TGW SYSTEMS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TGW SYSTEMS INC.
401k plan membership statisitcs for TGW SYSTEMS INC.
| Measure | Date | Value |
|---|
| 2022: TGW SYSTEMS INC. 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 223 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 253 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 257 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: TGW SYSTEMS INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 407 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 223 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 223 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: TGW SYSTEMS INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-09-01 | 383 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 407 |
| Number of retired or separated participants receiving benefits | 2020-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-09-01 | 0 |
| Total of all active and inactive participants | 2020-09-01 | 407 |
| Number of employers contributing to the scheme | 2020-09-01 | 0 |
| 2019: TGW SYSTEMS INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 251 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 383 |
| Number of retired or separated participants receiving benefits | 2019-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-09-01 | 0 |
| Total of all active and inactive participants | 2019-09-01 | 383 |
| Number of employers contributing to the scheme | 2019-09-01 | 0 |
| 2018: TGW SYSTEMS INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-09-01 | 344 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 251 |
| Number of retired or separated participants receiving benefits | 2018-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 0 |
| Total of all active and inactive participants | 2018-09-01 | 251 |
| Number of employers contributing to the scheme | 2018-09-01 | 0 |
| 2017: TGW SYSTEMS INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 344 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 0 |
| Total of all active and inactive participants | 2017-09-01 | 344 |
| Number of employers contributing to the scheme | 2017-09-01 | 0 |
| 2016: TGW SYSTEMS INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-09-01 | 258 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 249 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 0 |
| Total of all active and inactive participants | 2016-09-01 | 249 |
| 2015: TGW SYSTEMS INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 203 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 258 |
| Number of retired or separated participants receiving benefits | 2015-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-09-01 | 0 |
| Total of all active and inactive participants | 2015-09-01 | 258 |
| 2014: TGW SYSTEMS INC. 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-09-01 | 192 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 233 |
| Number of retired or separated participants receiving benefits | 2014-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-09-01 | 0 |
| Total of all active and inactive participants | 2014-09-01 | 233 |
| 2013: TGW SYSTEMS INC. 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-09-01 | 191 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 187 |
| Number of retired or separated participants receiving benefits | 2013-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-09-01 | 0 |
| Total of all active and inactive participants | 2013-09-01 | 187 |
| 2012: TGW SYSTEMS INC. 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-09-01 | 192 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 191 |
| Number of retired or separated participants receiving benefits | 2012-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-09-01 | 0 |
| Total of all active and inactive participants | 2012-09-01 | 191 |
| 2011: TGW SYSTEMS INC. 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-09-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 192 |
| Number of retired or separated participants receiving benefits | 2011-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-09-01 | 0 |
| Total of all active and inactive participants | 2011-09-01 | 192 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-09-01 | 0 |
| Total participants | 2011-09-01 | 192 |
| Number of participants with account balances | 2011-09-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-09-01 | 0 |
| 2010: TGW SYSTEMS INC. 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-09-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-09-01 | 214 |
| Number of retired or separated participants receiving benefits | 2010-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-09-01 | 0 |
| Total of all active and inactive participants | 2010-09-01 | 214 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-09-01 | 0 |
| Total participants | 2010-09-01 | 214 |
| Number of participants with account balances | 2010-09-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-09-01 | 0 |
| 2009: TGW SYSTEMS INC. 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-09-01 | 164 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 171 |
| Number of retired or separated participants receiving benefits | 2009-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-09-01 | 0 |
| Total of all active and inactive participants | 2009-09-01 | 171 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-09-01 | 0 |
| Total participants | 2009-09-01 | 171 |
| Number of participants with account balances | 2009-09-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-09-01 | 0 |
| Measure | Date | Value |
|---|
| 2012 : TGW SYSTEMS INC. 2012 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2012-08-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2012-08-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2012-08-31 | $0 |
| Total transfer of assets to this plan | 2012-08-31 | $0 |
| Total transfer of assets from this plan | 2012-08-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-08-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-08-31 | $0 |
