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LAFCU EMPLOYEE HEALTH PLAN 401k Plan overview

Plan NameLAFCU EMPLOYEE HEALTH PLAN
Plan identification number 501

LAFCU EMPLOYEE HEALTH PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    LAFCU (FKA LANSING AUTOMAKERS FEDERAL CREDIT UNION) has sponsored the creation of one or more 401k plans.

    Company Name:LAFCU (FKA LANSING AUTOMAKERS FEDERAL CREDIT UNION)
    Employer identification number (EIN):380893210
    NAIC Classification:522130
    NAIC Description:Credit Unions

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan LAFCU EMPLOYEE HEALTH PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012021-01-01ROBYN HOWELL2022-07-26
    5012020-01-01ROBYN HOWELL2021-06-22
    5012019-01-01ROBYN HOWELL2020-07-28
    5012018-01-01ROBYN HOWELL2019-09-13
    5012017-01-01
    5012016-01-01
    5012015-01-01
    5012014-01-01
    5012013-01-01
    5012012-01-01SHARON GILLISON
    5012011-01-01SHARON GILLISON
    5012010-01-01SHARON GILLISON
    5012009-01-01SHARON E GILLISON

    Plan Statistics for LAFCU EMPLOYEE HEALTH PLAN

    401k plan membership statisitcs for LAFCU EMPLOYEE HEALTH PLAN

    Measure Date Value
    2021: LAFCU EMPLOYEE HEALTH PLAN 2021 401k membership
    Total participants, beginning-of-year2021-01-01227
    Total number of active participants reported on line 7a of the Form 55002021-01-01148
    Number of retired or separated participants receiving benefits2021-01-0161
    Total of all active and inactive participants2021-01-01209
    2020: LAFCU EMPLOYEE HEALTH PLAN 2020 401k membership
    Total participants, beginning-of-year2020-01-01209
    Total number of active participants reported on line 7a of the Form 55002020-01-01132
    Number of retired or separated participants receiving benefits2020-01-0195
    Total of all active and inactive participants2020-01-01227
    2019: LAFCU EMPLOYEE HEALTH PLAN 2019 401k membership
    Total participants, beginning-of-year2019-01-01170
    Total number of active participants reported on line 7a of the Form 55002019-01-01139
    Number of retired or separated participants receiving benefits2019-01-0169
    Number of other retired or separated participants entitled to future benefits2019-01-011
    Total of all active and inactive participants2019-01-01209
    2018: LAFCU EMPLOYEE HEALTH PLAN 2018 401k membership
    Total participants, beginning-of-year2018-01-01167
    Total number of active participants reported on line 7a of the Form 55002018-01-01135
    Number of retired or separated participants receiving benefits2018-01-0135
    Total of all active and inactive participants2018-01-01170
    2017: LAFCU EMPLOYEE HEALTH PLAN 2017 401k membership
    Total participants, beginning-of-year2017-01-01162
    Total number of active participants reported on line 7a of the Form 55002017-01-01120
    Number of retired or separated participants receiving benefits2017-01-0147
    Total of all active and inactive participants2017-01-01167
    2016: LAFCU EMPLOYEE HEALTH PLAN 2016 401k membership
    Total participants, beginning-of-year2016-01-01181
    Total number of active participants reported on line 7a of the Form 55002016-01-01116
    Number of retired or separated participants receiving benefits2016-01-0146
    Total of all active and inactive participants2016-01-01162
    2015: LAFCU EMPLOYEE HEALTH PLAN 2015 401k membership
    Total participants, beginning-of-year2015-01-01192
    Total number of active participants reported on line 7a of the Form 55002015-01-01136
    Number of retired or separated participants receiving benefits2015-01-0145
    Total of all active and inactive participants2015-01-01181
    2014: LAFCU EMPLOYEE HEALTH PLAN 2014 401k membership
    Total participants, beginning-of-year2014-01-01164
    Total number of active participants reported on line 7a of the Form 55002014-01-01125
    Number of retired or separated participants receiving benefits2014-01-0167
    Total of all active and inactive participants2014-01-01192
    2013: LAFCU EMPLOYEE HEALTH PLAN 2013 401k membership
    Total participants, beginning-of-year2013-01-01123
    Total number of active participants reported on line 7a of the Form 55002013-01-01124
    Number of retired or separated participants receiving benefits2013-01-0140
    Total of all active and inactive participants2013-01-01164
    2012: LAFCU EMPLOYEE HEALTH PLAN 2012 401k membership
    Total participants, beginning-of-year2012-01-01158
    Total number of active participants reported on line 7a of the Form 55002012-01-0198
    Number of retired or separated participants receiving benefits2012-01-0125
    Total of all active and inactive participants2012-01-01123
    2011: LAFCU EMPLOYEE HEALTH PLAN 2011 401k membership
    Total participants, beginning-of-year2011-01-01177
    Total number of active participants reported on line 7a of the Form 55002011-01-01112
    Number of retired or separated participants receiving benefits2011-01-0146
    Total of all active and inactive participants2011-01-01158
    2010: LAFCU EMPLOYEE HEALTH PLAN 2010 401k membership
    Total participants, beginning-of-year2010-01-01148
    Total number of active participants reported on line 7a of the Form 55002010-01-01154
    Number of retired or separated participants receiving benefits2010-01-0123
