401k Plan data: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN plan

FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 401k Plan overview

Plan Name	FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN
Plan identification number	501

FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover

401k Sponsoring company profile

FUTURAMIC TOOL & ENGINEERING CO. has sponsored the creation of one or more 401k plans.

Company Name: FUTURAMIC TOOL & ENGINEERING CO.

Employer identification number (EIN): 381528262

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 JOHN COUCH 2023-10-11
501 2021-01-01 JOHN COUCH 2022-10-01
501 2020-01-01 JOHN COUCH 2021-10-13
501 2019-01-01 JOHN COUCH 2020-09-25
501 2018-01-01 JOHN COUCH 2019-10-07
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2015-01-01
501 2013-12-01
501 2012-12-01 MICHAEL SCOTT
501 2011-12-01 SANDRA TROUSDALE
501 2009-12-01 GORDON CZISCHKE
501 2008-12-01

Plan Statistics for FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN

401k plan membership statisitcs for FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN

Measure Date Value
2022: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 185
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 174
Total of all active and inactive participants 2022-01-01 174
2021: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 208
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 185
Total of all active and inactive participants 2021-01-01 185
2020: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 235
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 208
Total of all active and inactive participants 2020-01-01 208
2019: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 244
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 235
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 235
2018: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 239
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 244
Total of all active and inactive participants 2018-01-01 244
2017: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 227
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 239
Total of all active and inactive participants 2017-01-01 239
2016: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 189
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 227
Total of all active and inactive participants 2016-01-01 227
2015: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 174
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 189
Total of all active and inactive participants 2015-01-01 189
2013: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-12-01 147
Total number of active participants reported on line 7a of the Form 5500 2013-12-01 174
Total of all active and inactive participants 2013-12-01 174
2012: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-12-01 136
Total number of active participants reported on line 7a of the Form 5500 2012-12-01 147
Total of all active and inactive participants 2012-12-01 147
2011: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-12-01 128
Total number of active participants reported on line 7a of the Form 5500 2011-12-01 136
Total of all active and inactive participants 2011-12-01 136
2009: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-12-01 112
Total number of active participants reported on line 7a of the Form 5500 2009-12-01 127
Number of retired or separated participants receiving benefits 2009-12-01 1
Total of all active and inactive participants 2009-12-01 128

Measure	Date	Value
2022: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	185
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	174
Total of all active and inactive participants	2022-01-01	174
2021: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	208
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	185
Total of all active and inactive participants	2021-01-01	185
2020: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	235
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	208
Total of all active and inactive participants	2020-01-01	208
2019: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	244
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	235
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	235
2018: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	239
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	244
Total of all active and inactive participants	2018-01-01	244
2017: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	227
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	239
Total of all active and inactive participants	2017-01-01	239
2016: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	189
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	227
Total of all active and inactive participants	2016-01-01	227
2015: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	174
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	189
Total of all active and inactive participants	2015-01-01	189
2013: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-12-01	147
Total number of active participants reported on line 7a of the Form 5500	2013-12-01	174
Total of all active and inactive participants	2013-12-01	174
2012: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-12-01	136
Total number of active participants reported on line 7a of the Form 5500	2012-12-01	147
Total of all active and inactive participants	2012-12-01	147
2011: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-12-01	128
Total number of active participants reported on line 7a of the Form 5500	2011-12-01	136
Total of all active and inactive participants	2011-12-01	136
2009: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-12-01	112
Total number of active participants reported on line 7a of the Form 5500	2009-12-01	127
Number of retired or separated participants receiving benefits	2009-12-01	1
Total of all active and inactive participants	2009-12-01	128

