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MEIJER EXECUTIVE HEALTH PLAN 401k Plan overview

Plan NameMEIJER EXECUTIVE HEALTH PLAN
Plan identification number 510

MEIJER EXECUTIVE HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Supplemental unemployment
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Other welfare benefit cover

401k Sponsoring company profile

MEIJER, INC. has sponsored the creation of one or more 401k plans.

Company Name:MEIJER, INC.
Employer identification number (EIN):381274536

Additional information about MEIJER, INC.

Jurisdiction of Incorporation: Michigan Secretary of State
Incorporation Date: 0000-00-00
Company Identification Number: 060239
Legal Registered Office Address: TELEGRAPH ROAD STE 2345 BINGHAM FARMS 48025


United States of America (USA)
30600

More information about MEIJER, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEIJER EXECUTIVE HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102022-01-30BRADLEY J. FREIBURGER2023-11-08 JAMIE L. LARSON2023-11-08
5102021-01-31BRADLEY J. FREIBURGER2022-11-02 JAMIE L. LARSON2022-10-31
5102020-02-02BRADLEY J. FREIBURGER2021-11-03 JAMIE L. LARSON2021-11-03
5102019-02-02DANIEL E. WEBB2020-11-11 JAMIE L. LARSON2020-11-11
5102018-02-01DANIEL E. WEBB2019-11-07 JAMIE L. LARSON2019-11-07
5102017-02-01
5102016-02-01
5102015-02-01
5102014-02-01
5102013-02-01
5102012-02-01DANIEL E. WEBB
5102011-02-01DANIEL E. WEBB
5102010-02-01DANIEL E. WEBB
5102009-02-01DANIEL WEBB MICHAEL R JULIEN2010-11-10

Plan Statistics for MEIJER EXECUTIVE HEALTH PLAN

401k plan membership statisitcs for MEIJER EXECUTIVE HEALTH PLAN

Measure Date Value
2022: MEIJER EXECUTIVE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-3089
Total number of active participants reported on line 7a of the Form 55002022-01-3057
Number of retired or separated participants receiving benefits2022-01-3037
Total of all active and inactive participants2022-01-3094
2021: MEIJER EXECUTIVE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-3188
Total number of active participants reported on line 7a of the Form 55002021-01-3159
Number of retired or separated participants receiving benefits2021-01-3130
Number of other retired or separated participants entitled to future benefits2021-01-310
Total of all active and inactive participants2021-01-3189
2020: MEIJER EXECUTIVE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-0288
Total number of active participants reported on line 7a of the Form 55002020-02-0259
Number of retired or separated participants receiving benefits2020-02-0229
Total of all active and inactive participants2020-02-0288
2019: MEIJER EXECUTIVE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-0292
Total number of active participants reported on line 7a of the Form 55002019-02-0258
Number of retired or separated participants receiving benefits2019-02-0230
Total of all active and inactive participants2019-02-0288
2018: MEIJER EXECUTIVE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-0192
Total number of active participants reported on line 7a of the Form 55002018-02-0156
Number of retired or separated participants receiving benefits2018-02-0136
Total of all active and inactive participants2018-02-0192
2017: MEIJER EXECUTIVE HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-02-0194
Total number of active participants reported on line 7a of the Form 55002017-02-0163
Number of retired or separated participants receiving benefits2017-02-0129
Total of all active and inactive participants2017-02-0192
2016: MEIJER EXECUTIVE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-02-0192
Total number of active participants reported on line 7a of the Form 55002016-02-0168
Number of retired or separated participants receiving benefits2016-02-0126
Total of all active and inactive participants2016-02-0194
2015: MEIJER EXECUTIVE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-0168
Total number of active participants reported on line 7a of the Form 55002015-02-0172
Number of retired or separated participants receiving benefits2015-02-0120
Total of all active and inactive participants2015-02-0192
2014: MEIJER EXECUTIVE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-02-0166
Total number of active participants reported on line 7a of the Form 55002014-02-0166
Number of retired or separated participants receiving benefits2014-02-012
Total of all active and inactive participants2014-02-0168
2013: MEIJER EXECUTIVE HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-02-0168
Total number of active participants reported on line 7a of the Form 55002013-02-0159
Number of retired or separated participants receiving benefits2013-02-017
Total of all active and inactive participants2013-02-0166
2012: MEIJER EXECUTIVE HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-02-0164
Total number of active participants reported on line 7a of the Form 55002012-02-0164
Number of retired or separated participants receiving benefits2012-02-014
Total of all active and inactive participants2012-02-0168
2011: MEIJER EXECUTIVE HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-02-0165
Total number of active participants reported on line 7a of the Form 55002011-02-0159
Number of retired or separated participants receiving benefits2011-02-015
Total of all active and inactive participants2011-02-0164
2010: MEIJER EXECUTIVE HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-02-0187
Total number of active participants reported on line 7a of the Form 55002010-02-0159
Number of retired or separated participants receiving benefits2010-02-016
Total of all active and inactive participants2010-02-0165
2009: MEIJER EXECUTIVE HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-02-0192
Total number of active participants reported on line 7a of the Form 55002009-02-0162
Number of retired or separated participants receiving benefits2009-02-0125
Total of all active and inactive participants2009-02-0187
Total participants2009-02-0187

