401k Plan data: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN plan

FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 401k Plan overview

Plan Name	FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN
Plan identification number	501

FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN Benefits

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

401k Sponsoring company profile

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

Company Name: FRITZ ENTERPRISES, INC.

Employer identification number (EIN): 381960773

NAIC Classification: 331110
NAIC Description: Iron and Steel Mills and Ferroalloy Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-01-01 ORLANDO MAZZOTTA 2023-10-10
501 2021-01-01 ORLANDO MAZZOTTA 2022-10-14
501 2020-01-01 ORLANDO MAZZOTTA 2021-10-11
501 2019-01-01 ORLANDO MAZZOTTA 2020-07-29
501 2018-01-01 ORLANDO MAZZOTTA 2019-10-09
501 2017-01-01
501 2016-01-01
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 ORLANDO MAZZOTTA
501 2011-01-01 WILLIAM ELSON
501 2010-01-01 WILLIAM ELSON
501 2009-01-01 ROBERT MCDONALD
501 2009-01-01 ROBERT MCDONALD

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
501	2022-01-01	ORLANDO MAZZOTTA	2023-10-10
501	2021-01-01	ORLANDO MAZZOTTA	2022-10-14
501	2020-01-01	ORLANDO MAZZOTTA	2021-10-11
501	2019-01-01	ORLANDO MAZZOTTA	2020-07-29
501	2018-01-01	ORLANDO MAZZOTTA	2019-10-09
501	2017-01-01
501	2016-01-01
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	ORLANDO MAZZOTTA
501	2011-01-01	WILLIAM ELSON
501	2010-01-01	WILLIAM ELSON
501	2009-01-01	ROBERT MCDONALD
501	2009-01-01	ROBERT MCDONALD

Plan Statistics for FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN

401k plan membership statisitcs for FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN

Measure Date Value
2022: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 172
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 165
Total of all active and inactive participants 2022-01-01 165
2021: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 217
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 172
Total of all active and inactive participants 2021-01-01 172
2020: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 233
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 217
Total of all active and inactive participants 2020-01-01 217
2019: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 235
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 233
Total of all active and inactive participants 2019-01-01 233
2018: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 234
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 235
Total of all active and inactive participants 2018-01-01 235
2017: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 239
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 234
Total of all active and inactive participants 2017-01-01 234
2016: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 305
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 239
Total of all active and inactive participants 2016-01-01 239
2015: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 366
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 305
Total of all active and inactive participants 2015-01-01 305
2014: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 395
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 366
Total of all active and inactive participants 2014-01-01 366
2013: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 419
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 395
Total of all active and inactive participants 2013-01-01 395
2012: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 400
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 419
Total of all active and inactive participants 2012-01-01 419
2011: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 399
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 400
Total of all active and inactive participants 2011-01-01 400
2010: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 545
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 399
Total of all active and inactive participants 2010-01-01 399
2009: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 573
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 545
Total of all active and inactive participants 2009-01-01 545

Measure	Date	Value
2022: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	172
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	165
Total of all active and inactive participants	2022-01-01	165
2021: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	217
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	172
Total of all active and inactive participants	2021-01-01	172
2020: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	233
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	217
Total of all active and inactive participants	2020-01-01	217
2019: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	235
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	233
Total of all active and inactive participants	2019-01-01	233
2018: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	234
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	235
Total of all active and inactive participants	2018-01-01	235
2017: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	239
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	234
Total of all active and inactive participants	2017-01-01	234
2016: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	305
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	239
Total of all active and inactive participants	2016-01-01	239
2015: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	366
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	305
Total of all active and inactive participants	2015-01-01	305
2014: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	395
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	366
Total of all active and inactive participants	2014-01-01	366
2013: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	419
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	395
Total of all active and inactive participants	2013-01-01	395
2012: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	400
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	419
Total of all active and inactive participants	2012-01-01	419
2011: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	399
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	400
Total of all active and inactive participants	2011-01-01	400
2010: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	545
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	399
Total of all active and inactive participants	2010-01-01	399
2009: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	573
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	545
Total of all active and inactive participants	2009-01-01	545

