TRUSTEES OF UAW LOCAL 241 HEALTH AND WELFARE FUND has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan UAW LOCAL 241 HEALTH AND WELFARE FUND
| Measure | Date | Value |
|---|
| 2023 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2023 401k financial data |
|---|
| Total plan liabilities at end of year | 2023-12-31 | $760 |
| Total plan liabilities at beginning of year | 2023-12-31 | $720 |
| Total income from all sources | 2023-12-31 | $982,558 |
| Expenses. Total of all expenses incurred | 2023-12-31 | $958,922 |
| Benefits paid (including direct rollovers) | 2023-12-31 | $930,430 |
| Total plan assets at end of year | 2023-12-31 | $271,589 |
| Total plan assets at beginning of year | 2023-12-31 | $247,913 |
| Value of fidelity bond covering the plan | 2023-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2023-12-31 | $228,815 |
| Expenses. Other expenses not covered elsewhere | 2023-12-31 | $3,157 |
| Other income received | 2023-12-31 | $2,289 |
| Net income (gross income less expenses) | 2023-12-31 | $23,636 |
| Net plan assets at end of year (total assets less liabilities) | 2023-12-31 | $270,829 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-12-31 | $247,193 |
| Total contributions received or receivable from employer(s) | 2023-12-31 | $751,454 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2023-12-31 | $25,335 |
| 2022 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $720 |
| Total plan liabilities at beginning of year | 2022-12-31 | $680 |
| Total income from all sources | 2022-12-31 | $930,792 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $991,353 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $966,224 |
| Total plan assets at end of year | 2022-12-31 | $247,913 |
| Total plan assets at beginning of year | 2022-12-31 | $308,434 |
| Value of fidelity bond covering the plan | 2022-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2022-12-31 | $207,417 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $2,427 |
| Other income received | 2022-12-31 | $1,555 |
| Net income (gross income less expenses) | 2022-12-31 | $-60,561 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $247,193 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $307,754 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $721,820 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $22,702 |
| 2021 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $680 |
| Total plan liabilities at beginning of year | 2021-12-31 | $690 |
| Total income from all sources | 2021-12-31 | $949,554 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $980,209 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $957,260 |
| Total plan assets at end of year | 2021-12-31 | $308,434 |
| Total plan assets at beginning of year | 2021-12-31 | $339,099 |
| Value of fidelity bond covering the plan | 2021-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2021-12-31 | $204,561 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $3,011 |
| Other income received | 2021-12-31 | $13 |
| Net income (gross income less expenses) | 2021-12-31 | $-30,655 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $307,754 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $338,409 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $744,980 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $19,938 |
| 2020 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $690 |
| Total plan liabilities at beginning of year | 2020-12-31 | $560 |
| Total income from all sources | 2020-12-31 | $967,688 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $998,787 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $978,089 |
| Total plan assets at end of year | 2020-12-31 | $339,099 |
| Total plan assets at beginning of year | 2020-12-31 | $370,068 |
| Value of fidelity bond covering the plan | 2020-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2020-12-31 | $189,084 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $2,556 |
| Other income received | 2020-12-31 | $276 |
| Net income (gross income less expenses) | 2020-12-31 | $-31,099 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $338,409 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $369,508 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $778,328 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $18,142 |
| 2019 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $560 |
| Total plan liabilities at beginning of year | 2019-12-31 | $890 |
| Total income from all sources | 2019-12-31 | $1,063,059 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $999,025 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $976,620 |
| Total plan assets at end of year | 2019-12-31 | $370,068 |
| Total plan assets at beginning of year | 2019-12-31 | $306,364 |
| Value of fidelity bond covering the plan | 2019-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $199,396 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $2,636 |
| Other income received | 2019-12-31 | $1,736 |
| Net income (gross income less expenses) | 2019-12-31 | $64,034 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $369,508 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $305,474 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $861,927 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $19,769 |
| 2018 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $890 |
| Total plan liabilities at beginning of year | 2018-12-31 | $606 |
| Total income from all sources | 2018-12-31 | $996,979 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $939,231 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $916,652 |
| Total plan assets at end of year | 2018-12-31 | $306,364 |
| Total plan assets at beginning of year | 2018-12-31 | $248,332 |
| Value of fidelity bond covering the plan | 2018-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $190,523 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $2,547 |
| Net income (gross income less expenses) | 2018-12-31 | $57,748 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $305,474 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $247,726 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $806,456 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $20,032 |
| 2017 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $606 |
| Total plan liabilities at beginning of year | 2017-12-31 | $880 |
| Total income from all sources | 2017-12-31 | $976,668 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $912,755 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $890,213 |
| Total plan assets at end of year | 2017-12-31 | $248,332 |
| Total plan assets at beginning of year | 2017-12-31 | $184,693 |
| Value of fidelity bond covering the plan | 2017-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $177,963 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $2,580 |
| Net income (gross income less expenses) | 2017-12-31 | $63,913 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $247,726 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $183,813 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $798,705 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $19,962 |
| 2016 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $880 |
| Total plan liabilities at beginning of year | 2016-12-31 | $1,874 |
| Total income from all sources | 2016-12-31 | $924,448 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $900,205 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $877,306 |
| Total plan assets at end of year | 2016-12-31 | $184,693 |
| Total plan assets at beginning of year | 2016-12-31 | $161,444 |
| Value of fidelity bond covering the plan | 2016-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $178,813 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $2,667 |
| Net income (gross income less expenses) | 2016-12-31 | $24,243 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $183,813 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $159,570 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $745,635 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $20,232 |
| 2015 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $1,874 |
| Total plan liabilities at beginning of year | 2015-12-31 | $942 |
| Total income from all sources | 2015-12-31 | $858,586 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $820,439 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $793,289 |
| Total plan assets at end of year | 2015-12-31 | $161,444 |
| Total plan assets at beginning of year | 2015-12-31 | $122,365 |
| Value of fidelity bond covering the plan | 2015-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $168,728 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $2,443 |
| Net income (gross income less expenses) | 2015-12-31 | $38,147 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $159,570 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $121,423 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $689,858 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $24,707 |