Financial Data on MEIJER EXECUTIVE HEALTH PLAN

Measure Date Value
2023 : MEIJER EXECUTIVE HEALTH PLAN 2023 401k financial data
Total income from all sources2023-01-28$2,169,729
Expenses. Total of all expenses incurred2023-01-28$2,169,729
Benefits paid (including direct rollovers)2023-01-28$2,169,729
Value of fidelity bond covering the plan2023-01-28$500,000
Total contributions received or receivable from participants2023-01-28$563,869
Net income (gross income less expenses)2023-01-28$0
Total contributions received or receivable from employer(s)2023-01-28$1,605,860
2022 : MEIJER EXECUTIVE HEALTH PLAN 2022 401k financial data
Total income from all sources2022-01-29$2,056,588
Expenses. Total of all expenses incurred2022-01-29$2,056,588
Benefits paid (including direct rollovers)2022-01-29$2,056,588
Value of fidelity bond covering the plan2022-01-29$500,000
Total contributions received or receivable from participants2022-01-29$552,463
Net income (gross income less expenses)2022-01-29$0
Total contributions received or receivable from employer(s)2022-01-29$1,504,125
2021 : MEIJER EXECUTIVE HEALTH PLAN 2021 401k financial data
Total income from all sources2021-01-30$1,988,878
Expenses. Total of all expenses incurred2021-01-30$1,988,878
Benefits paid (including direct rollovers)2021-01-30$1,988,878
Value of fidelity bond covering the plan2021-01-30$500,000
Total contributions received or receivable from participants2021-01-30$523,845
Net income (gross income less expenses)2021-01-30$0
Total contributions received or receivable from employer(s)2021-01-30$1,465,033
2020 : MEIJER EXECUTIVE HEALTH PLAN 2020 401k financial data
Total income from all sources2020-02-01$1,882,533
Expenses. Total of all expenses incurred2020-02-01$1,882,533
Benefits paid (including direct rollovers)2020-02-01$1,882,533
Value of fidelity bond covering the plan2020-02-01$500,000
Total contributions received or receivable from participants2020-02-01$795,001
Net income (gross income less expenses)2020-02-01$0
Total contributions received or receivable from employer(s)2020-02-01$1,087,532
2018 : MEIJER EXECUTIVE HEALTH PLAN 2018 401k financial data
Total income from all sources2018-01-31$2,109,273
Expenses. Total of all expenses incurred2018-01-31$2,109,273
Benefits paid (including direct rollovers)2018-01-31$2,109,273
Value of fidelity bond covering the plan2018-01-31$500,000
Total contributions received or receivable from participants2018-01-31$572,808
Net income (gross income less expenses)2018-01-31$0
Total contributions received or receivable from employer(s)2018-01-31$1,536,465
2017 : MEIJER EXECUTIVE HEALTH PLAN 2017 401k financial data
Total income from all sources2017-01-31$2,091,548
Expenses. Total of all expenses incurred2017-01-31$2,091,548
Benefits paid (including direct rollovers)2017-01-31$2,091,548
Total contributions received or receivable from participants2017-01-31$586,993
Net income (gross income less expenses)2017-01-31$0
Total contributions received or receivable from employer(s)2017-01-31$1,504,555
