MOBILE MEDICAL RESPONSE INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MOBILE MEDICAL RESPONSE, INC. WELFARE BENEFIT PLAN
401k plan membership statisitcs for MOBILE MEDICAL RESPONSE, INC. WELFARE BENEFIT PLAN
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 040000100025667 |
Policy instance | 7 |
Insurance contract or identification number | 040000100025667 | Number of Individuals Covered | 217 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $8,119 | Total amount of fees paid to insurance company | USD $1,628 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $54,125 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,119 | Amount paid for insurance broker fees | 1628 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001025740100000 |
Policy instance | 3 |
Insurance contract or identification number | 001025740100000 | Number of Individuals Covered | 69 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,915 | Total amount of fees paid to insurance company | USD $485 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,436 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,915 | Amount paid for insurance broker fees | 485 | Additional information about fees paid to insurance broker | BROKER BONUS | 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 | 100341 |
Policy instance | 4 |
Insurance contract or identification number | 100341 | Number of Individuals Covered | 268 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $39,433 | Total amount of fees paid to insurance company | USD $1,573 | 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 $39,433 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1573 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001025740200000 |
Policy instance | 5 |
Insurance contract or identification number | 001025740200000 | Number of Individuals Covered | 403 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $4,435 | Total amount of fees paid to insurance company | USD $878 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $29,568 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,435 | Amount paid for insurance broker fees | 878 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001025740300000 |
Policy instance | 6 |
Insurance contract or identification number | 001025740300000 | Number of Individuals Covered | 387 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $17,735 | Total amount of fees paid to insurance company | USD $3,035 | Other welfare benefits provided | WEEKLY INCOME | Welfare Benefit Premiums Paid to Carrier | USD $118,233 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,735 | Amount paid for insurance broker fees | 3035 | Additional information about fees paid to insurance broker | BROKER BONUS | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 004030075340000 |
Policy instance | 8 |
Insurance contract or identification number | 004030075340000 | Number of Individuals Covered | 210 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $1,307 | Total amount of fees paid to insurance company | USD $285 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL SPOUSE AD&D | Welfare Benefit Premiums Paid to Carrier | USD $8,715 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,307 | Amount paid for insurance broker fees | 285 | Additional information about fees paid to insurance broker | BROKER BONUS | 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 | 100341 |
Policy instance | 9 |
Insurance contract or identification number | 100341 | Number of Individuals Covered | 440 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $60,979 | 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 $58,522 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 1 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 283 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $2,595 | 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 $2,595 | 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 | 0001753 |
Policy instance | 2 |
Insurance contract or identification number | 0001753 | Number of Individuals Covered | 714 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $13,563 | 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 $13,563 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 004030075340000 |
Policy instance | 8 |
Insurance contract or identification number | 004030075340000 | Number of Individuals Covered | 246 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $1,522 | Total amount of fees paid to insurance company | USD $24 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | VOL SPOUSE AD&D | Welfare Benefit Premiums Paid to Carrier | USD $10,147 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,522 | Amount paid for insurance broker fees | 24 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 1 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 286 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,718 | 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 $2,718 | 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 | 0001753 |
Policy instance | 2 |
Insurance contract or identification number | 0001753 | Number of Individuals Covered | 728 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $14,256 | 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 $14,256 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001025740100000 |
Policy instance | 3 |
Insurance contract or identification number | 001025740100000 | Number of Individuals Covered | 48 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,587 | Total amount of fees paid to insurance company | USD $24 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,247 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,587 | Amount paid for insurance broker fees | 24 | 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 | 100341 |
Policy instance | 4 |
Insurance contract or identification number | 100341 | Number of Individuals Covered | 298 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $41,271 | 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 $41,271 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001025740200000 |
Policy instance | 5 |
Insurance contract or identification number | 001025740200000 | Number of Individuals Covered | 373 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $4,683 | Total amount of fees paid to insurance company | USD $24 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $31,220 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,683 | Amount paid for insurance broker fees | 24 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001025740300000 |
Policy instance | 6 |
Insurance contract or identification number | 001025740300000 | Number of Individuals Covered | 358 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $16,184 | Total amount of fees paid to insurance company | USD $24 | Other welfare benefits provided | WEEKLY INCOME | Welfare Benefit Premiums Paid to Carrier | USD $107,894 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,184 | Amount paid for insurance broker fees | 24 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 040000100025667 |