Form 5500 Responses for FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN

2022: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE 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 benefit arrangement – Insurance	Yes
2021: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE 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 benefit arrangement – Insurance	Yes
2020: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE 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 benefit arrangement – Insurance	Yes
2019: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE 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 benefit arrangement – Insurance	Yes
2018: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE 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 benefit arrangement – Insurance	Yes
2017: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE 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 benefit arrangement – Insurance	Yes
2016: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE 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 benefit arrangement – Insurance	Yes
2015: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2012: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2011: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2010: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2009: FRITZ ENTERPRISES, INC. GROUP HEALTH, DISABILITY, AND LIFE INSURANCE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BP5X

Policy instance

Insurance contract or identification number	G000BP5X
Number of Individuals Covered	591
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $14,299
Total amount of fees paid to insurance company	USD $8,877
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $206,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $14,299
Amount paid for insurance broker fees	8877
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E5665583

Policy instance

Insurance contract or identification number	E5665583
Number of Individuals Covered	3
Insurance policy start date	2022-07-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $276
Total amount of fees paid to insurance company	USD $38
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $877
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $201
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

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

Policy contract number

275478

Policy instance

Insurance contract or identification number	275478
Number of Individuals Covered	427
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $44,549
Total amount of fees paid to insurance company	USD $2,296
Health 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 $44,549
Amount paid for insurance broker fees	2296
Insurance broker organization code?	3

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

Policy contract number

0010102

Policy instance

Insurance contract or identification number	0010102
Number of Individuals Covered	460
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $7,261
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,261
Amount paid for insurance broker fees	0

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E5665534

Policy instance

Insurance contract or identification number	E5665534
Number of Individuals Covered	2
Insurance policy start date	2022-07-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $459
Total amount of fees paid to insurance company	USD $67
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $328
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E5665542

Policy instance

Insurance contract or identification number	E5665542
Number of Individuals Covered	3
Insurance policy start date	2022-07-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $546
Total amount of fees paid to insurance company	USD $53
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $413
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E5665559

Policy instance

Insurance contract or identification number	E5665559
Number of Individuals Covered	8
Insurance policy start date	2022-07-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $1,523
Total amount of fees paid to insurance company	USD $161
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,403
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,148
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )

Policy contract number

E5665567

Policy instance

Insurance contract or identification number	E5665567
Number of Individuals Covered	27
Insurance policy start date	2022-07-01
Insurance policy end date	2022-12-31
Total amount of commissions paid to insurance broker	USD $3,542
Total amount of fees paid to insurance company	USD $436
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $12,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,553
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BP5X

Policy instance

Insurance contract or identification number	G000BP5X
Number of Individuals Covered	615
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $23,063
Total amount of fees paid to insurance company	USD $6,053
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $183,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $23,063
Amount paid for insurance broker fees	6053
Insurance broker organization code?	3

CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )

Policy contract number

10430

Policy instance

Insurance contract or identification number	10430
Number of Individuals Covered	172
Insurance policy start date	2021-01-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $2,107
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,075
Insurance broker organization code?	3

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

Policy contract number

275478

Policy instance

Insurance contract or identification number	275478
Number of Individuals Covered	449
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $44,334
Total amount of fees paid to insurance company	USD $1,120
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health 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 $44,334
Amount paid for insurance broker fees	1120
Insurance broker organization code?	3

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

Policy contract number

0010102

Policy instance

Insurance contract or identification number	0010102
Number of Individuals Covered	478
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Total amount of commissions paid to insurance broker	USD $6,894
Total amount of fees paid to insurance company	USD $2,968
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 $6,894
Amount paid for insurance broker fees	2968

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

Policy contract number

0010102

Policy instance

Insurance contract or identification number	0010102
Number of Individuals Covered	486
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $6,572
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 $6,572
Insurance broker organization code?	3