| Expenses. Interest paid | 2012-08-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2012-08-31 | $0 |
| Total income from all sources (including contributions) | 2012-08-31 | $2,028,368 |
| Total loss/gain on sale of assets | 2012-08-31 | $0 |
| Total of all expenses incurred | 2012-08-31 | $0 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-08-31 | $0 |
| Expenses. Certain deemed distributions of participant loans | 2012-08-31 | $0 |
| Value of total corrective distributions | 2012-08-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-08-31 | $2,028,368 |
| Value of total assets at end of year | 2012-08-31 | $0 |
| Value of total assets at beginning of year | 2012-08-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-08-31 | $0 |
| Total income from rents | 2012-08-31 | $0 |
| Total interest from all sources | 2012-08-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-08-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-08-31 | No |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2012-08-31 | $0 |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-08-31 | $0 |
| Assets. Real estate other than employer real property at end of year | 2012-08-31 | $0 |
| Assets. Real estate other than employer real property at beginning of year | 2012-08-31 | $0 |
| Administrative expenses professional fees incurred | 2012-08-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2012-08-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2012-08-31 | $0 |
| Was this plan covered by a fidelity bond | 2012-08-31 | No |
| Value of fidelity bond cover | 2012-08-31 | $0 |
| If this is an individual account plan, was there a blackout period | 2012-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-08-31 | No |
| Amount of non-exempt transactions with any party-in-interest | 2012-08-31 | $0 |
| Contributions received from participants | 2012-08-31 | $456,841 |
| Participant contributions at end of year | 2012-08-31 | $0 |
| Participant contributions at beginning of year | 2012-08-31 | $0 |
| Participant contributions at end of year | 2012-08-31 | $0 |
| Participant contributions at beginning of year | 2012-08-31 | $0 |
| Assets. Other investments not covered elsewhere at end of year | 2012-08-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2012-08-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-08-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-08-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-08-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-08-31 | $0 |
| Assets. Loans (other than to participants) at end of year | 2012-08-31 | $0 |
| Assets. Loans (other than to participants) at beginning of year | 2012-08-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-08-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-08-31 | $0 |
| Other income not declared elsewhere | 2012-08-31 | $0 |
| Administrative expenses (other) incurred | 2012-08-31 | $0 |
| Liabilities. Value of operating payables at end of year | 2012-08-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2012-08-31 | $0 |
| Total non interest bearing cash at end of year | 2012-08-31 | $0 |
| Total non interest bearing cash at beginning of year | 2012-08-31 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-08-31 | No |
| Income. Non cash contributions | 2012-08-31 | $0 |
| Value of net income/loss | 2012-08-31 | $2,028,368 |
| Value of net assets at end of year (total assets less liabilities) | 2012-08-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-08-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-08-31 | No |
| Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year | 2012-08-31 | $0 |
| Were any leases to which the plan was party in default or uncollectible | 2012-08-31 | No |
| Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year | 2012-08-31 | $0 |
| Assets. partnership/joint venture interests at end of year | 2012-08-31 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2012-08-31 | $0 |
| Investment advisory and management fees | 2012-08-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-08-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-08-31 | $0 |
| Interest on participant loans | 2012-08-31 | $0 |
| Income. Interest from loans (other than to participants) | 2012-08-31 | $0 |
| Interest earned on other investments | 2012-08-31 | $0 |
| Income. Interest from US Government securities | 2012-08-31 | $0 |
| Income. Interest from corporate debt instruments | 2012-08-31 | $0 |
| Value of interest in master investment trust accounts at end of year | 2012-08-31 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2012-08-31 | $0 |
| Value of interest in common/collective trusts at end of year | 2012-08-31 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2012-08-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-08-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-08-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-08-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-08-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2012-08-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2012-08-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2012-08-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2012-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-08-31 | $0 |
| Asset value of US Government securities at end of year | 2012-08-31 | $0 |
| Asset value of US Government securities at beginning of year | 2012-08-31 | $0 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-08-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2012-08-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2012-08-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2012-08-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-08-31 | No |
| Assets. Invements in employer securities at end of year | 2012-08-31 | $0 |
| Assets. Invements in employer securities at beginning of year | 2012-08-31 | $0 |
| Assets. Value of employer real property at end of year | 2012-08-31 | $0 |