    Total of all active and inactive participants2010-01-01177
    2009: LAFCU EMPLOYEE HEALTH PLAN 2009 401k membership
    Total participants, beginning-of-year2009-01-01146
    Total number of active participants reported on line 7a of the Form 55002009-01-01124
    Number of retired or separated participants receiving benefits2009-01-0124
    Total of all active and inactive participants2009-01-01148

    Form 5500 Responses for LAFCU EMPLOYEE HEALTH PLAN

    2021: LAFCU EMPLOYEE HEALTH PLAN 2021 form 5500 responses
    2021-01-01Type of plan entitySingle employer plan
    2021-01-01Plan is a collectively bargained planYes
    2021-01-01Plan funding arrangement – InsuranceYes
    2021-01-01Plan funding arrangement – General assets of the sponsorYes
    2021-01-01Plan benefit arrangement – InsuranceYes
    2021-01-01Plan benefit arrangement – General assets of the sponsorYes
    2020: LAFCU EMPLOYEE HEALTH PLAN 2020 form 5500 responses
    2020-01-01Type of plan entitySingle employer plan
    2020-01-01Plan is a collectively bargained planYes
    2020-01-01Plan funding arrangement – InsuranceYes
    2020-01-01Plan funding arrangement – General assets of the sponsorYes
    2020-01-01Plan benefit arrangement – InsuranceYes
    2020-01-01Plan benefit arrangement – General assets of the sponsorYes
    2019: LAFCU EMPLOYEE HEALTH PLAN 2019 form 5500 responses
    2019-01-01Type of plan entitySingle employer plan
    2019-01-01Plan is a collectively bargained planYes
    2019-01-01Plan funding arrangement – InsuranceYes
    2019-01-01Plan funding arrangement – General assets of the sponsorYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement – General assets of the sponsorYes
    2018: LAFCU EMPLOYEE HEALTH PLAN 2018 form 5500 responses
    2018-01-01Type of plan entitySingle employer plan
    2018-01-01Plan is a collectively bargained planYes
    2018-01-01Plan funding arrangement – InsuranceYes
    2018-01-01Plan funding arrangement – General assets of the sponsorYes
    2018-01-01Plan benefit arrangement – InsuranceYes
    2018-01-01Plan benefit arrangement – General assets of the sponsorYes
    2017: LAFCU EMPLOYEE HEALTH PLAN 2017 form 5500 responses
    2017-01-01Type of plan entitySingle employer plan
    2017-01-01Plan is a collectively bargained planYes
    2017-01-01Plan funding arrangement – InsuranceYes
    2017-01-01Plan funding arrangement – General assets of the sponsorYes
    2017-01-01Plan benefit arrangement – InsuranceYes
    2017-01-01Plan benefit arrangement – General assets of the sponsorYes
    2016: LAFCU EMPLOYEE HEALTH PLAN 2016 form 5500 responses
    2016-01-01Type of plan entitySingle employer plan
    2016-01-01Plan is a collectively bargained planYes
    2016-01-01Plan funding arrangement – InsuranceYes
    2016-01-01Plan funding arrangement – General assets of the sponsorYes
    2016-01-01Plan benefit arrangement – InsuranceYes
    2016-01-01Plan benefit arrangement – General assets of the sponsorYes
    2015: LAFCU EMPLOYEE HEALTH PLAN 2015 form 5500 responses
    2015-01-01Type of plan entitySingle employer plan
    2015-01-01Plan is a collectively bargained planYes
    2015-01-01Plan funding arrangement – InsuranceYes
    2015-01-01Plan funding arrangement – General assets of the sponsorYes
    2015-01-01Plan benefit arrangement – InsuranceYes
    2015-01-01Plan benefit arrangement – General assets of the sponsorYes
    2014: LAFCU EMPLOYEE HEALTH PLAN 2014 form 5500 responses
    2014-01-01Type of plan entitySingle employer plan
    2014-01-01Plan is a collectively bargained planYes
    2014-01-01Plan funding arrangement – InsuranceYes
    2014-01-01Plan funding arrangement – General assets of the sponsorYes
    2014-01-01Plan benefit arrangement – InsuranceYes
    2014-01-01Plan benefit arrangement – General assets of the sponsorYes
    2013: LAFCU EMPLOYEE HEALTH PLAN 2013 form 5500 responses
    2013-01-01Type of plan entitySingle employer plan
    2013-01-01Plan is a collectively bargained planYes
    2013-01-01Plan funding arrangement – InsuranceYes
    2013-01-01Plan funding arrangement – General assets of the sponsorYes
    2013-01-01Plan benefit arrangement – InsuranceYes
    2013-01-01Plan benefit arrangement – General assets of the sponsorYes
    2012: LAFCU EMPLOYEE HEALTH PLAN 2012 form 5500 responses
    2012-01-01Type of plan entitySingle employer plan
    2012-01-01Plan is a collectively bargained planYes
    2012-01-01Plan funding arrangement – InsuranceYes
    2012-01-01Plan funding arrangement – General assets of the sponsorYes
    2012-01-01Plan benefit arrangement – InsuranceYes
    2012-01-01Plan benefit arrangement – General assets of the sponsorYes
    2011: LAFCU EMPLOYEE HEALTH PLAN 2011 form 5500 responses
    2011-01-01Type of plan entitySingle employer plan
    2011-01-01Plan is a collectively bargained planYes
    2011-01-01Plan funding arrangement – InsuranceYes
    2011-01-01Plan funding arrangement – General assets of the sponsorYes
    2011-01-01Plan benefit arrangement – InsuranceYes
    2011-01-01Plan benefit arrangement – General assets of the sponsorYes
    2010: LAFCU EMPLOYEE HEALTH PLAN 2010 form 5500 responses
    2010-01-01Type of plan entitySingle employer plan
    2010-01-01Plan is a collectively bargained planYes
    2010-01-01Plan funding arrangement – InsuranceYes
