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ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN
Plan identification number 501

ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

ESPEC NORTH AMERICA, INC. has sponsored the creation of one or more 401k plans.

Company Name:ESPEC NORTH AMERICA, INC.
Employer identification number (EIN):133183033
NAIC Classification:333200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-09-01MARTIN NEIDLINGER2023-12-19
5012021-09-01MARTY NEIDLINGER2023-01-24
5012020-09-01MARTIN NEIDLINGER2022-12-13
5012019-09-01MARTY NEIDLINGER2023-01-09
5012018-09-01MARTIN NEIDLINGER2022-12-13
5012017-09-01ANTHONY GARCIA ANTHONY GARCIA2019-02-25
5012016-09-01THOMAS P. JEAKLE THOMAS P. JEAKLE2018-03-27
5012015-09-01THOMAS P. JEAKLE THOMAS P. JEAKLE2017-06-15
5012015-09-01 THOMAS P. JEAKLE2017-06-14
5012014-09-01MARY ANNE ZIMMERMAN MARY ANNE ZIMMERMAN2016-06-14
5012013-09-01MARY ANNE ZIMMERMAN MARY ANNE ZIMMERMAN2015-05-11
5012012-09-01LUKE POLEGA LUKE POLEGA2014-04-25
5012011-09-01MARY ANNE ZIMMERMAN MARY ANNE ZIMMERMAN2013-06-12
5012009-09-01MARY ANNE ZIMMERMAN MARY ANNE ZIMMERMAN2011-05-25

Plan Statistics for ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN

Measure Date Value
2022: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-09-01243
Total number of active participants reported on line 7a of the Form 55002022-09-01239
Number of retired or separated participants receiving benefits2022-09-012
Number of other retired or separated participants entitled to future benefits2022-09-010
Total of all active and inactive participants2022-09-01241
Number of employers contributing to the scheme2022-09-010
2021: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-01241
Total number of active participants reported on line 7a of the Form 55002021-09-01239
Number of retired or separated participants receiving benefits2021-09-010
Number of other retired or separated participants entitled to future benefits2021-09-010
Total of all active and inactive participants2021-09-01239
Number of employers contributing to the scheme2021-09-010
2020: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-01240
Total number of active participants reported on line 7a of the Form 55002020-09-01241
Number of retired or separated participants receiving benefits2020-09-010
Number of other retired or separated participants entitled to future benefits2020-09-010
Total of all active and inactive participants2020-09-01241
Number of employers contributing to the scheme2020-09-010
2019: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-01239
Total number of active participants reported on line 7a of the Form 55002019-09-01240
Number of retired or separated participants receiving benefits2019-09-010
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-01240
Number of employers contributing to the scheme2019-09-010
2018: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-01541
Total number of active participants reported on line 7a of the Form 55002018-09-01239
Number of retired or separated participants receiving benefits2018-09-010
Number of other retired or separated participants entitled to future benefits2018-09-010
Total of all active and inactive participants2018-09-01239
Number of employers contributing to the scheme2018-09-010
2017: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01520
Total number of active participants reported on line 7a of the Form 55002017-09-01541
Number of retired or separated participants receiving benefits2017-09-010
Number of other retired or separated participants entitled to future benefits2017-09-010
Total of all active and inactive participants2017-09-01541
2016: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01501
Total number of active participants reported on line 7a of the Form 55002016-09-01520
Number of retired or separated participants receiving benefits2016-09-010
Number of other retired or separated participants entitled to future benefits2016-09-010
Total of all active and inactive participants2016-09-01520
2015: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-01437
Total number of active participants reported on line 7a of the Form 55002015-09-01501
Number of retired or separated participants receiving benefits2015-09-010
Number of other retired or separated participants entitled to future benefits2015-09-010
Total of all active and inactive participants2015-09-01501
2014: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-01385
Total number of active participants reported on line 7a of the Form 55002014-09-01437
Number of retired or separated participants receiving benefits2014-09-010
Number of other retired or separated participants entitled to future benefits2014-09-010
Total of all active and inactive participants2014-09-01437
2013: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-01375
Total number of active participants reported on line 7a of the Form 55002013-09-01385
Total of all active and inactive participants2013-09-01385
2012: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-01363
Total number of active participants reported on line 7a of the Form 55002012-09-01375
Total of all active and inactive participants2012-09-01375
2011: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-01324
Total number of active participants reported on line 7a of the Form 55002011-09-01363
Total of all active and inactive participants2011-09-01363
2009: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-01301
Total number of active participants reported on line 7a of the Form 55002009-09-01291
Total of all active and inactive participants2009-09-01291