Policy instance | 7 |
Insurance contract or identification number | 040000100025667 | Number of Individuals Covered | 248 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $8,683 | Total amount of fees paid to insurance company | USD $24 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $57,887 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,683 | Amount paid for insurance broker fees | 24 | 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 | 100341 |
Policy instance | 9 |
Insurance contract or identification number | 100341 | Number of Individuals Covered | 452 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $61,673 | 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 $61,673 | 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 | 0001753 |
Policy instance | 2 |
Insurance contract or identification number | 0001753 | Number of Individuals Covered | 711 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $14,056 | 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 $14,056 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001025740100000 |
Policy instance | 3 |
Insurance contract or identification number | 001025740100000 | Number of Individuals Covered | 59 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,171 | Total amount of fees paid to insurance company | USD $748 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,475 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,171 | Amount paid for insurance broker fees | 748 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 1 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 259 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,632 | 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 $2,632 | 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 | 100341 |
Policy instance | 4 |
Insurance contract or identification number | 100341 | Number of Individuals Covered | 714 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $41,555 | Total amount of fees paid to insurance company | USD $2,070 | 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 $41,555 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2070 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001025740300000 |
Policy instance | 6 |
Insurance contract or identification number | 001025740300000 | Number of Individuals Covered | 357 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $15,178 | Total amount of fees paid to insurance company | USD $5,311 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $101,184 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,178 | Amount paid for insurance broker fees | 5311 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 040000100025667 |
Policy instance | 7 |
Insurance contract or identification number | 040000100025667 | Number of Individuals Covered | 180 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $6,301 | Total amount of fees paid to insurance company | USD $2,163 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $42,008 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,301 | Amount paid for insurance broker fees | 2163 | Insurance broker organization code? | 3 |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 001025740200000 |
Policy instance | 5 |
Insurance contract or identification number | 001025740200000 | Number of Individuals Covered | 359 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $3,796 | Total amount of fees paid to insurance company | USD $1,358 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $25,307 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,796 | Amount paid for insurance broker fees | 1358 | Insurance broker organization code? | 3 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 1 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 265 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | 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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DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 0001480 |
Policy instance | 2 |
Insurance contract or identification number | 0001480 | Number of Individuals Covered | 71 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,152 | 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 $1,152 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 3U7128 |
Policy instance | 3 |
Insurance contract or identification number | 3U7128 | Number of Individuals Covered | 70 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $13,203 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $347,990 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,203 | Insurance broker organization code? | 3 |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | EAB1000033 |
Policy instance | 4 |
Insurance contract or identification number | EAB1000033 | Number of Individuals Covered | 364 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $33,965 | Total amount of fees paid to insurance company | USD $9,621 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFSUP1 | Welfare Benefit Premiums Paid to Carrier | USD $226,429 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $33,965 | Amount paid for insurance broker fees | 9621 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 51810 |
Policy instance | 5 |
Insurance contract or identification number | 51810 | Number of Individuals Covered | 65 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $197 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $197 |
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DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 0001753 |
Policy instance | 6 |
Insurance contract or identification number | 0001753 | Number of Individuals Covered | 719 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $13,906 | 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 $13,906 | 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 | 100341 |
Policy instance | 7 |
Insurance contract or identification number | 100341 | Number of Individuals Covered | 733 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $92,162 | 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 $87,902 | Insurance broker organization code? | 3 |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 1 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 274 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | 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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DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 0001480 |
Policy instance | 2 |
Insurance contract or identification number | 0001480 | Number of Individuals Covered | 55 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $1,306 | 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 $1,306 | Insurance broker organization code? | 3 |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 3U7128 |
Policy instance | 3 |
Insurance contract or identification number | 3U7128 | Number of Individuals Covered | 60 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $19,818 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $258,887 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,818 | 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 | R0396499 |