Form 5500 Responses for FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN

2022: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2021: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2020: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2019: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2018: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2017: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2016: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2015: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-12-01	Type of plan entity	Single employer plan
2013-12-01	Submission has been amended	Yes
2013-12-01	Plan funding arrangement – Insurance	Yes
2013-12-01	Plan benefit arrangement – Insurance	Yes
2012: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-12-01	Type of plan entity	Single employer plan
2012-12-01	Plan funding arrangement – Insurance	Yes
2012-12-01	Plan benefit arrangement – Insurance	Yes
2011: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-12-01	Type of plan entity	Single employer plan
2011-12-01	Plan funding arrangement – Insurance	Yes
2011-12-01	Plan benefit arrangement – Insurance	Yes
2009: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-12-01	Type of plan entity	Single employer plan
2009-12-01	This submission is the final filing	No
2009-12-01	Plan funding arrangement – Insurance	Yes
2009-12-01	Plan benefit arrangement – Insurance	Yes
2008: FUTURAMIC TOOL & ENGINEERING COMPANY WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-12-01	Type of plan entity	Single employer plan
2008-12-01	Submission has been amended	No
2008-12-01	This submission is the final filing	No
2008-12-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-12-01	Plan is a collectively bargained plan	No

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010268361

Policy instance

Insurance contract or identification number	000010268361
Number of Individuals Covered	200
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $979
Total amount of fees paid to insurance company	USD $700
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $6,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $979
Amount paid for insurance broker fees	647
Insurance broker organization code?	3

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

Policy contract number

135613

Policy instance

Insurance contract or identification number	135613
Number of Individuals Covered	174
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $13,076
Total amount of fees paid to insurance company	USD $54,067
Welfare Benefit Premiums Paid to Carrier	USD $309,277
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,974
Amount paid for insurance broker fees	33272
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

5345

Policy instance

Insurance contract or identification number	5345
Number of Individuals Covered	407
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,486
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,486
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

8773

Policy instance

Insurance contract or identification number	8773
Number of Individuals Covered	376
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $2,884
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $28,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,884
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

00040001000

Policy instance

Insurance contract or identification number	00040001000
Number of Individuals Covered	143
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $11,454
Total amount of fees paid to insurance company	USD $8,218
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $76,362
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,454
Amount paid for insurance broker fees	7599
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010268362

Policy instance

Insurance contract or identification number	000010268362
Number of Individuals Covered	200
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $6,173
Total amount of fees paid to insurance company	USD $5,014
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $41,156
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,173
Amount paid for insurance broker fees	4619
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000403008058

Policy instance

Insurance contract or identification number	000403008058
Number of Individuals Covered	75
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,413
Total amount of fees paid to insurance company	USD $999
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $9,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,413
Amount paid for insurance broker fees	924
Insurance broker organization code?	3

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010268363

Policy instance

Insurance contract or identification number	000010268363
Number of Individuals Covered	134
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $4,336
Total amount of fees paid to insurance company	USD $9,197
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $86,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,336
Amount paid for insurance broker fees	8508
Insurance broker organization code?	3

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

Policy contract number

135613

Policy instance

Insurance contract or identification number	135613
Number of Individuals Covered	185
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $13,391
Total amount of fees paid to insurance company	USD $45,753
Welfare Benefit Premiums Paid to Carrier	USD $344,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,119
Amount paid for insurance broker fees	45753
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX968319

Policy instance

Insurance contract or identification number	FLX968319
Number of Individuals Covered	211
Insurance policy start date	2021-04-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $8,748
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,748
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK965633

Policy instance

Insurance contract or identification number	LK965633
Number of Individuals Covered	211
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $8,909
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $59,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,909
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK969794

Policy instance

Insurance contract or identification number	OK969794
Number of Individuals Covered	43
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $241
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $2,407
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $241
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK969795

Policy instance

Insurance contract or identification number	OK969795
Number of Individuals Covered	111
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $1,890
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $18,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,890
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0005345

Policy instance

Insurance contract or identification number	0005345
Number of Individuals Covered	448
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $4,751
Total amount of fees paid to insurance company	USD $290
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,751
Amount paid for insurance broker fees	290
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

8773

Policy instance

Insurance contract or identification number	8773
Number of Individuals Covered	387
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $3,175
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $31,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,175
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT963055

