEW BUSINESS BONUS RETENTION BONUS
Insurance broker organization code?	3

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

30023689

Policy instance

Insurance contract or identification number	30023689
Number of Individuals Covered	68
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $756
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $10,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $756
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

100272472

Policy instance

Insurance contract or identification number	100272472
Number of Individuals Covered	108
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $2,110
Total amount of fees paid to insurance company	USD $638
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $17,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,110
Amount paid for insurance broker fees	638
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3

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Company Name:	MID-MICHIGAN INDUSTRIES, INC.
Employer identification number (EIN):	382001352
NAIC Classification:	624310
NAIC Description:	Vocational Rehabilitation Services

Jurisdiction of Incorporation:	Michigan Secretary of State
Incorporation Date:	0000-00-00
Company Identification Number:	738140
Legal Registered Office Address:	2426 PARKWAY DR MT PLEASANT United States of America (USA) 48858