401k Plan data: FIRST RECOVERY GROUP, LLC MEDICAL PLAN plan

FIRST RECOVERY GROUP, LLC MEDICAL PLAN 401k Plan overview

Plan Name	FIRST RECOVERY GROUP, LLC MEDICAL PLAN
Plan identification number	501

FIRST RECOVERY GROUP, LLC MEDICAL PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision)

401k Sponsoring company profile

FIRST RECOVERY GROUP, LLC has sponsored the creation of one or more 401k plans.

Company Name: FIRST RECOVERY GROUP, LLC

Employer identification number (EIN): 364381191

NAIC Classification: 524290

Additional information about FIRST RECOVERY GROUP, LLC

Jurisdiction of Incorporation: Michigan Department of Licensing & Regulatory Affairs

Incorporation Date:

Company Identification Number: B75270

More information about FIRST RECOVERY GROUP, LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FIRST RECOVERY GROUP, LLC MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-03-01 CONNIE JANOWSKI
501 2017-03-01

Plan Statistics for FIRST RECOVERY GROUP, LLC MEDICAL PLAN

401k plan membership statisitcs for FIRST RECOVERY GROUP, LLC MEDICAL PLAN

Measure Date Value
2017: FIRST RECOVERY GROUP, LLC MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year 2017-03-01 106
Total number of active participants reported on line 7a of the Form 5500 2017-03-01 101
Number of retired or separated participants receiving benefits 2017-03-01 3
Number of other retired or separated participants entitled to future benefits 2017-03-01 0
Total of all active and inactive participants 2017-03-01 104

Measure	Date	Value
2017: FIRST RECOVERY GROUP, LLC MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year	2017-03-01	106
Total number of active participants reported on line 7a of the Form 5500	2017-03-01	101
Number of retired or separated participants receiving benefits	2017-03-01	3
Number of other retired or separated participants entitled to future benefits	2017-03-01	0
Total of all active and inactive participants	2017-03-01	104

Form 5500 Responses for FIRST RECOVERY GROUP, LLC MEDICAL PLAN

2017: FIRST RECOVERY GROUP, LLC MEDICAL PLAN 2017 form 5500 responses
2017-03-01	Type of plan entity	Single employer plan
2017-03-01	First time form 5500 has been submitted	Yes
2017-03-01	Submission has been amended	No
2017-03-01	This submission is the final filing	No
2017-03-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2017-03-01	Plan is a collectively bargained plan	No
2017-03-01	Plan funding arrangement – Insurance	Yes
2017-03-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )

Policy contract number

260667

Policy instance

Insurance contract or identification number	260667
Number of Individuals Covered	183
Insurance policy start date	2017-03-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $26,473
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $20,678
Insurance broker organization code?	3
Insurance broker name	ACTION BENEFITS COMPANY

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

260667

Policy instance

Insurance contract or identification number	260667
Number of Individuals Covered	23
Insurance policy start date	2017-03-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,566
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,743
Insurance broker organization code?	3
Insurance broker name	ACTION BENEFITS COMPANY

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Company Name:	FIRST RECOVERY GROUP, LLC
Employer identification number (EIN):	364381191
NAIC Classification:	524290

Jurisdiction of Incorporation:	Michigan Department of Licensing & Regulatory Affairs
Incorporation Date:
Company Identification Number:	B75270