Policy instance

Insurance contract or identification number	VDT963055
Number of Individuals Covered	138
Insurance policy start date	2021-01-01
Insurance policy end date	2022-01-01
Total amount of commissions paid to insurance broker	USD $5,391
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $107,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,391
Insurance broker organization code?	4

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

Policy contract number

135613

Policy instance

Insurance contract or identification number	135613
Number of Individuals Covered	208
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $12,297
Total amount of fees paid to insurance company	USD $50,490
Welfare Benefit Premiums Paid to Carrier	USD $351,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,297
Amount paid for insurance broker fees	49212
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX968319

Policy instance

Insurance contract or identification number	FLX968319
Number of Individuals Covered	239
Insurance policy start date	2020-04-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,278
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,278
Additional information about fees paid to insurance broker	STANDARD COMMISSIONS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK965633

Policy instance

Insurance contract or identification number	LK965633
Number of Individuals Covered	239
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $4,483
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,483
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK969794

Policy instance

Insurance contract or identification number	OK969794
Number of Individuals Covered	47
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $657
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $6,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $657
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK969795

Policy instance

Insurance contract or identification number	OK969795
Number of Individuals Covered	95
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $605
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $6,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $605
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0005345

Policy instance

Insurance contract or identification number	0005345
Number of Individuals Covered	547
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,513
Total amount of fees paid to insurance company	USD $1,172
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,513
Amount paid for insurance broker fees	1172
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

8773

Policy instance

Insurance contract or identification number	8773
Number of Individuals Covered	454
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $3,531
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,531
Additional information about fees paid to insurance broker	COMMISSIONS
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

VDT963055

Policy instance

Insurance contract or identification number	VDT963055
Number of Individuals Covered	143
Insurance policy start date	2020-01-01
Insurance policy end date	2021-01-01
Total amount of commissions paid to insurance broker	USD $1,132
Total amount of fees paid to insurance company	USD $2,268
Other welfare benefits provided	SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $22,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,132
Amount paid for insurance broker fees	2268
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	4

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

Policy contract number

135613

Policy instance

Insurance contract or identification number	135613
Number of Individuals Covered	218
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,828
Total amount of fees paid to insurance company	USD $51,232
Welfare Benefit Premiums Paid to Carrier	USD $336,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,828
Amount paid for insurance broker fees	49912
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

8773

Policy instance

Insurance contract or identification number	8773
Number of Individuals Covered	470
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $3,510
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $35,104
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,510
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0005345

Policy instance

Insurance contract or identification number	0005345
Number of Individuals Covered	556
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $6,543
Total amount of fees paid to insurance company	USD $485
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,543
Amount paid for insurance broker fees	485
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK969795

Policy instance

Insurance contract or identification number	OK969795
Number of Individuals Covered	117
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $884
Total amount of fees paid to insurance company	USD $93
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $8,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $884
Amount paid for insurance broker fees	93
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK969794

Policy instance

Insurance contract or identification number	OK969794
Number of Individuals Covered	44
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $533
Total amount of fees paid to insurance company	USD $44
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $5,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $533
Amount paid for insurance broker fees	44
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK965633

Policy instance

Insurance contract or identification number	LK965633
Number of Individuals Covered	235
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $9,075
Total amount of fees paid to insurance company	USD $501
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $60,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,075
Amount paid for insurance broker fees	501
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX968319

Policy instance

Insurance contract or identification number	FLX968319
Number of Individuals Covered	235
Insurance policy start date	2019-01-01
Insurance policy end date	2020-01-01
Total amount of commissions paid to insurance broker	USD $8,477
Total amount of fees paid to insurance company	USD $695
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $84,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,477
Amount paid for insurance broker fees	695
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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

Policy contract number

19243

Policy instance

Insurance contract or identification number	19243
Number of Individuals Covered	219
Insurance policy start date	2018-12-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $13,213
Total amount of fees paid to insurance company	USD $52,596
Welfare Benefit Premiums Paid to Carrier	USD $376,241
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,213
Amount paid for insurance broker fees	49912
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )

Policy contract number

0005345

Policy instance

Insurance contract or identification number	0005345
Number of Individuals Covered	562
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $10,754
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,754
Insurance broker organization code?	3