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

Policy contract number

275478

Policy instance

Insurance contract or identification number	275478
Number of Individuals Covered	447
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $32,426
Total amount of fees paid to insurance company	USD $2,476
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health 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 $32,426
Insurance broker organization code?	3
Amount paid for insurance broker fees	2476
Additional information about fees paid to insurance broker	INCENTIVE PAYMENTS

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )

Policy contract number

G000BP5X

Policy instance

Insurance contract or identification number	G000BP5X
Number of Individuals Covered	563
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Total amount of commissions paid to insurance broker	USD $19,202
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $163,730
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $19,202
Insurance broker organization code?	3

PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )

Policy contract number

61925

Policy instance

Insurance contract or identification number	61925
Number of Individuals Covered	399
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $11,163
Total amount of fees paid to insurance company	USD $74
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $169,048
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,163
Additional information about fees paid to insurance broker	SALES AND SERVICE COMPENSATION
Insurance broker organization code?	3
Amount paid for insurance broker fees	74

ULLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	249
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $16,249
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

70892, 70893

Policy instance

Insurance contract or identification number	70892, 70893
Number of Individuals Covered	509
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Total amount of commissions paid to insurance broker	USD $35,910
Total amount of fees paid to insurance company	USD $2,795
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health 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 $29,967
Insurance broker organization code?	3
Amount paid for insurance broker fees	2795
Additional information about fees paid to insurance broker	THIRD PARTY ADMINISTRATOR FEES

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016553-00

Policy instance

Insurance contract or identification number	01-016553-00
Number of Individuals Covered	235
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $12,352
Total amount of fees paid to insurance company	USD $2,791
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $123,523
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,352
Insurance broker organization code?	3
Amount paid for insurance broker fees	2791
Additional information about fees paid to insurance broker	GROUP SUPPLEMENTAL COMMISSION

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

Policy contract number

70892, 70893

Policy instance

Insurance contract or identification number	70892, 70893
Number of Individuals Covered	521
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $36,785
Total amount of fees paid to insurance company	USD $2,619
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health 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 $36,785
Insurance broker organization code?	3
Amount paid for insurance broker fees	2619

ULLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	236
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $8,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016553-00

Policy instance

Insurance contract or identification number	01-016553-00
Number of Individuals Covered	167
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Total amount of commissions paid to insurance broker	USD $3,762
Total amount of fees paid to insurance company	USD $850
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,762
Insurance broker organization code?	3
Amount paid for insurance broker fees	850
Additional information about fees paid to insurance broker	GROUP SUPPLEMENTAL COMMISSION

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016553-00

Policy instance

Insurance contract or identification number	01-016553-00
Number of Individuals Covered	222
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $12,371
Total amount of fees paid to insurance company	USD $2,430
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $123,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,371
Insurance broker organization code?	3
Amount paid for insurance broker fees	2430
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

70892, 70893

Policy instance

Insurance contract or identification number	70892, 70893
Number of Individuals Covered	201
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	1
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	5
Insurance broker name	BLUE CROSS BLUE SHIELD OF MICHIGAN

ULLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	234
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $8,424
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016553-00

Policy instance

Insurance contract or identification number	01-016553-00
Number of Individuals Covered	155
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $3,450
Total amount of fees paid to insurance company	USD $678
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $34,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,450
Insurance broker organization code?	3
Amount paid for insurance broker fees	678
Insurance broker name	GALLAGHER BENEFIT SERVICES

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016553-00

Policy instance

Insurance contract or identification number	01-016553-00
Number of Individuals Covered	238
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $11,717
Total amount of fees paid to insurance company	USD $2,823
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $117,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,717
Insurance broker organization code?	3
Amount paid for insurance broker fees	2823
Insurance broker name	GALLAGHER BENEFIT SERVICES

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016553-00

Policy instance

Insurance contract or identification number	01-016553-00
Number of Individuals Covered	226
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,066
Total amount of fees paid to insurance company	USD $738
Temporary Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $30,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,066
Insurance broker organization code?	3
Amount paid for insurance broker fees	738
Insurance broker name	GALLAGHER BENEFIT SERVICES

ULLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	305
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $10,989
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