2016 : MEIJER EXECUTIVE HEALTH PLAN 2016 401k financial data
Total income from all sources2016-01-31$2,333,064
Expenses. Total of all expenses incurred2016-01-31$2,333,064
Benefits paid (including direct rollovers)2016-01-31$2,333,064
Total contributions received or receivable from participants2016-01-31$594,042
Net income (gross income less expenses)2016-01-31$0
Total contributions received or receivable from employer(s)2016-01-31$1,739,022
2015 : MEIJER EXECUTIVE HEALTH PLAN 2015 401k financial data
Total income from all sources2015-01-31$2,070,472
Expenses. Total of all expenses incurred2015-01-31$2,070,472
Benefits paid (including direct rollovers)2015-01-31$2,070,472
Total contributions received or receivable from participants2015-01-31$563,472
Net income (gross income less expenses)2015-01-31$0
Total contributions received or receivable from employer(s)2015-01-31$1,507,000
2014 : MEIJER EXECUTIVE HEALTH PLAN 2014 401k financial data
Total income from all sources2014-01-31$1,955,892
Expenses. Total of all expenses incurred2014-01-31$1,955,892
Benefits paid (including direct rollovers)2014-01-31$1,955,892
Total contributions received or receivable from participants2014-01-31$534,360
Net income (gross income less expenses)2014-01-31$0
Total contributions received or receivable from employer(s)2014-01-31$1,421,532
2013 : MEIJER EXECUTIVE HEALTH PLAN 2013 401k financial data
Total income from all sources2013-01-31$1,889,043
Expenses. Total of all expenses incurred2013-01-31$1,889,043
Benefits paid (including direct rollovers)2013-01-31$1,889,043
Total contributions received or receivable from participants2013-01-31$487,403
Net income (gross income less expenses)2013-01-31$0
Total contributions received or receivable from employer(s)2013-01-31$1,401,640
2012 : MEIJER EXECUTIVE HEALTH PLAN 2012 401k financial data
Total income from all sources2012-01-31$1,719,526
Expenses. Total of all expenses incurred2012-01-31$1,719,526
Benefits paid (including direct rollovers)2012-01-31$1,719,526
Total contributions received or receivable from participants2012-01-31$445,530
Net income (gross income less expenses)2012-01-31$0
Net plan assets at end of year (total assets less liabilities)2012-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2012-01-31$0
Total contributions received or receivable from employer(s)2012-01-31$1,273,996
2011 : MEIJER EXECUTIVE HEALTH PLAN 2011 401k financial data
Total income from all sources2011-01-31$1,995,345
Expenses. Total of all expenses incurred2011-01-31$1,995,345
Benefits paid (including direct rollovers)2011-01-31$1,995,345
Total plan assets at end of year2011-01-31$0
Total plan assets at beginning of year2011-01-31$0
Total contributions received or receivable from participants2011-01-31$394,216
Net income (gross income less expenses)2011-01-31$0
Net plan assets at end of year (total assets less liabilities)2011-01-31$0
Net plan assets at beginning of year (total assets less liabilities)2011-01-31$0
Total contributions received or receivable from employer(s)2011-01-31$1,601,129