Policy instance | 4 |
Insurance contract or identification number | R0396499 | Number of Individuals Covered | 47 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $1,265 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,111 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,265 | Insurance broker organization code? | 3 |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | EAB1000033 |
Policy instance | 5 |
Insurance contract or identification number | EAB1000033 | Number of Individuals Covered | 467 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $36,213 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFSUP1 | Welfare Benefit Premiums Paid to Carrier | USD $242,186 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,213 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 51810 |
Policy instance | 6 |
Insurance contract or identification number | 51810 | Number of Individuals Covered | 49 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $193 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,931 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $193 |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-1099 |
Policy instance | 7 |
Insurance contract or identification number | 12049684-1099 | Number of Individuals Covered | 1 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | 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 CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 100341 |
Policy instance | 9 |
Insurance contract or identification number | 100341 | Number of Individuals Covered | 781 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $53,703 | 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 $42,407 | 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 | 0001753 |
Policy instance | 8 |
Insurance contract or identification number | 0001753 | Number of Individuals Covered | 782 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $7,134 | 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 $7,134 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 51810 |
Policy instance | 7 |
Insurance contract or identification number | 51810 | Number of Individuals Covered | 66 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $232 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,318 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $232 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | EAB1000033 |
Policy instance | 6 |
Insurance contract or identification number | EAB1000033 | Number of Individuals Covered | 416 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $54,945 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFSUP1 | Welfare Benefit Premiums Paid to Carrier | USD $232,506 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54,945 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | R0396499 |
Policy instance | 5 |
Insurance contract or identification number | R0396499 | Number of Individuals Covered | 47 | Insurance policy start date | 2016-10-01 | Insurance policy end date | 2017-09-30 | Total amount of commissions paid to insurance broker | USD $1,284 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,369 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,284 | Insurance broker organization code? | 3 | Insurance broker name | UNITED BENEFIT ADVISORS INC - HQ |
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UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 674640 |
Policy instance | 4 |
Insurance contract or identification number | 674640 | Number of Individuals Covered | 65 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $13,230 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $258,373 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,230 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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ALLIANCE HEALTH AND LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60134 ) |
Policy contract number | 10004906 |
Policy instance | 3 |
Insurance contract or identification number | 10004906 | Number of Individuals Covered | 725 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $107,885 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,509,309 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $107,885 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS |
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DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 0001480 |
Policy instance | 2 |
Insurance contract or identification number | 0001480 | Number of Individuals Covered | 73 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $1,710 | 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 $1,710 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC. |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 1 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 289 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | 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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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010196990 |
Policy instance | 4 |
Insurance contract or identification number | 000010196990 | Number of Individuals Covered | 380 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $20,037 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $133,581 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,037 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 40000100018911 |
Policy instance | 6 |
Insurance contract or identification number | 40000100018911 | Number of Individuals Covered | 156 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $6,024 | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $40,159 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,024 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
Policy contract number | 000010196988 |
Policy instance | 5 |
Insurance contract or identification number | 000010196988 | Number of Individuals Covered | 404 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $5,283 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $35,218 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,283 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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CONSUMER'S MUTUAL INSURANCE OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 15128 ) |
Policy contract number | MILG0181 |
Policy instance | 1 |
Insurance contract or identification number | MILG0181 | Number of Individuals Covered | 319 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $127,710 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,533,322 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $127,710 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS |
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DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 0001753 |
Policy instance | 3 |