| Assets. Value of employer real property at beginning of year | 2012-08-31 | $0 |
| Contributions received in cash from employer | 2012-08-31 | $1,571,527 |
| Employer contributions (assets) at end of year | 2012-08-31 | $0 |
| Employer contributions (assets) at beginning of year | 2012-08-31 | $0 |
| Income. Dividends from preferred stock | 2012-08-31 | $0 |
| Income. Dividends from common stock | 2012-08-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-08-31 | $0 |
| Asset. Corporate debt instrument preferred debt at end of year | 2012-08-31 | $0 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2012-08-31 | $0 |
| Asset. Corporate debt instrument debt (other) at end of year | 2012-08-31 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2012-08-31 | $0 |
| Contract administrator fees | 2012-08-31 | $0 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-08-31 | No |
| Assets. Corporate common stocks other than exployer securities at end of year | 2012-08-31 | $0 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2012-08-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2012-08-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-08-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2012-08-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2012-08-31 | $0 |
| Did the plan have assets held for investment | 2012-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-08-31 | No |
| Aggregate proceeds on sale of assets | 2012-08-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2012-08-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2012-08-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2012-08-31 | $0 |
| 2011 : TGW SYSTEMS INC. 2011 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2011-08-31 | $0 |
| Unrealized appreciation/depreciation of other (non real estate) assets | 2011-08-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2011-08-31 | $0 |
| Total transfer of assets to this plan | 2011-08-31 | $0 |
| Total transfer of assets from this plan | 2011-08-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-08-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-08-31 | $0 |
| Expenses. Interest paid | 2011-08-31 | $0 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2011-08-31 | $0 |
| Total income from all sources (including contributions) | 2011-08-31 | $827,653 |
| Total loss/gain on sale of assets | 2011-08-31 | $0 |
| Total of all expenses incurred | 2011-08-31 | $0 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-08-31 | $0 |
| Expenses. Certain deemed distributions of participant loans | 2011-08-31 | $0 |
| Value of total corrective distributions | 2011-08-31 | $0 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-08-31 | $827,653 |
| Value of total assets at end of year | 2011-08-31 | $0 |
| Value of total assets at beginning of year | 2011-08-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-08-31 | $0 |
| Total income from rents | 2011-08-31 | $0 |
| Total interest from all sources | 2011-08-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-08-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-08-31 | No |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2011-08-31 | $0 |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-08-31 | $0 |
| Assets. Real estate other than employer real property at end of year | 2011-08-31 | $0 |
| Assets. Real estate other than employer real property at beginning of year | 2011-08-31 | $0 |
| Administrative expenses professional fees incurred | 2011-08-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at end of year | 2011-08-31 | $0 |
| Assets. Corporate prefeered stocks other than exployer securities at beginning of year | 2011-08-31 | $0 |
| Was this plan covered by a fidelity bond | 2011-08-31 | No |
| Value of fidelity bond cover | 2011-08-31 | $0 |
| If this is an individual account plan, was there a blackout period | 2011-08-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-08-31 | No |
| Amount of non-exempt transactions with any party-in-interest | 2011-08-31 | $0 |
| Contributions received from participants | 2011-08-31 | $372,464 |
| Participant contributions at end of year | 2011-08-31 | $0 |
| Participant contributions at beginning of year | 2011-08-31 | $0 |
| Participant contributions at end of year | 2011-08-31 | $0 |
| Participant contributions at beginning of year | 2011-08-31 | $0 |
| Assets. Other investments not covered elsewhere at end of year | 2011-08-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2011-08-31 | $0 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-08-31 | $0 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-08-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-08-31 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-08-31 | $0 |
| Assets. Loans (other than to participants) at end of year | 2011-08-31 | $0 |
| Assets. Loans (other than to participants) at beginning of year | 2011-08-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-08-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-08-31 | $0 |
| Other income not declared elsewhere | 2011-08-31 | $0 |
| Administrative expenses (other) incurred | 2011-08-31 | $0 |
| Liabilities. Value of operating payables at end of year | 2011-08-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2011-08-31 | $0 |
| Total non interest bearing cash at end of year | 2011-08-31 | $0 |
| Total non interest bearing cash at beginning of year | 2011-08-31 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-08-31 | No |
| Income. Non cash contributions | 2011-08-31 | $0 |
| Value of net income/loss | 2011-08-31 | $827,653 |
| Value of net assets at end of year (total assets less liabilities) | 2011-08-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-08-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-08-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-08-31 | No |
| Amount of loans by the plan or fixed income obligations due to the plan which were in default/classified-as-uncollectible as of the close of the plan year | 2011-08-31 | $0 |