| 2014 : UAW LOCAL 241 HEALTH AND WELFARE FUND 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-12-31 | $942 |
| Total income from all sources | 2014-12-31 | $926,148 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $804,725 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $777,619 |
| Total plan assets at end of year | 2014-12-31 | $122,365 |
| Value of fidelity bond covering the plan | 2014-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $166,669 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $2,239 |
| Other income received | 2014-12-31 | $46,316 |
| Net income (gross income less expenses) | 2014-12-31 | $121,423 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $121,423 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $713,163 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $24,867 |
| 2023: UAW LOCAL 241 HEALTH AND WELFARE FUND 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Multi-employer plan |
| 2023-01-01 | Plan is a collectively bargained plan | Yes |
| 2023-01-01 | Plan funding arrangement – Trust | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement - Trust | Yes |
| 2022: UAW LOCAL 241 HEALTH AND WELFARE FUND 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Multi-employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: UAW LOCAL 241 HEALTH AND WELFARE FUND 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Multi-employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: UAW LOCAL 241 HEALTH AND WELFARE FUND 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Multi-employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: UAW LOCAL 241 HEALTH AND WELFARE FUND 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Multi-employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: UAW LOCAL 241 HEALTH AND WELFARE FUND 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Multi-employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: UAW LOCAL 241 HEALTH AND WELFARE FUND 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Multi-employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: UAW LOCAL 241 HEALTH AND WELFARE FUND 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Multi-employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: UAW LOCAL 241 HEALTH AND WELFARE FUND 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Multi-employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: UAW LOCAL 241 HEALTH AND WELFARE FUND 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Multi-employer plan |
| 2014-01-01 | First time form 5500 has been submitted | Yes |
| 2014-01-01 | Plan is a collectively bargained plan | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 ) |
| Policy contract number | 311112 |
| Policy instance | 6 |
| Insurance contract or identification number | 311112 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $35,127 | | Total amount of fees paid to insurance company | USD $704 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $878,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022767 |
| Policy instance | 5 |
| Insurance contract or identification number | 50022767 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $225 | | 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 $1,504 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022770 |
| Policy instance | 4 |
| Insurance contract or identification number | 50022770 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $285 | | 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 $1,817 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022936 |
| Policy instance | 3 |
| Insurance contract or identification number | 50022936 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $246 | | 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 $1,584 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 867 |
| Policy instance | 2 |
| Insurance contract or identification number | 867 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $932 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,973 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022588 |
| Policy instance | 1 |
| Insurance contract or identification number | 50022588 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $270 | | 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 $1,817 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022770 |
| Policy instance | 1 |
| Insurance contract or identification number | 50022770 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $258 | | 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 $1,718 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022767 |
| Policy instance | 2 |
| Insurance contract or identification number | 50022767 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $237 | | 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 $1,585 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 10190152 |
| Policy instance | 3 |
| Insurance contract or identification number | 10190152 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $451,607 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022588 |
| Policy instance | 4 |
| Insurance contract or identification number | 50022588 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $262 | | 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 $1,754 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 867 |
| Policy instance | 5 |
| Insurance contract or identification number | 867 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $932 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $46,892 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022936 |
| Policy instance | 6 |
| Insurance contract or identification number | 50022936 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $293 | | 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 $1,951 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MEDICA (National Association of Insurance Commissioners NAIC id number: 12459 ) |
| Policy contract number | 311112 |
| Policy instance | 7 |
| Insurance contract or identification number | 311112 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $18,434 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $460,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022936 |
| Policy instance | 1 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022588 |
| Policy instance | 2 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022767 |
| Policy instance | 4 |
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 867 |
| Policy instance | 3 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 10190152 |
| Policy instance | 5 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022770 |
| Policy instance | 6 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022767 |
| Policy instance | 6 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 10190152 |
| Policy instance | 5 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022588 |
| Policy instance | 4 |
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 867 |
| Policy instance | 3 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022770 |
| Policy instance | 2 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022936 |
| Policy instance | 1 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 10190152 |
| Policy instance | 1 |
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 867 |
| Policy instance | 2 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022770 |
| Policy instance | 3 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022936 |
| Policy instance | 4 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022588 |
| Policy instance | 5 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022767 |
| Policy instance | 6 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 10190152 |
| Policy instance | 1 |
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 727 |
| Policy instance | 3 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022588/500227 |
| Policy instance | 2 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022588/500227 |
| Policy instance | 1 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 10190152 |
| Policy instance | 2 |
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 727 |
| Policy instance | 3 |
| DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 ) |
| Policy contract number | 0000000727 |
| Policy instance | 4 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022588 |
| Policy instance | 3 |
| USABLE LIFE (National Association of Insurance Commissioners NAIC id number: 94358 ) |
| Policy contract number | 50022588 |
| Policy instance | 2 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN503 |
| Policy instance | 1 |
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | CN503 |
| Policy instance | 1 |