    2010-01-01Plan funding arrangement – General assets of the sponsorYes
    2010-01-01Plan benefit arrangement – InsuranceYes
    2010-01-01Plan benefit arrangement – General assets of the sponsorYes
    2009: LAFCU EMPLOYEE HEALTH PLAN 2009 form 5500 responses
    2009-01-01Type of plan entitySingle employer plan
    2009-01-01This submission is the final filingNo
    2009-01-01Plan is a collectively bargained planYes
    2009-01-01Plan funding arrangement – InsuranceYes
    2009-01-01Plan funding arrangement – General assets of the sponsorYes
    2009-01-01Plan benefit arrangement – InsuranceYes
    2009-01-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
    Policy contract number7907
    Policy instance 5
    Insurance contract or identification number7907
    Number of Individuals Covered484
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $6,536
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,536
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number936298
    Policy instance 4
    Insurance contract or identification number936298
    Number of Individuals Covered224
    Insurance policy start date2020-11-01
    Insurance policy end date2021-10-31
    Total amount of commissions paid to insurance brokerUSD $11,615
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedVOLUNTARY LIFE, STD, AD&D AND EAP
    Welfare Benefit Premiums Paid to CarrierUSD $126,786
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,615
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
    Policy contract number00119045/0005
    Policy instance 3
    Insurance contract or identification number00119045/0005
    Number of Individuals Covered296
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $58,710
    Total amount of fees paid to insurance companyUSD $840
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $58,710
    Amount paid for insurance broker fees840
    Insurance broker organization code?3
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number303364
    Policy instance 2
    Insurance contract or identification number303364
    Number of Individuals Covered61
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $6,600
    Health Insurance Welfare BenefitYes
    Other welfare benefits providedMEDICARE LPPO
    Welfare Benefit Premiums Paid to CarrierUSD $148,379
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $0
    Amount paid for insurance broker fees6600
    Additional information about fees paid to insurance brokerBROKER RETENSION BONUS
    Insurance broker organization code?3
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract number119045
    Policy instance 1
    Insurance contract or identification number119045
    Number of Individuals Covered2
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $924
    Total amount of fees paid to insurance companyUSD $6
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $924
    Amount paid for insurance broker fees6
    Additional information about fees paid to insurance brokerMISCELLANEOUS ADMIN
    Insurance broker organization code?3
    EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number10203001001
    Policy instance 6
    Insurance contract or identification number10203001001
    Number of Individuals Covered487
    Insurance policy start date2021-01-01
    Insurance policy end date2021-12-31
    Total amount of commissions paid to insurance brokerUSD $4,316
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $40,068
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,316
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number936298
    Policy instance 4
    Insurance contract or identification number936298
    Number of Individuals Covered218
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $14,118
    Total amount of fees paid to insurance companyUSD $1,504
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D, EMPLOYEE ASSIST PLAN
    Welfare Benefit Premiums Paid to CarrierUSD $125,704
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $14,118
    Amount paid for insurance broker fees1504
    Additional information about fees paid to insurance brokerEAP CONTRACT ADMINISTRATION
    Insurance broker organization code?3
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract number119045
    Policy instance 1
    Insurance contract or identification number119045
    Number of Individuals Covered2
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $476
    Total amount of fees paid to insurance companyUSD $6
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $476
    Amount paid for insurance broker fees6
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number303364
    Policy instance 2
    Insurance contract or identification number303364
    Number of Individuals Covered58
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $7,000
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $190,313
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,000
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
    Policy contract number00119045/0005
    Policy instance 3
    Insurance contract or identification number00119045/0005
    Number of Individuals Covered285
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $30,252
    Total amount of fees paid to insurance companyUSD $852
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $30,252