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

8773

Policy instance

Insurance contract or identification number	8773
Number of Individuals Covered	482
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,857
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $38,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,857
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK969795

Policy instance

Insurance contract or identification number	OK969795
Number of Individuals Covered	116
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $853
Total amount of fees paid to insurance company	USD $547
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $8,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $853
Amount paid for insurance broker fees	547
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

OK969794

Policy instance

Insurance contract or identification number	OK969794
Number of Individuals Covered	42
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $365
Total amount of fees paid to insurance company	USD $244
Other welfare benefits provided	ACCIDENTAL DEATH
Welfare Benefit Premiums Paid to Carrier	USD $3,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $365
Amount paid for insurance broker fees	244
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

LK965633

Policy instance

Insurance contract or identification number	LK965633
Number of Individuals Covered	244
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $6,331
Total amount of fees paid to insurance company	USD $2,602
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,331
Amount paid for insurance broker fees	2602
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

FLX968319

Policy instance

Insurance contract or identification number	FLX968319
Number of Individuals Covered	244
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $5,851
Total amount of fees paid to insurance company	USD $3,730
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,509
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,851
Amount paid for insurance broker fees	3730
Additional information about fees paid to insurance broker	FEES
Insurance broker organization code?	3

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

Policy contract number

19243

Policy instance

Insurance contract or identification number	19243
Number of Individuals Covered	239
Insurance policy start date	2017-12-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $15,970
Total amount of fees paid to insurance company	USD $49,912
Welfare Benefit Premiums Paid to Carrier	USD $363,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,720
Amount paid for insurance broker fees	49912
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE CONSULTING GROUP, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10212836

Policy instance

Insurance contract or identification number	10212836
Number of Individuals Covered	263
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,379
Total amount of fees paid to insurance company	USD $332
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,379
Amount paid for insurance broker fees	332
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE CONSULTING GROUP, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

40000100020748

Policy instance

Insurance contract or identification number	40000100020748
Number of Individuals Covered	132
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $7,528
Total amount of fees paid to insurance company	USD $301
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,528
Amount paid for insurance broker fees	301
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE CONSULTING GROUP, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

10212835

Policy instance

Insurance contract or identification number	10212835
Number of Individuals Covered	263
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,243
Total amount of fees paid to insurance company	USD $140
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $10,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,243
Amount paid for insurance broker fees	140
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	4
Insurance broker name	CAMBRIDGE CONSULTING GROUP, LLC

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

403005547

Policy instance

Insurance contract or identification number	403005547
Number of Individuals Covered	55
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $1,743
Total amount of fees paid to insurance company	USD $144
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY AD&D
Welfare Benefit Premiums Paid to Carrier	USD $11,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,743
Amount paid for insurance broker fees	144
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE CONSULTING GROUP, LLC

NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )

Policy contract number

8773

Policy instance

Insurance contract or identification number	8773
Number of Individuals Covered	524
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,482
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,482
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE CONSULTING GROUP, LLC

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

Policy contract number

19243

Policy instance

Insurance contract or identification number	19243
Number of Individuals Covered	189
Insurance policy start date	2015-12-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $18,340
Total amount of fees paid to insurance company	USD $35,334
Welfare Benefit Premiums Paid to Carrier	USD $423,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,662
Amount paid for insurance broker fees	35334
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE FINANCIAL SERVICES, INC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

213710

Policy instance

Insurance contract or identification number	213710
Number of Individuals Covered	257
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,164
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $87,140
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,164
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE FINANCIAL SERVICES, INC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

213710

Policy instance

Insurance contract or identification number	213710
Number of Individuals Covered	206
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,365
Total amount of fees paid to insurance company	USD $0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,418
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,365
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE FINANCIAL SERVICES, INC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

213710

Policy instance

Insurance contract or identification number	213710
Number of Individuals Covered	129
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $2,100
Total amount of fees paid to insurance company	USD $0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,100
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE FINANCIAL SERVICES, INC