Insurance contract or identification number | 0001753 | Number of Individuals Covered | 766 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $2,423 | 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 $2,423 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC. |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 2 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 245 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | 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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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0AN24 |
Policy instance | 6 |
Insurance contract or identification number | GLTD0AN24 | Number of Individuals Covered | 60 | Insurance policy start date | 2013-12-01 | Insurance policy end date | 2014-12-01 | Total amount of commissions paid to insurance broker | USD $2,564 | Total amount of fees paid to insurance company | USD $600 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,094 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,564 | Amount paid for insurance broker fees | 600 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AN24 |
Policy instance | 7 |
Insurance contract or identification number | GVTL0AN24 | Number of Individuals Covered | 161 | Insurance policy start date | 2013-12-01 | Insurance policy end date | 2014-12-01 | Total amount of commissions paid to insurance broker | USD $6,957 | Total amount of fees paid to insurance company | USD $1,716 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D - VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $46,379 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,957 | Amount paid for insurance broker fees | 1716 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUG0AN24 |
Policy instance | 5 |
Insurance contract or identification number | GUG0AN24 | Number of Individuals Covered | 350 | Insurance policy start date | 2013-12-01 | Insurance policy end date | 2014-12-01 | Total amount of commissions paid to insurance broker | USD $10,958 | Total amount of fees paid to insurance company | USD $2,563 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $73,053 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,958 | Amount paid for insurance broker fees | 2563 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AN24 |
Policy instance | 4 |
Insurance contract or identification number | GLUG0AN24 | Number of Individuals Covered | 372 | Insurance policy start date | 2013-12-01 | Insurance policy end date | 2014-12-01 | Total amount of commissions paid to insurance broker | USD $4,020 | Total amount of fees paid to insurance company | USD $939 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $26,798 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,020 | Amount paid for insurance broker fees | 939 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 0001753 |
Policy instance | 3 |
Insurance contract or identification number | 0001753 | Number of Individuals Covered | 769 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC. |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 2 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 236 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | 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 CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 45627 |
Policy instance | 1 |
Insurance contract or identification number | 45627 | Number of Individuals Covered | 768 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $33,903 | Total amount of fees paid to insurance company | USD $9,522 | 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 $33,903 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 9522 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS |
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DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 0001753 |
Policy instance | 3 |
Insurance contract or identification number | 0001753 | Number of Individuals Covered | 750 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 45627 |
Policy instance | 1 |
Insurance contract or identification number | 45627 | Number of Individuals Covered | 748 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $76,728 | Total amount of fees paid to insurance company | USD $8,484 | 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 $9,772 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 502 | Insurance broker name | BROWN & BROWN OF CENTRAL MI |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0AN24 |
Policy instance | 7 |
Insurance contract or identification number | GVTL0AN24 | Number of Individuals Covered | 175 | Insurance policy start date | 2012-12-01 | Insurance policy end date | 2013-12-01 | Total amount of commissions paid to insurance broker | USD $6,749 | Total amount of fees paid to insurance company | USD $161 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D - VOLUNTARY | Welfare Benefit Premiums Paid to Carrier | USD $44,993 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,749 | Amount paid for insurance broker fees | 161 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0AN24 |
Policy instance | 4 |
Insurance contract or identification number | GLUG0AN24 | Number of Individuals Covered | 347 | Insurance policy start date | 2012-12-01 | Insurance policy end date | 2013-12-01 | Total amount of commissions paid to insurance broker | USD $3,707 | Total amount of fees paid to insurance company | USD $71 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $24,713 | 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 | Amount paid for insurance broker fees | 71 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLTD0AN24 |
Policy instance | 6 |
Insurance contract or identification number | GLTD0AN24 | Number of Individuals Covered | 53 | Insurance policy start date | 2012-12-01 | Insurance policy end date | 2013-12-01 | Total amount of commissions paid to insurance broker | USD $2,379 | Total amount of fees paid to insurance company | USD $47 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,861 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,379 | Amount paid for insurance broker fees | 47 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GUG0AN24 |
Policy instance | 5 |
Insurance contract or identification number | GUG0AN24 | Number of Individuals Covered | 325 | Insurance policy start date | 2012-12-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $10,128 | Total amount of fees paid to insurance company | USD $197 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $67,518 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,128 | Amount paid for insurance broker fees | 197 | Additional information about fees paid to insurance broker | AGENT OR BROKER OF RECORD OTHER COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 2 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 215 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | 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 CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 45627 |
Policy instance | 1 |
