GARDNER WHITE FURNITURE CO., INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN
Measure | Date | Value |
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2022: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-04-01 | 827 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 776 |
Number of retired or separated participants receiving benefits | 2022-04-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
Total of all active and inactive participants | 2022-04-01 | 778 |
2021: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-04-01 | 786 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 829 |
Number of retired or separated participants receiving benefits | 2021-04-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 0 |
Total of all active and inactive participants | 2021-04-01 | 831 |
2020: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-04-01 | 413 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 768 |
Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
Total of all active and inactive participants | 2020-04-01 | 768 |
2019: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-04-01 | 338 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 332 |
Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
Total of all active and inactive participants | 2019-04-01 | 332 |
2018: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-04-01 | 517 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 341 |
Number of retired or separated participants receiving benefits | 2018-04-01 | 82 |
Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 0 |
Total of all active and inactive participants | 2018-04-01 | 423 |
2017: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-04-01 | 483 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 261 |
Number of retired or separated participants receiving benefits | 2017-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
Total of all active and inactive participants | 2017-04-01 | 261 |
2016: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-04-01 | 483 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 446 |
Number of retired or separated participants receiving benefits | 2016-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 0 |
Total of all active and inactive participants | 2016-04-01 | 446 |
2015: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-04-01 | 435 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 359 |
Number of retired or separated participants receiving benefits | 2015-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 0 |
Total of all active and inactive participants | 2015-04-01 | 359 |
2014: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-04-01 | 368 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 319 |
Number of retired or separated participants receiving benefits | 2014-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-04-01 | 0 |
Total of all active and inactive participants | 2014-04-01 | 319 |
Total participants, beginning-of-year | 2014-01-01 | 341 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 252 |
Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
Total of all active and inactive participants | 2014-01-01 | 252 |
2013: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 460 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 379 |
Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
Total of all active and inactive participants | 2013-01-01 | 379 |
2012: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 257 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 460 |
Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
Total of all active and inactive participants | 2012-01-01 | 460 |
2011: GARDNER WHITE FURNITURE CO.,INC WELFARE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 266 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 257 |
Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
Total of all active and inactive participants | 2011-01-01 | 257 |
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 10567 |
Policy instance | 12 |
Insurance contract or identification number | 10567 | Number of Individuals Covered | 250 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $2,157 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,157 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 255278 |
Policy instance | 1 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 213 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $58,423 | Total amount of fees paid to insurance company | USD $1,514 | 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 $21,123 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1514 |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 255278 |
Policy instance | 2 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 834 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $156,719 | Total amount of fees paid to insurance company | USD $5,785 | 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 $55,032 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 5785 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0737528 |
Policy instance | 3 |
Insurance contract or identification number | R0737528 | Number of Individuals Covered | 644 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $35,489 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | GRPACCVOEN & GRPHSPVOEN | Welfare Benefit Premiums Paid to Carrier | USD $174,248 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,783 | Insurance broker organization code? | 3 |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0011972648 |
Policy instance | 4 |
Insurance contract or identification number | 0011972648 | Number of Individuals Covered | 337 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $29,661 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $105,548 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,395 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 5 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 801 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $993 | Total amount of fees paid to insurance company | USD $389 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $9,931 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $993 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 389 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 6 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 297 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $6,595 | Total amount of fees paid to insurance company | USD $3,371 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $187,539 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,595 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 3371 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 7 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 36 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $1,454 | Total amount of fees paid to insurance company | USD $388 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,543 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,454 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 388 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 8 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 188 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $5,328 | Total amount of fees paid to insurance company | USD $2,140 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $103,751 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,328 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2140 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 9 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 206 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $8,493 | Total amount of fees paid to insurance company | USD $2,780 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $81,876 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,493 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2780 |
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NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
Policy contract number | 3242 |
Policy instance | 10 |
Insurance contract or identification number | 3242 | Number of Individuals Covered | 936 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $6,754 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $67,535 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,754 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 10567 |
Policy instance | 11 |
Insurance contract or identification number | 10567 | Number of Individuals Covered | 865 | Insurance policy start date | 2022-08-01 | Insurance policy end date | 2023-07-31 | Total amount of commissions paid to insurance broker | USD $17,273 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,273 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 9 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 191 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $3,748 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $24,985 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,748 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 7 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 38 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $375 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,754 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $375 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 6 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 241 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $3,657 | Total amount of fees paid to insurance company | USD $0 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $43,145 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,657 | Insurance broker organization code? | 3 |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0011972648 |
Policy instance | 4 |