    Amount paid for insurance broker fees852
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
    Policy contract number7907
    Policy instance 5
    Insurance contract or identification number7907
    Number of Individuals Covered465
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $6,036
    Total amount of fees paid to insurance companyUSD $627
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,036
    Amount paid for insurance broker fees627
    Additional information about fees paid to insurance brokerOTHER COMPENSATION
    Insurance broker organization code?3
    EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number10203001001
    Policy instance 6
    Insurance contract or identification number10203001001
    Number of Individuals Covered461
    Insurance policy start date2020-01-01
    Insurance policy end date2020-12-31
    Total amount of commissions paid to insurance brokerUSD $3,950
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $39,503
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,950
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number303364
    Policy instance 3
    Insurance contract or identification number303364
    Number of Individuals Covered50
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $5,000
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $131,276
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,000
    Insurance broker organization code?3
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number568525
    Policy instance 1
    Insurance contract or identification number568525
    Number of Individuals Covered157
    Insurance policy start date2018-06-01
    Insurance policy end date2019-06-01
    Total amount of commissions paid to insurance brokerUSD $11,882
    Total amount of fees paid to insurance companyUSD $906
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $170,465
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,882
    Amount paid for insurance broker fees906
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract number119045
    Policy instance 2
    Insurance contract or identification number119045
    Number of Individuals Covered2
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $-702
    Total amount of fees paid to insurance companyUSD $18
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $-702
    Amount paid for insurance broker fees18
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number000000568525
    Policy instance 10
    Insurance contract or identification number000000568525
    Number of Individuals Covered150
    Insurance policy start date2019-06-01
    Insurance policy end date2019-11-01
    Total amount of commissions paid to insurance brokerUSD $7,205
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedADD
    Welfare Benefit Premiums Paid to CarrierUSD $60,816
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,205
    Insurance broker organization code?3
    BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
    Policy contract number00119045/0005
    Policy instance 4
    Insurance contract or identification number00119045/0005
    Number of Individuals Covered287
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $44,718
    Total amount of fees paid to insurance companyUSD $1,722
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $44,718
    Amount paid for insurance broker fees1722
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number936298
    Policy instance 5
    Insurance contract or identification number936298
    Number of Individuals Covered218
    Insurance policy start date2019-11-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $257
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $17,319
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees257
    Additional information about fees paid to insurance brokerEAP FEE
    Insurance broker organization code?3
    DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
    Policy contract number7907
    Policy instance 6
    Insurance contract or identification number7907
    Number of Individuals Covered447
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $6,285
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,285
    Insurance broker organization code?3
    EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
    Policy contract number10203001001
    Policy instance 7
    Insurance contract or identification number10203001001
    Number of Individuals Covered446
    Insurance policy start date2019-01-01
    Insurance policy end date2019-12-31
    Total amount of commissions paid to insurance brokerUSD $3,505
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $38,253
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,505
    Insurance broker organization code?3
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract number119045
    Policy instance 8
    Insurance contract or identification number119045
    Number of Individuals Covered428
    Insurance policy start date2018-02-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $14,406
    Total amount of fees paid to insurance companyUSD $21
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $14,406
    Amount paid for insurance broker fees21
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
    Policy contract number119045 / 0005
    Policy instance 9