Insurance contract or identification number | 45627 | Number of Individuals Covered | 295 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $33,953 | Total amount of fees paid to insurance company | USD $7,317 | 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 $22,165 | Amount paid for insurance broker fees | 7317 | Insurance broker organization code? | 3 | Insurance broker name | RUSSELL MANZ |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 2 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 221 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | 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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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 000000225225 |
Policy instance | 3 |
Insurance contract or identification number | 000000225225 | Number of Individuals Covered | 337 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2012-12-01 | Total amount of commissions paid to insurance broker | USD $6,170 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,686 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,196 | Insurance broker organization code? | 3 | Insurance broker name | LIEBESKIND, MICHAEL B. |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 000000225226 |
Policy instance | 4 |
Insurance contract or identification number | 000000225226 | Number of Individuals Covered | 96 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2012-12-01 | Total amount of commissions paid to insurance broker | USD $2,910 | Other welfare benefits provided | LIFESTYLE AD&D & LIFESTYLE LIFE | Welfare Benefit Premiums Paid to Carrier | USD $18,227 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,315 | Insurance broker organization code? | 3 | Insurance broker name | ADVANCED BENEFIT SOLUTIONS |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 964984 |
Policy instance | 3 |
Insurance contract or identification number | OK 964984 | Number of Individuals Covered | 295 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $30 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $296 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 750788 |
Policy instance | 5 |
Insurance contract or identification number | LK 750788 | Number of Individuals Covered | 295 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $970 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,703 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 000000225226 |
Policy instance | 8 |
Insurance contract or identification number | 000000225226 | Number of Individuals Covered | 109 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-05-11 | Total amount of commissions paid to insurance broker | USD $6,223 | Other welfare benefits provided | LIFESTYLE ADD LIFESTYLE LIFE | Welfare Benefit Premiums Paid to Carrier | USD $34,251 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 6 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 167 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 962389 |
Policy instance | 4 |
Insurance contract or identification number | LK 962389 | Number of Individuals Covered | 29 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $98 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $976 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX963330 |
Policy instance | 2 |
Insurance contract or identification number | FLX963330 | Number of Individuals Covered | 295 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $1,129 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,288 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 45627 |
Policy instance | 1 |
Insurance contract or identification number | 45627 | Number of Individuals Covered | 278 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $37,741 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 000000225225 |
Policy instance | 7 |
Insurance contract or identification number | 000000225225 | Number of Individuals Covered | 351 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-05-01 | Total amount of commissions paid to insurance broker | USD $11,571 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $104,842 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12049684-0062 |
Policy instance | 6 |
Insurance contract or identification number | 12049684-0062 | Number of Individuals Covered | 116 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 750788 |
Policy instance | 5 |
Insurance contract or identification number | LK 750788 | Number of Individuals Covered | 327 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2011-01-01 | Total amount of commissions paid to insurance broker | USD $8,062 | Total amount of fees paid to insurance company | USD $1,629 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $80,620 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,062 | Amount paid for insurance broker fees | 1629 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | NATIONAL EMPLOYEE BENEFIT |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | LK 962389 |
Policy instance | 4 |
Insurance contract or identification number | LK 962389 | Number of Individuals Covered | 21 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2011-01-01 | Total amount of commissions paid to insurance broker | USD $855 | Total amount of fees paid to insurance company | USD $171 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,548 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $855 | Amount paid for insurance broker fees | 171 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | NATIONAL EMPLOYEE BENEFIT |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | FLX963330 |
Policy instance | 2 |
Insurance contract or identification number | FLX963330 | Number of Individuals Covered | 306 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2011-01-01 | Total amount of commissions paid to insurance broker | USD $3,505 | Total amount of fees paid to insurance company | USD $709 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,053 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,505 | Amount paid for insurance broker fees | 709 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | NATIONAL EMPLOYEE BENEFIT |
|
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 45627 |
Policy instance | 1 |
Insurance contract or identification number | 45627 | Number of Individuals Covered | 257 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $39,356 | Total amount of fees paid to insurance company | USD $1,635 | 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 $35,448 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1635 | Insurance broker name | EDWARD BECKER, JR. |
|
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | OK 964984 |
Policy instance | 3 |
Insurance contract or identification number | OK 964984 | Number of Individuals Covered | 306 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2011-01-01 | Total amount of commissions paid to insurance broker | USD $262 | Total amount of fees paid to insurance company | USD $54 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $2,618 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $262 | Amount paid for insurance broker fees | 54 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | NATIONAL EMPLOYEE BENEFIT |
|