| Were any leases to which the plan was party in default or uncollectible | 2011-08-31 | No |
| Amount of leases to which the plan was a party which were in default/classified-as-uncollectible during the year | 2011-08-31 | $0 |
| Assets. partnership/joint venture interests at end of year | 2011-08-31 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2011-08-31 | $0 |
| Investment advisory and management fees | 2011-08-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-08-31 | $0 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2011-08-31 | $0 |
| Interest on participant loans | 2011-08-31 | $0 |
| Income. Interest from loans (other than to participants) | 2011-08-31 | $0 |
| Interest earned on other investments | 2011-08-31 | $0 |
| Income. Interest from US Government securities | 2011-08-31 | $0 |
| Income. Interest from corporate debt instruments | 2011-08-31 | $0 |
| Value of interest in master investment trust accounts at end of year | 2011-08-31 | $0 |
| Value of interest in master investment trust accounts at beginning of year | 2011-08-31 | $0 |
| Value of interest in common/collective trusts at end of year | 2011-08-31 | $0 |
| Value of interest in common/collective trusts at beginning of year | 2011-08-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-08-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-08-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-08-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-08-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at end of year | 2011-08-31 | $0 |
| Assets. Value of investments in 103.12 investment entities at beginning of year | 2011-08-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2011-08-31 | $0 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2011-08-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-08-31 | $0 |
| Asset value of US Government securities at end of year | 2011-08-31 | $0 |
| Asset value of US Government securities at beginning of year | 2011-08-31 | $0 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2011-08-31 | $0 |
| Net investment gain/loss from pooled separate accounts | 2011-08-31 | $0 |
| Net investment gain or loss from common/collective trusts | 2011-08-31 | $0 |
| Net gain/loss from 103.12 investment entities | 2011-08-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-08-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-08-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-08-31 | No |
| Assets. Invements in employer securities at end of year | 2011-08-31 | $0 |
| Assets. Invements in employer securities at beginning of year | 2011-08-31 | $0 |
| Assets. Value of employer real property at end of year | 2011-08-31 | $0 |
| Assets. Value of employer real property at beginning of year | 2011-08-31 | $0 |
| Contributions received in cash from employer | 2011-08-31 | $455,189 |
| Employer contributions (assets) at end of year | 2011-08-31 | $0 |
| Employer contributions (assets) at beginning of year | 2011-08-31 | $0 |
| Income. Dividends from preferred stock | 2011-08-31 | $0 |
| Income. Dividends from common stock | 2011-08-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-08-31 | $0 |
| Asset. Corporate debt instrument preferred debt at end of year | 2011-08-31 | $0 |
| Asset. Corporate debt instrument preferred debt at beginning of year | 2011-08-31 | $0 |
| Asset. Corporate debt instrument debt (other) at end of year | 2011-08-31 | $0 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2011-08-31 | $0 |
| Contract administrator fees | 2011-08-31 | $0 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-08-31 | No |
| Assets. Corporate common stocks other than exployer securities at end of year | 2011-08-31 | $0 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2011-08-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2011-08-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-08-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2011-08-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2011-08-31 | $0 |
| Did the plan have assets held for investment | 2011-08-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-08-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-08-31 | No |
| Aggregate proceeds on sale of assets | 2011-08-31 | $0 |
| Aggregate carrying amount (costs) on sale of assets | 2011-08-31 | $0 |
| Liabilities. Value of acquisition indebtedness at end of year | 2011-08-31 | $0 |
| Liabilities. Value of acquisition indebtedness at beginning of year | 2011-08-31 | $0 |
| 2022: TGW SYSTEMS INC. 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: TGW SYSTEMS INC. 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: TGW SYSTEMS INC. 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: TGW SYSTEMS INC. 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: TGW SYSTEMS INC. 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: TGW SYSTEMS INC. 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: TGW SYSTEMS INC. 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Submission has been amended | No |
| 2016-09-01 | This submission is the final filing | No |
| 2016-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-09-01 | Plan is a collectively bargained plan | No |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: TGW SYSTEMS INC. 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Submission has been amended | No |
| 2015-09-01 | This submission is the final filing | No |
| 2015-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-09-01 | Plan is a collectively bargained plan | No |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: TGW SYSTEMS INC. 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Submission has been amended | No |
| 2014-09-01 | This submission is the final filing | No |
| 2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-09-01 | Plan is a collectively bargained plan | No |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: TGW SYSTEMS INC. 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Submission has been amended | No |