Form 5500 Responses for MEIJER EXECUTIVE HEALTH PLAN

2022: MEIJER EXECUTIVE HEALTH PLAN 2022 form 5500 responses
2022-01-30Type of plan entitySingle employer plan
2022-01-30This return/report is a short plan year return/report (less than 12 months)Yes
2022-01-30Plan funding arrangement – InsuranceYes
2022-01-30Plan funding arrangement – TrustYes
2022-01-30Plan benefit arrangement – InsuranceYes
2022-01-30Plan benefit arrangement - TrustYes
2021: MEIJER EXECUTIVE HEALTH PLAN 2021 form 5500 responses
2021-01-31Type of plan entitySingle employer plan
2021-01-31This return/report is a short plan year return/report (less than 12 months)Yes
2021-01-31Plan funding arrangement – InsuranceYes
2021-01-31Plan funding arrangement – TrustYes
2021-01-31Plan benefit arrangement – InsuranceYes
2021-01-31Plan benefit arrangement - TrustYes
2020: MEIJER EXECUTIVE HEALTH PLAN 2020 form 5500 responses
2020-02-02Type of plan entitySingle employer plan
2020-02-02This return/report is a short plan year return/report (less than 12 months)Yes
2020-02-02Plan funding arrangement – InsuranceYes
2020-02-02Plan funding arrangement – TrustYes
2020-02-02Plan benefit arrangement – InsuranceYes
2020-02-02Plan benefit arrangement - TrustYes
2019: MEIJER EXECUTIVE HEALTH PLAN 2019 form 5500 responses
2019-02-02Type of plan entitySingle employer plan
2019-02-02Plan funding arrangement – InsuranceYes
2019-02-02Plan funding arrangement – TrustYes
2019-02-02Plan benefit arrangement – InsuranceYes
2019-02-02Plan benefit arrangement - TrustYes
2018: MEIJER EXECUTIVE HEALTH PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan funding arrangement – TrustYes
2018-02-01Plan benefit arrangement – InsuranceYes
2018-02-01Plan benefit arrangement - TrustYes
2017: MEIJER EXECUTIVE HEALTH PLAN 2017 form 5500 responses
2017-02-01Type of plan entitySingle employer plan
2017-02-01Plan funding arrangement – InsuranceYes
2017-02-01Plan funding arrangement – TrustYes
2017-02-01Plan benefit arrangement – InsuranceYes
2017-02-01Plan benefit arrangement - TrustYes
2016: MEIJER EXECUTIVE HEALTH PLAN 2016 form 5500 responses
2016-02-01Type of plan entitySingle employer plan
2016-02-01Plan funding arrangement – InsuranceYes
2016-02-01Plan funding arrangement – TrustYes
2016-02-01Plan benefit arrangement – InsuranceYes
2016-02-01Plan benefit arrangement - TrustYes
2015: MEIJER EXECUTIVE HEALTH PLAN 2015 form 5500 responses
2015-02-01Type of plan entitySingle employer plan
2015-02-01Plan funding arrangement – InsuranceYes
2015-02-01Plan funding arrangement – TrustYes
2015-02-01Plan benefit arrangement – InsuranceYes
2015-02-01Plan benefit arrangement - TrustYes
2014: MEIJER EXECUTIVE HEALTH PLAN 2014 form 5500 responses
2014-02-01Type of plan entitySingle employer plan
2014-02-01Plan funding arrangement – InsuranceYes
2014-02-01Plan funding arrangement – TrustYes
2014-02-01Plan benefit arrangement – InsuranceYes
2014-02-01Plan benefit arrangement - TrustYes
2013: MEIJER EXECUTIVE HEALTH PLAN 2013 form 5500 responses
2013-02-01Type of plan entitySingle employer plan
2013-02-01Plan funding arrangement – InsuranceYes
2013-02-01Plan funding arrangement – TrustYes
2013-02-01Plan benefit arrangement – InsuranceYes
2013-02-01Plan benefit arrangement - TrustYes
2012: MEIJER EXECUTIVE HEALTH PLAN 2012 form 5500 responses
2012-02-01Type of plan entitySingle employer plan
2012-02-01Plan funding arrangement – InsuranceYes
2012-02-01Plan funding arrangement – TrustYes
2012-02-01Plan benefit arrangement – InsuranceYes
2012-02-01Plan benefit arrangement - TrustYes
2011: MEIJER EXECUTIVE HEALTH PLAN 2011 form 5500 responses
2011-02-01Type of plan entitySingle employer plan
2011-02-01Plan funding arrangement – InsuranceYes
2011-02-01Plan funding arrangement – TrustYes
2011-02-01Plan benefit arrangement – InsuranceYes
2011-02-01Plan benefit arrangement - TrustYes
2010: MEIJER EXECUTIVE HEALTH PLAN 2010 form 5500 responses
2010-02-01Type of plan entitySingle employer plan
2010-02-01Plan funding arrangement – InsuranceYes
2010-02-01Plan funding arrangement – TrustYes
2010-02-01Plan benefit arrangement – InsuranceYes
2010-02-01Plan benefit arrangement - TrustYes
2009: MEIJER EXECUTIVE HEALTH PLAN 2009 form 5500 responses
2009-02-01Type of plan entitySingle employer plan
2009-02-01Submission has been amendedNo
2009-02-01This submission is the final filingNo
2009-02-01This return/report is a short plan year return/report (less than 12 months)No
2009-02-01Plan is a collectively bargained planNo
2009-02-01Plan funding arrangement – InsuranceYes
2009-02-01Plan funding arrangement – TrustYes
2009-02-01Plan funding arrangement – General assets of the sponsorYes
2009-02-01Plan benefit arrangement – InsuranceYes
2009-02-01Plan benefit arrangement - TrustYes
2009-02-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number100564
Policy instance 1
Insurance contract or identification number100564