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

Policy contract number

19243

Policy instance

Insurance contract or identification number	19243
Number of Individuals Covered	174
Insurance policy start date	2013-12-01
Insurance policy end date	2014-11-30
Total amount of commissions paid to insurance broker	USD $14,240
Total amount of fees paid to insurance company	USD $32,616
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $303,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $10,433
Amount paid for insurance broker fees	32616
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE FINANCIAL

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

213710

Policy instance

Insurance contract or identification number	213710
Number of Individuals Covered	235
Insurance policy start date	2013-07-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $4,523
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,164
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,523
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE CONSULTING GROUP, LLC

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )

Policy contract number

42424001

Policy instance

Insurance contract or identification number	42424001
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $64
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Amount paid for insurance broker fees	64
Additional information about fees paid to insurance broker	GROSS DEALER CONCESSION
Insurance broker name	NEW ENGLAND FINANCIAL

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

1213710

Policy instance

Insurance contract or identification number	1213710
Number of Individuals Covered	146
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $3,186
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,775
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,186
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE FINANCIAL SERVICES, INC

NEW ENGLAND FINANCIAL (National Association of Insurance Commissioners NAIC id number: 91626 )

Policy contract number

42424001

Policy instance

Insurance contract or identification number	42424001
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $106
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,500
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Amount paid for insurance broker fees	106
Additional information about fees paid to insurance broker	GROSS DEALER COMMISSION
Insurance broker organization code?	3
Insurance broker name	NEW ENGLAND FINANCIAL

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

Policy contract number

19243

Policy instance

Insurance contract or identification number	19243
Number of Individuals Covered	147
Insurance policy start date	2012-12-01
Insurance policy end date	2013-11-30
Total amount of commissions paid to insurance broker	USD $52,366
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $270,349
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $49,356
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE FINANCIAL SERVICES, INC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

213710

Policy instance

Insurance contract or identification number	213710
Number of Individuals Covered	146
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $3,042
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $20,990
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,042
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE FINANCIAL SERVICES, INC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

213710

Policy instance

Insurance contract or identification number	213710
Number of Individuals Covered	100
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $2,233
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,110
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,233
Insurance broker organization code?	3
Insurance broker name	CAMBRIDGE FINANCIAL SERVICES, INC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

213710

Policy instance

Insurance contract or identification number	213710
Number of Individuals Covered	124
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $3,249
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,212
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

213710

Policy instance

Insurance contract or identification number	213710
Number of Individuals Covered	74
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $2,259
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $27,683
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010093949

Policy instance

Insurance contract or identification number	000010093949
Number of Individuals Covered	124
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $8,504
Total amount of fees paid to insurance company	USD $1,231
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

19243

Policy instance

Insurance contract or identification number	19243
Number of Individuals Covered	136
Insurance policy start date	2011-12-01
Insurance policy end date	2012-11-30
Total amount of commissions paid to insurance broker	USD $39,289
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $274,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )

Policy contract number

000010093949

Policy instance

Insurance contract or identification number	000010093949
Number of Individuals Covered	122
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $8,080
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

19243

Policy instance

Insurance contract or identification number	19243
Number of Individuals Covered	139
Insurance policy start date	2010-12-01
Insurance policy end date	2011-11-30
Total amount of commissions paid to insurance broker	USD $35,931
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Welfare Benefit Premiums Paid to Carrier	USD $238,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	FUTURAMIC TOOL & ENGINEERING CO.
Employer identification number (EIN):	381528262
NAIC Classification:	332900

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	JOHN COUCH	2023-10-11
501	2021-01-01	JOHN COUCH	2022-10-01
501	2020-01-01	JOHN COUCH	2021-10-13
501	2019-01-01	JOHN COUCH	2020-09-25
501	2018-01-01	JOHN COUCH	2019-10-07
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2015-01-01
501	2013-12-01
501	2012-12-01	MICHAEL SCOTT
501	2011-12-01	SANDRA TROUSDALE
501	2009-12-01	GORDON CZISCHKE
501	2008-12-01