| 2013-09-01 | This submission is the final filing | No |
| 2013-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-09-01 | Plan is a collectively bargained plan | No |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: TGW SYSTEMS INC. 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Submission has been amended | No |
| 2012-09-01 | This submission is the final filing | No |
| 2012-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-09-01 | Plan is a collectively bargained plan | No |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: TGW SYSTEMS INC. 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Submission has been amended | No |
| 2011-09-01 | This submission is the final filing | No |
| 2011-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-09-01 | Plan is a collectively bargained plan | No |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: TGW SYSTEMS INC. 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Submission has been amended | No |
| 2010-09-01 | This submission is the final filing | No |
| 2010-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-09-01 | Plan is a collectively bargained plan | No |
| 2010-09-01 | Plan funding arrangement – Insurance | Yes |
| 2010-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: TGW SYSTEMS INC. 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | Submission has been amended | No |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-09-01 | Plan is a collectively bargained plan | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMDC0BV5L |
| Policy instance | 3 |
| Insurance contract or identification number | GMDC0BV5L | | Number of Individuals Covered | 116 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $742 | | Total amount of fees paid to insurance company | USD $567 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $5,518 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $742 | | Amount paid for insurance broker fees | 418 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10037791001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10037791001 | | Number of Individuals Covered | 356 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,847 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,847 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5783 |
| Policy instance | 1 |
| Insurance contract or identification number | 5783 | | Number of Individuals Covered | 408 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $7,647 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,647 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BV5L |
| Policy instance | 4 |
| Insurance contract or identification number | GLUG0BV5L | | Number of Individuals Covered | 253 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $25,629 | | Total amount of fees paid to insurance company | USD $7,691 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM,CRITICAL ILLNESS,ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $226,125 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,629 | | Amount paid for insurance broker fees | 5668 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0BV5L |
| Policy instance | 4 |
| Insurance contract or identification number | GLUG0BV5L | | Number of Individuals Covered | 223 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $21,557 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,EMPLOYEE ASSISTANCE PROGRAM,CRITICAL ILLNESS,ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $190,593 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,557 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | GMDC0BV5L |
| Policy instance | 3 |
| Insurance contract or identification number | GMDC0BV5L | | Number of Individuals Covered | 111 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,453 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $9,687 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,453 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10037791001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10037791001 | | Number of Individuals Covered | 294 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,001 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,001 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5783 |
| Policy instance | 1 |
| Insurance contract or identification number | 5783 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $7,016 | | Total amount of fees paid to insurance company | USD $185 | | 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 $7,016 | | Amount paid for insurance broker fees | 185 | | Additional information about fees paid to insurance broker | RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5783 |
| Policy instance | 1 |
| Insurance contract or identification number | 5783 | | Number of Individuals Covered | 575 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $9,985 | | Total amount of fees paid to insurance company | USD $688 | | 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 $9,985 | | Amount paid for insurance broker fees | 688 | | Additional information about fees paid to insurance broker | NEW BUSINESS BONUS RETENTION BONUS | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10037791001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10037791001 | | Number of Individuals Covered | 508 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,859 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,569 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,859 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 147910 |
| Policy instance | 3 |
| Insurance contract or identification number | 147910 | | Number of Individuals Covered | 407 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $15,900 | | Total amount of fees paid to insurance company | USD $4,955 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $247,740 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,900 | | Amount paid for insurance broker fees | 4955 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 147910 |
| Policy instance | 3 |