Insurance contract or identification number | 0011972648 | Number of Individuals Covered | 306 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $10,924 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,530 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,697 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 5 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 814 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $337 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $3,365 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $337 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0737528 |
Policy instance | 3 |
Insurance contract or identification number | R0737528 | Number of Individuals Covered | 464 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $8,973 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | GRPACCVOEN & GRPHSPVOEN | Welfare Benefit Premiums Paid to Carrier | USD $33,550 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,136 | Insurance broker organization code? | 3 |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 255278 |
Policy instance | 2 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 812 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $54,082 | Total amount of fees paid to insurance company | USD $2,480 | 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 $54,082 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1442 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 255278 |
Policy instance | 1 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 181 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $15,881 | Total amount of fees paid to insurance company | USD $428 | 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 $15,881 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 272 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 8 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 170 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2022-07-31 | Total amount of commissions paid to insurance broker | USD $3,388 | Total amount of fees paid to insurance company | USD $0 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,769 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,388 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 255278 |
Policy instance | 1 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 136 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $47,642 | Total amount of fees paid to insurance company | USD $1,285 | 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 $47,642 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 817 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 7 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 185 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $7,547 | Total amount of fees paid to insurance company | USD $3,062 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $70,783 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,547 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 3062 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 6 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 34 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $984 | Total amount of fees paid to insurance company | USD $451 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,839 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $984 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 451 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BVQ4 |
Policy instance | 5 |
Insurance contract or identification number | G000BVQ4 | Number of Individuals Covered | 802 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $981 | Total amount of fees paid to insurance company | USD $451 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $9,807 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $981 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 451 |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0011972648 |
Policy instance | 4 |
Insurance contract or identification number | 0011972648 | Number of Individuals Covered | 399 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $64,798 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $112,409 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $57,882 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0737528 |
Policy instance | 3 |
Insurance contract or identification number | R0737528 | Number of Individuals Covered | 631 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $52,532 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | GRPACCVOEN & GRPHSPVOEN | Welfare Benefit Premiums Paid to Carrier | USD $160,957 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $47,115 | Insurance broker organization code? | 3 |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 255278 |
Policy instance | 2 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 609 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $162,246 | Total amount of fees paid to insurance company | USD $7,439 | 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 $162,246 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 4325 |
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PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
Policy contract number | 0011972648 |
Policy instance | 5 |
Insurance contract or identification number | 0011972648 | Number of Individuals Covered | 200 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $16,793 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $45,080 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,375 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0737528 |
Policy instance | 4 |
Insurance contract or identification number | R0737528 | Number of Individuals Covered | 355 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $22,885 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | GRPACCVOEN & GRPHSPVOEN | Welfare Benefit Premiums Paid to Carrier | USD $82,925 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,073 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 3 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 768 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $30,557 | Total amount of fees paid to insurance company | USD $14,446 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $331,133 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $30,557 | Amount paid for insurance broker fees | 14446 | Insurance broker organization code? | 3 |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 255278 |
Policy instance | 2 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 674 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $104,532 | Total amount of fees paid to insurance company | USD $1,487 | 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 $104,532 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1487 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 255278 |
Policy instance | 1 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 97 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $26,659 | Total amount of fees paid to insurance company | USD $68 | 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 $26,659 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 68 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0737528 |
Policy instance | 4 |
Insurance contract or identification number | R0737528 | Number of Individuals Covered | 267 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $34,644 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | GRP HSP VOL 12 & GRP ACC VOL 11 | Welfare Benefit Premiums Paid to Carrier | USD $67,546 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $25,199 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 3 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 407 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $27,914 | Total amount of fees paid to insurance company | USD $16,415 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $302,680 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,914 | Amount paid for insurance broker fees | 16415 | Insurance broker organization code? | 3 |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 255278 |
Policy instance | 2 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 449 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $86,623 | Total amount of fees paid to insurance company | USD $3,063 | 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 $86,623 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 3063 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 255278 |
Policy instance | 1 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 23 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $6,911 | Total amount of fees paid to insurance company | USD $130 | 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 $6,911 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 130 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 3 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 415 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $29,690 | Total amount of fees paid to insurance company | USD $15,110 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $312,376 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,690 | Amount paid for insurance broker fees | 15110 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 255278 |
Policy instance | 1 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 21 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $7,880 | Total amount of fees paid to insurance company | USD $43 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 43 | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $7,880 |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 255278 |
Policy instance | 2 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 489 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $95,182 | Total amount of fees paid to insurance company | USD $1,535 | 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 $95,182 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1535 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 255278 |
Policy instance | 1 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 14 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $7,169 | Total amount of fees paid to insurance company | USD $120 | 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 $6,728 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 120 | Insurance broker name | LSG INSURANCE PARTNERS |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 255278 |