Form 5500 Responses for ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN

2022: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-09-01Type of plan entitySingle employer plan
2022-09-01Plan funding arrangement – InsuranceYes
2022-09-01Plan funding arrangement – General assets of the sponsorYes
2022-09-01Plan benefit arrangement – InsuranceYes
2022-09-01Plan benefit arrangement – General assets of the sponsorYes
2021: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-09-01Type of plan entitySingle employer plan
2021-09-01Plan funding arrangement – InsuranceYes
2021-09-01Plan funding arrangement – General assets of the sponsorYes
2021-09-01Plan benefit arrangement – InsuranceYes
2021-09-01Plan benefit arrangement – General assets of the sponsorYes
2020: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-09-01Type of plan entitySingle employer plan
2020-09-01Plan funding arrangement – InsuranceYes
2020-09-01Plan funding arrangement – General assets of the sponsorYes
2020-09-01Plan benefit arrangement – InsuranceYes
2020-09-01Plan benefit arrangement – General assets of the sponsorYes
2019: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-09-01Type of plan entitySingle employer plan
2019-09-01Plan funding arrangement – InsuranceYes
2019-09-01Plan funding arrangement – General assets of the sponsorYes
2019-09-01Plan benefit arrangement – InsuranceYes
2019-09-01Plan benefit arrangement – General assets of the sponsorYes
2018: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-09-01Type of plan entitySingle employer plan
2018-09-01Plan funding arrangement – InsuranceYes
2018-09-01Plan funding arrangement – General assets of the sponsorYes
2018-09-01Plan benefit arrangement – InsuranceYes
2018-09-01Plan benefit arrangement – General assets of the sponsorYes
2017: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan benefit arrangement – InsuranceYes
2016: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan benefit arrangement – InsuranceYes
2015: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-09-01Type of plan entitySingle employer plan
2015-09-01Submission has been amendedYes
2015-09-01Plan funding arrangement – InsuranceYes
2015-09-01Plan benefit arrangement – InsuranceYes
2014: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-09-01Type of plan entitySingle employer plan
2014-09-01Plan funding arrangement – InsuranceYes
2014-09-01Plan benefit arrangement – InsuranceYes
2013: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-09-01Type of plan entitySingle employer plan
2013-09-01Plan funding arrangement – InsuranceYes
2013-09-01Plan benefit arrangement – InsuranceYes
2012: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-09-01Type of plan entitySingle employer plan
2012-09-01Plan funding arrangement – InsuranceYes
2012-09-01Plan benefit arrangement – InsuranceYes
2011: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-09-01Type of plan entitySingle employer plan
2011-09-01Plan funding arrangement – InsuranceYes
2011-09-01Plan benefit arrangement – InsuranceYes
2009: ESPEC NORTH AMERICA, INC. WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01This submission is the final filingNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUGC65D
Policy instance 5
Insurance contract or identification numberGLUGC65D
Number of Individuals Covered239
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $12,971
Total amount of fees paid to insurance companyUSD $976
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $140,297
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,204
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )
Policy contract number793304 S001
Policy instance 4
Insurance contract or identification number793304 S001
Number of Individuals Covered90
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $18,013
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $600,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,013
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number11605
Policy instance 3
Insurance contract or identification number11605
Number of Individuals Covered497
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number793304
Policy instance 2
Insurance contract or identification number793304
Number of Individuals Covered400
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $59,005
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,966,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,005
Amount paid for insurance broker fees0
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-106865
Policy instance 1
Insurance contract or identification numberETB-106865
Number of Individuals Covered239
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $188
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $188
Amount paid for insurance broker fees0
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-106865
Policy instance 4
Insurance contract or identification numberETB-106865
Number of Individuals Covered239
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $188
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $188
Amount paid for insurance broker fees0
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberEAB1000064
Policy instance 3
Insurance contract or identification numberEAB1000064
Number of Individuals Covered239
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $14,583
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $116,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,583
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30077432
Policy instance 2
Insurance contract or identification number30077432
Number of Individuals Covered198
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $36,267
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 number163634
Policy instance 1
Insurance contract or identification number163634
Number of Individuals Covered520