Number of Individuals Covered263
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $111,720
Total amount of fees paid to insurance companyUSD $1,766
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 $111,720
Amount paid for insurance broker fees1766
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number100564
Policy instance 1
Insurance contract or identification number100564
Number of Individuals Covered252
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $73,392
Total amount of fees paid to insurance companyUSD $192,556
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
Amount paid for insurance broker fees192556
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $73,392
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number100564
Policy instance 1
Insurance contract or identification number100564
Number of Individuals Covered249
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $179,792
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 $94,651
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number100564
Policy instance 1
Insurance contract or identification number100564
Number of Individuals Covered248
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $59,364
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 $59,364
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number71432
Policy instance 1
Insurance contract or identification number71432
Number of Individuals Covered261
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $74,748
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 $74,748
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number71432
Policy instance 1
Insurance contract or identification number71432
Number of Individuals Covered269
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $73,498
Total amount of fees paid to insurance companyUSD $137
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 $73,498
Amount paid for insurance broker fees137
Additional information about fees paid to insurance brokerSALES AND SERVICES
Insurance broker organization code?3
Insurance broker namePATRICK R. COLEMAN
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number71432
Policy instance 1
Insurance contract or identification number71432
Number of Individuals Covered281
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $76,560
Total amount of fees paid to insurance companyUSD $1,403
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,558,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $76,560
Amount paid for insurance broker fees1403
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
Insurance broker namePATRICK R. COLEMAN
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number71432
Policy instance 1
Insurance contract or identification number71432
Number of Individuals Covered261
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $70,932
Total amount of fees paid to insurance companyUSD $10,750
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
Welfare Benefit Premiums Paid to CarrierUSD $2,392,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,932
Amount paid for insurance broker fees10750
Additional information about fees paid to insurance brokerSALES AND SERVICE
Insurance broker organization code?3
Insurance broker namePATRICK R. COLEMAN
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number71432
Policy instance 1
Insurance contract or identification number71432
Number of Individuals Covered258
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $64,691
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
Welfare Benefit Premiums Paid to CarrierUSD $2,336,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,691
Insurance broker organization code?3
Insurance broker namePATRICK R. COLEMAN
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number71432
Policy instance 1
Insurance contract or identification number71432
Number of Individuals Covered261
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $53,148
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
Welfare Benefit Premiums Paid to CarrierUSD $2,329,607
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,148
Insurance broker organization code?3
Insurance broker namePATRICK R. COLEMAN
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number71432
Policy instance 1
Insurance contract or identification number71432
Number of Individuals Covered256
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $50,340
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
Welfare Benefit Premiums Paid to CarrierUSD $2,098,719
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 number71432
Policy instance 1
Insurance contract or identification number71432
Number of Individuals Covered278
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $54,166
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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