| Insurance contract or identification number | 147910 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $15,484 | | Total amount of fees paid to insurance company | USD $2,738 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $187,238 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,036 | | Amount paid for insurance broker fees | 1345 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 1003779 |
| Policy instance | 2 |
| Insurance contract or identification number | 1003779 | | Number of Individuals Covered | 461 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,410 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,184 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5783 |
| Policy instance | 1 |
| Insurance contract or identification number | 5783 | | Number of Individuals Covered | 491 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $7,683 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,101 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 147910 |
| Policy instance | 4 |
| Insurance contract or identification number | 147910 | | Number of Individuals Covered | 344 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $11,948 | | Total amount of fees paid to insurance company | USD $2,396 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $127,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,948 | | Amount paid for insurance broker fees | 2396 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10037791001 |
| Policy instance | 3 |
| Insurance contract or identification number | 10037791001 | | Number of Individuals Covered | 421 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,761 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,761 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 412960 |
| Policy instance | 2 |
| Insurance contract or identification number | 412960 | | Number of Individuals Covered | 262 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | 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 number | 412960 |
| Policy instance | 1 |
| Insurance contract or identification number | 412960 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | 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 | | Dental Insurance Welfare Benefit | Yes | | 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 | 412960 |
| Policy instance | 3 |
| Insurance contract or identification number | 412960 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $80,446 | | Total amount of fees paid to insurance company | USD $340 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $67,197 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 340 | | Additional information about fees paid to insurance broker | FEES AND OTHER COMMISSSIONS | | Insurance broker name | UNKNOWN |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 3361571336 |
| Policy instance | 1 |
| Insurance contract or identification number | 3361571336 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $157,312 | | Total amount of fees paid to insurance company | USD $16 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $16,186 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $156,530 | | Amount paid for insurance broker fees | 16 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AGENT ALLIANCE CORPORATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 147910/147911 |
| Policy instance | 2 |
| Insurance contract or identification number | 147910/147911 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $8,170 | | Total amount of fees paid to insurance company | USD $582 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $79,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,170 | | Amount paid for insurance broker fees | 582 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 412960 |
| Policy instance | 2 |
| Insurance contract or identification number | 412960 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $6,088 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,370 | | Insurance broker organization code? | 3 | | Insurance broker name | GROTENHUIS |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 788058 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 788058 S001 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $10,611 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $357,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,611 | | Insurance broker organization code? | 3 | | Insurance broker name | LINNEA HOEKWATER |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 3361571336 |
| Policy instance | 3 |
| Insurance contract or identification number | 3361571336 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $2,061 | | Total amount of fees paid to insurance company | USD $16 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $14,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,374 | | Amount paid for insurance broker fees | 10 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AGENT ALLIANCE CORPORATION |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 147910/147911 |
| Policy instance | 4 |
| Insurance contract or identification number | 147910/147911 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $7,033 | | Total amount of fees paid to insurance company | USD $488 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $69,646 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,033 | | Amount paid for insurance broker fees | 488 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 788058 S001 |
| Policy instance | 5 |
| Insurance contract or identification number | 788058 S001 | | Number of Individuals Covered | 183 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $20,798 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $708,071 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,798 | | Insurance broker organization code? | 3 | | Insurance broker name | LINNEA HOEKWATER |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 788058 S001 |
| Policy instance | 5 |