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $8,627
Total amount of fees paid to insurance companyUSD $950
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,846
Amount paid for insurance broker fees950
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-106865
Policy instance 4
Insurance contract or identification numberETB-106865
Number of Individuals Covered84
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $187
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $187
Amount paid for insurance broker fees0
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberEAB1000064
Policy instance 3
Insurance contract or identification numberEAB1000064
Number of Individuals Covered241
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $15,368
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $104,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,368
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30077432
Policy instance 2
Insurance contract or identification number30077432
Number of Individuals Covered178
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $1,528
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,307
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,528
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number163634
Policy instance 1
Insurance contract or identification number163634
Number of Individuals Covered492
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $9,063
Total amount of fees paid to insurance companyUSD $315
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,063
Amount paid for insurance broker fees315
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number163634
Policy instance 1
Insurance contract or identification number163634
Number of Individuals Covered511
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $8,879
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,879
Amount paid for insurance broker fees0
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-106865
Policy instance 4
Insurance contract or identification numberETB-106865
Number of Individuals Covered84
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $188
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $188
Amount paid for insurance broker fees0
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberEAB1000064
Policy instance 3
Insurance contract or identification numberEAB1000064
Number of Individuals Covered240
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $14,428
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $97,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,428
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30077432
Policy instance 2
Insurance contract or identification number30077432
Number of Individuals Covered182
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $353
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $353
Amount paid for insurance broker fees0
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number163634
Policy instance 1
Insurance contract or identification number163634
Number of Individuals Covered520
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $18,223
Total amount of fees paid to insurance companyUSD $461
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,223
Amount paid for insurance broker fees461
Additional information about fees paid to insurance brokerFEES AND OTHER COMMISSIONS
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-106865
Policy instance 4
Insurance contract or identification numberETB-106865
Number of Individuals Covered84
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $188
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to CarrierUSD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $188
Amount paid for insurance broker fees0
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberEAB1000064
Policy instance 3
Insurance contract or identification numberEAB1000064
Number of Individuals Covered239
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $13,137
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $88,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,137
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30077432
Policy instance 2
Insurance contract or identification number30077432
Number of Individuals Covered174
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $1,480
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,480
Amount paid for insurance broker fees0
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30077432
Policy instance 5
Insurance contract or identification number30077432
Number of Individuals Covered161
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,409
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberETB-106865
Policy instance 3
Insurance contract or identification numberETB-106865
Number of Individuals Covered84
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $188
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00163634/0001
Policy instance 4
Insurance contract or identification number00163634/0001
Number of Individuals Covered406
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $23,851
Total amount of fees paid to insurance companyUSD $2,025
Health Insurance Welfare BenefitYes
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 number163634
Policy instance 2
Insurance contract or identification number163634
Number of Individuals Covered504
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $17,593
Total amount of fees paid to insurance companyUSD $421
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberEAB1000064
Policy instance 1
Insurance contract or identification numberEAB1000064
Number of Individuals Covered227
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $12,211
Total amount of fees paid to insurance companyUSD $3,946
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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