    Insurance contract or identification number119045 / 0005
    Number of Individuals Covered280
    Insurance policy start date2018-02-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $30,385
    Total amount of fees paid to insurance companyUSD $1,867
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $30,385
    Amount paid for insurance broker fees1867
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
    Policy contract number00119045/0005
    Policy instance 5
    Insurance contract or identification number00119045/0005
    Number of Individuals Covered261
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $29,712
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $29,712
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number303374
    Policy instance 4
    Insurance contract or identification number303374
    Number of Individuals Covered5
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $16,378
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Insurance broker organization code?3
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract number303364
    Policy instance 3
    Insurance contract or identification number303364
    Number of Individuals Covered43
    Insurance policy start date2018-01-01
    Insurance policy end date2018-12-31
    Total amount of commissions paid to insurance brokerUSD $2,550
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $149,148
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,550
    Insurance broker organization code?3
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract number119045
    Policy instance 2
    Insurance contract or identification number119045
    Number of Individuals Covered404
    Insurance policy start date2017-02-01
    Insurance policy end date2018-01-31
    Total amount of commissions paid to insurance brokerUSD $11,648
    Total amount of fees paid to insurance companyUSD $583
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,648
    Amount paid for insurance broker fees583
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number568525
    Policy instance 1
    Insurance contract or identification number568525
    Number of Individuals Covered114
    Insurance policy start date2017-06-01
    Insurance policy end date2018-06-01
    Total amount of commissions paid to insurance brokerUSD $9,574
    Total amount of fees paid to insurance companyUSD $1,152
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $167,294
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,574
    Amount paid for insurance broker fees1152
    Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
    Insurance broker organization code?3
    BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
    Policy contract number00119045/0005
    Policy instance 5
    Insurance contract or identification number00119045/0005
    Number of Individuals Covered244
    Insurance policy start date2016-02-01
    Insurance policy end date2017-01-31
    Total amount of commissions paid to insurance brokerUSD $34,200
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,329,688
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $34,200
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 69671 )
    Policy contract numberR4696
    Policy instance 4
    Insurance contract or identification numberR4696
    Number of Individuals Covered4
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $200
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $12,751
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $200
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract numberR4693
    Policy instance 3
    Insurance contract or identification numberR4693
    Number of Individuals Covered41
    Insurance policy start date2017-01-01
    Insurance policy end date2017-12-31
    Total amount of commissions paid to insurance brokerUSD $2,550
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $127,507
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,550
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract number119045
    Policy instance 2
    Insurance contract or identification number119045
    Number of Individuals Covered374
    Insurance policy start date2016-02-01
    Insurance policy end date2017-01-31
    Total amount of commissions paid to insurance brokerUSD $9,339
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,339
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number568525
    Policy instance 1
    Insurance contract or identification number568525
    Number of Individuals Covered196
    Insurance policy start date2016-06-01
    Insurance policy end date2017-06-01
    Total amount of commissions paid to insurance brokerUSD $11,181
    Total amount of fees paid to insurance companyUSD $1,246
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $166,113
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,181
    Amount paid for insurance broker fees1246
    Additional information about fees paid to insurance brokerADDITIONAL AGENT COMPENSATION
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number568525
    Policy instance 1
    Insurance contract or identification number568525
    Number of Individuals Covered184
    Insurance policy start date2014-06-01
    Insurance policy end date2015-05-31
    Total amount of commissions paid to insurance brokerUSD $10,617