Policy instance | 2 |
Insurance contract or identification number | 255278 | Number of Individuals Covered | 498 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $101,650 | Total amount of fees paid to insurance company | USD $4,457 | 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 $101,650 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 4457 | Insurance broker name | LSG INSURANCE PARTNERS |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 3 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 432 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $24,268 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $261,419 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,268 | Insurance broker organization code? | 3 | Insurance broker name | LSG INSURANCE PARTNERS |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 62045-760 |
Policy instance | 1 |
Insurance contract or identification number | 62045-760 | Number of Individuals Covered | 4 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $669 | Welfare Benefit Premiums Paid to Carrier | USD $34,371 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $669 | Insurance broker organization code? | 3 | Insurance broker name | JAY R SCHREIBMAN |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 00255278/0001 |
Policy instance | 2 |
Insurance contract or identification number | 00255278/0001 | Number of Individuals Covered | 492 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $67,891 | Welfare Benefit Premiums Paid to Carrier | USD $1,527,920 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $67,891 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN SCHWARTZ & GOLDMAN INC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07294 |
Policy instance | 4 |
Insurance contract or identification number | 07294 | Number of Individuals Covered | 64 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $2,163 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,421 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,163 | Additional information about fees paid to insurance broker | SALES & SERVICE COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LUBIN SCHWARTZ & GOLDMAN INC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 3 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 363 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $23,244 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $254,416 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,244 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN SCHWARTZ & GOLDMAN INC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07294 |
Policy instance | 4 |
Insurance contract or identification number | 07294 | Number of Individuals Covered | 66 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $2,230 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,865 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,230 | Additional information about fees paid to insurance broker | SALES & SERVICE COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LUBIN SCHWARTZ & GOLDMAN INC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 3 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 367 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $19,986 | Total amount of fees paid to insurance company | USD $9,461 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $221,532 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,986 | Amount paid for insurance broker fees | 9461 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN SCHWARTZ & GOLDMAN INC |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 00255278/0001 |
Policy instance | 2 |
Insurance contract or identification number | 00255278/0001 | Number of Individuals Covered | 497 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $69,146 | Welfare Benefit Premiums Paid to Carrier | USD $1,435,128 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $69,146 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN SCHWARTZ & GOLDMAN INC |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 62045-760 |
Policy instance | 1 |
Insurance contract or identification number | 62045-760 | Number of Individuals Covered | 3 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $1,688 | Welfare Benefit Premiums Paid to Carrier | USD $27,265 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,688 | Insurance broker organization code? | 3 | Insurance broker name | JAY R SCHREIBMAN |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 00255278/0001 |
Policy instance | 2 |
Insurance contract or identification number | 00255278/0001 | Number of Individuals Covered | 379 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $13,245 | Welfare Benefit Premiums Paid to Carrier | USD $276,104 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,245 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN SCHWARTZ & GOLDMAN INC |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 62045-760 |
Policy instance | 1 |
Insurance contract or identification number | 62045-760 | Number of Individuals Covered | 5 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $1,049 | Welfare Benefit Premiums Paid to Carrier | USD $24,507 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,049 | Insurance broker organization code? | 3 | Insurance broker name | JAY R SCHREIBMAN |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 3 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 277 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $4,090 | Total amount of fees paid to insurance company | USD $6,603 | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $46,256 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,090 | Amount paid for insurance broker fees | 6603 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN SCHWARTZ & GOLDMAN INC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07294 |
Policy instance | 4 |
Insurance contract or identification number | 07294 | Number of Individuals Covered | 61 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $515 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $3,434 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $515 | Additional information about fees paid to insurance broker | SALES & SERVICE COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LUBIN SCHWARTZ & GOLDMAN INC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07294 |
Policy instance | 3 |
Insurance contract or identification number | 07294 | Number of Individuals Covered | 61 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $2,038 | Long Term Disability 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 $2,038 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN, SCHWARTZ & GOLDMAN, INC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 2 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 269 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $17,709 | Total amount of fees paid to insurance company | USD $6,603 | Dental 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 $17,709 | Amount paid for insurance broker fees | 6603 | Additional information about fees paid to insurance broker | SALES & SERVICE COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LUBIN, SCHWARTZ & GOLDMAN, INC. |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 00255278/0001 |
Policy instance | 1 |
Insurance contract or identification number | 00255278/0001 | Number of Individuals Covered | 379 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $58,825 | 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 $58,825 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN, SCHWARTZ & GOLDMAN, INC |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 00255278/0001 |
Policy instance | 1 |
Insurance contract or identification number | 00255278/0001 | Number of Individuals Covered | 460 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $59,158 | 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 $59,158 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN, SCHWARTZ & GOLDMAN, INC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07294 |
Policy instance | 3 |
Insurance contract or identification number | 07294 | Number of Individuals Covered | 82 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $1,820 | Long Term Disability 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 $1,820 | Insurance broker organization code? | 3 | Insurance broker name | LUBIN, SCHWARTZ & GOLDMAN, INC |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 2 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 320 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $18,439 | Total amount of fees paid to insurance company | USD $8,946 | Dental 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 $18,439 | Amount paid for insurance broker fees | 8946 | Additional information about fees paid to insurance broker | SALES & SERVICE COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LUBIN, SCHWARTZ & GOLDMAN, INC. |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07294 |
Policy instance | 3 |
Insurance contract or identification number | 07294 | Number of Individuals Covered | 78 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $1,538 | Long Term Disability Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00402757 |
Policy instance | 2 |
Insurance contract or identification number | 00402757 | Number of Individuals Covered | 261 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $14,119 | Total amount of fees paid to insurance company | USD $8,123 | Dental 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 |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 002552780001 |
Policy instance | 1 |
Insurance contract or identification number | 002552780001 | Number of Individuals Covered | 195 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $53,816 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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