| Insurance contract or identification number | 788058 S001 | | Number of Individuals Covered | 200 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $20,912 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $697,087 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,956 | | Insurance broker organization code? | 3 | | Insurance broker name | LINNEA HOEKWATER |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 788058 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 788058 S001 | | Number of Individuals Covered | 72 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $12,442 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $414,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,597 | | Insurance broker organization code? | 3 | | Insurance broker name | LINNEA HOEKWATER |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 412960 |
| Policy instance | 2 |
| Insurance contract or identification number | 412960 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 3361571336 |
| Policy instance | 3 |
| Insurance contract or identification number | 3361571336 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,045 | | Total amount of fees paid to insurance company | USD $27 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,633 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $614 | | Amount paid for insurance broker fees | 8 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | AGENT ALLIANCE CORPORATION |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 147910/147911 |
| Policy instance | 4 |
| Insurance contract or identification number | 147910/147911 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,444 | | Total amount of fees paid to insurance company | USD $447 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $60,574 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,965 | | Amount paid for insurance broker fees | 247 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 412960 |
| Policy instance | 2 |
| Insurance contract or identification number | 412960 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $11,761 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $11,761 | | Insurance broker organization code? | 3 | | Insurance broker name | AGENT ALLIANCE CORPORATION |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 3361571336 |
| Policy instance | 3 |
| Insurance contract or identification number | 3361571336 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $2,205 | | Total amount of fees paid to insurance company | USD $21 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $14,699 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,470 | | Amount paid for insurance broker fees | 14 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | FRINGE BENEFIT SYSTEMS, INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 147910/147911 |
| Policy instance | 4 |
| Insurance contract or identification number | 147910/147911 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,905 | | Total amount of fees paid to insurance company | USD $576 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $67,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,905 | | Amount paid for insurance broker fees | 576 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | WELLS FARGO INSURANCE SERVICES |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 788058 |
| Policy instance | 1 |
| Insurance contract or identification number | 788058 | | Number of Individuals Covered | 282 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $28,429 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $947,629 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,429 | | Insurance broker organization code? | 3 | | Insurance broker name | CONTANCE D. REYNOLDS |
|
| MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 140319 |
| Policy instance | 2 |
| Insurance contract or identification number | 140319 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $22,305 | | Total amount of fees paid to insurance company | USD $2,687 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000147910 |
| Policy instance | 1 |
| Insurance contract or identification number | 000000147910 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $5,498 | | Total amount of fees paid to insurance company | USD $510 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D LIFE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 412960 |
| Policy instance | 3 |
| Insurance contract or identification number | 412960 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $11,761 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 788058 S001 |
| Policy instance | 4 |
| Insurance contract or identification number | 788058 S001 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $10,122 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 788058 S001 |
| Policy instance | 5 |
| Insurance contract or identification number | 788058 S001 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-08-31 | | Total amount of commissions paid to insurance broker | USD $8,830 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 140319 |
| Policy instance | 2 |
| Insurance contract or identification number | 140319 | | Number of Individuals Covered | 83 | | Total amount of commissions paid to insurance broker | USD $4,683 | | Total amount of fees paid to insurance company | USD $43,807 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 412960 |
| Policy instance | 1 |
| Insurance contract or identification number | 412960 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $3,251 | | Total amount of fees paid to insurance company | USD $154 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 147910, 147910 |
| Policy instance | 3 |
| Insurance contract or identification number | 147910, 147910 | | Number of Individuals Covered | 186 | | Total amount of commissions paid to insurance broker | USD $6,539 | | Total amount of fees paid to insurance company | USD $942 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D LIFE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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