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $142,878
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $10,617
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract numberR4693
    Policy instance 3
    Insurance contract or identification numberR4693
    Number of Individuals Covered36
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $2,800
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $107,153
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,800
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 69671 )
    Policy contract numberR4696
    Policy instance 4
    Insurance contract or identification numberR4696
    Number of Individuals Covered3
    Insurance policy start date2015-01-01
    Insurance policy end date2015-12-31
    Total amount of commissions paid to insurance brokerUSD $150
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $9,075
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $150
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract numberGRP 42618
    Policy instance 2
    Insurance contract or identification numberGRP 42618
    Number of Individuals Covered373
    Insurance policy start date2014-02-01
    Insurance policy end date2015-01-31
    Total amount of commissions paid to insurance brokerUSD $45,647
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $45,647
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number568525
    Policy instance 1
    Insurance contract or identification number568525
    Number of Individuals Covered175
    Insurance policy start date2013-06-01
    Insurance policy end date2014-05-31
    Total amount of commissions paid to insurance brokerUSD $8,961
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $155,663
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $8,961
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract numberGRP 42618
    Policy instance 2
    Insurance contract or identification numberGRP 42618
    Number of Individuals Covered367
    Insurance policy start date2013-02-01
    Insurance policy end date2014-01-31
    Total amount of commissions paid to insurance brokerUSD $48,519
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $48,519
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract numberR4693
    Policy instance 3
    Insurance contract or identification numberR4693
    Number of Individuals Covered33
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $2,100
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $78,859
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,100
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 69671 )
    Policy contract numberR4696
    Policy instance 4
    Insurance contract or identification numberR4696
    Number of Individuals Covered3
    Insurance policy start date2014-01-01
    Insurance policy end date2014-12-31
    Total amount of commissions paid to insurance brokerUSD $150
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $8,165
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $150
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 69671 )
    Policy contract numberR4696
    Policy instance 4
    Insurance contract or identification numberR4696
    Number of Individuals Covered3
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $150
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $6,633
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $150
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number568525
    Policy instance 1
    Insurance contract or identification number568525
    Number of Individuals Covered159
    Insurance policy start date2012-06-01
    Insurance policy end date2013-05-31
    Total amount of commissions paid to insurance brokerUSD $9,995
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $145,739
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,995
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract numberGRP 42618
    Policy instance 2
    Insurance contract or identification numberGRP 42618
    Number of Individuals Covered347
    Insurance policy start date2012-02-01
    Insurance policy end date2013-01-31
    Total amount of commissions paid to insurance brokerUSD $46,741
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $46,741
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract numberR4693
    Policy instance 3
    Insurance contract or identification numberR4693
    Number of Individuals Covered24
    Insurance policy start date2013-01-01
    Insurance policy end date2013-12-31
    Total amount of commissions paid to insurance brokerUSD $1,750
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $53,265
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,750
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number568525
    Policy instance 1
    Insurance contract or identification number568525
    Number of Individuals Covered156
    Insurance policy start date2011-06-01
    Insurance policy end date2012-05-31
    Total amount of commissions paid to insurance brokerUSD $11,468
    Total amount of fees paid to insurance companyUSD $731
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $157,575
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $11,468
    Amount paid for insurance broker fees731
    Additional information about fees paid to insurance brokerBROKER BONUS.
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
    Policy contract numberGRP 42618
    Policy instance 2
    Insurance contract or identification numberGRP 42618
    Number of Individuals Covered338
    Insurance policy start date2011-02-01
    Insurance policy end date2012-01-31
    Total amount of commissions paid to insurance brokerUSD $39,024
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $39,024
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract numberR4693
    Policy instance 3
    Insurance contract or identification numberR4693
    Number of Individuals Covered22
    Insurance policy start date2012-01-01
    Insurance policy end date2012-12-31
    Total amount of commissions paid to insurance brokerUSD $1,500
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $55,759
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,500
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
    Policy contract numberR2718
    Policy instance 3
    Insurance contract or identification numberR2718
    Number of Individuals Covered19
    Insurance policy start date2011-01-01
    Insurance policy end date2011-12-31
    Total amount of commissions paid to insurance brokerUSD $3,150
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $42,016
    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 number568525
    Policy instance 1
    Insurance contract or identification number568525
    Number of Individuals Covered154
    Insurance policy start date2010-06-01
    Insurance policy end date2011-05-31
    Total amount of commissions paid to insurance brokerUSD $9,842
    Total amount of fees paid to insurance companyUSD $357
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $142,768
    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 numberGRP 42618
    Policy instance 2
    Insurance contract or identification numberGRP 42618
    Number of Individuals Covered340
    Insurance policy start date2010-02-01
    Insurance policy end date2011-01-31
    Total amount of commissions paid to insurance brokerUSD $46,021
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PHYSICIANS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95849 )
    Policy contract numberL0001337-1000
    Policy instance 3
    Insurance contract or identification numberL0001337-1000
    Number of Individuals Covered260
    Insurance policy start date2009-02-01
    Insurance policy end date2010-01-31
    Total amount of commissions paid to insurance brokerUSD $39,822
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,272,659
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $39,545
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker namePAULA HOWARD
    UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
    Policy contract number568525
    Policy instance 2
    Insurance contract or identification number568525
    Number of Individuals Covered154
    Insurance policy start date2009-06-01
    Insurance policy end date2010-05-31
    Total amount of commissions paid to insurance brokerUSD $9,837
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D
    Welfare Benefit Premiums Paid to CarrierUSD $130,392
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,837
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
    Policy contract number3903
    Policy instance 1
    Insurance contract or identification number3903
    Number of Individuals Covered150
    Insurance policy start date2010-01-01
    Insurance policy end date2010-12-31
    Total amount of commissions paid to insurance brokerUSD $1,427
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Dental Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,427
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.
    VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
    Policy contract number30006774
    Policy instance 4
    Insurance contract or identification number30006774
    Number of Individuals Covered150
    Insurance policy start date2010-01-01
    Insurance policy end date2010-01-31
    Total amount of commissions paid to insurance brokerUSD $71
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $3,071
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $71
    Amount paid for insurance broker fees0
    Insurance broker organization code?3
    Insurance broker nameCENTENNIAL EMPLOYEE BENEFITS, INC.

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