70892, 70893

Policy instance

Insurance contract or identification number	70892, 70893
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Insurance broker organization code?	5
Insurance broker name	BLUE CROSS BLUE SHIELD OF MICHIGAN

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016553-00

Policy instance

Insurance contract or identification number	01-016553-00
Number of Individuals Covered	334
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $13,690
Total amount of fees paid to insurance company	USD $2,273
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
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $136,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,690
Insurance broker organization code?	3
Amount paid for insurance broker fees	2273
Insurance broker name	GALLAGHER BENEFIT SERVICES

ULLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	366
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $13,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

70892, 70893

Policy instance

Insurance contract or identification number	70892, 70893
Number of Individuals Covered	312
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	5
Insurance broker name	BLUE CROSS BLUE SHIELD OF MICHIGAN

SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )

Policy contract number

01-016553-00

Policy instance

Insurance contract or identification number	01-016553-00
Number of Individuals Covered	257
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,837
Total amount of fees paid to insurance company	USD $632
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 $38,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,837
Insurance broker organization code?	3
Amount paid for insurance broker fees	632
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

212311

Policy instance

Insurance contract or identification number	212311
Number of Individuals Covered	263
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $5,386
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 $53,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,386
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

ULLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	395
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $14,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

00117910/0002

Policy instance

Insurance contract or identification number	00117910/0002
Number of Individuals Covered	6
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $824
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $25,057
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $824
Insurance broker organization code?	3
Insurance broker name	THE RAINS GROUP, INC.

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

Policy contract number

212311

Policy instance

Insurance contract or identification number	212311
Number of Individuals Covered	342
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $8,809
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 $87,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $8,809
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES OF MI

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

Policy contract number

001179710/0003

Policy instance

Insurance contract or identification number	001179710/0003
Number of Individuals Covered	2
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $541
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $16,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $541
Insurance broker organization code?	3
Insurance broker name	THE RAINS GROUP, INC.

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

Policy contract number

70892, 70893

Policy instance

Insurance contract or identification number	70892, 70893
Number of Individuals Covered	311
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Health 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 $0
Insurance broker organization code?	5
Insurance broker name	BLUE CROSS BLUE SHIELD OF MICHIGAN

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

Policy contract number

212311

Policy instance

Insurance contract or identification number	212311
Number of Individuals Covered	284
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $5,944
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 $59,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,944
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

ULLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	419
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $302
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $15,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $302
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

00117910/0002

Policy instance

Insurance contract or identification number	00117910/0002
Number of Individuals Covered	28
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $4,004
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $122,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,004
Insurance broker organization code?	3
Insurance broker name	THE RAINS GROUP, INC.

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

Policy contract number

001179710/0003

Policy instance

Insurance contract or identification number	001179710/0003
Number of Individuals Covered	19
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $3,376
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $93,864
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,376
Insurance broker organization code?	3
Insurance broker name	THE RAINS GROUP, INC.

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

Policy contract number

212311

Policy instance

Insurance contract or identification number	212311
Number of Individuals Covered	373
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $9,791
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 $97,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $9,791
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES OF MI

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

Policy contract number

70892, 70893

Policy instance

Insurance contract or identification number	70892, 70893
Number of Individuals Covered	326
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 $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	5
Insurance broker name	BLUE CROSS BLUE SHIELD OF MICHIGAN

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

Policy contract number

212311

Policy instance

Insurance contract or identification number	212311
Number of Individuals Covered	297
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $5,282
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 $52,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ULLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	400
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $14,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

001179710/0003

Policy instance

Insurance contract or identification number	001179710/0003
Number of Individuals Covered	30
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $3,101
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $124,048
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

212311

Policy instance

Insurance contract or identification number	212311
Number of Individuals Covered	380
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $11,077
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 $110,775
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

70892, 70893

Policy instance

Insurance contract or identification number	70892, 70893
Number of Individuals Covered	307
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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

Policy contract number

00117910/0002

Policy instance

Insurance contract or identification number	00117910/0002
Number of Individuals Covered	46
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $4,183
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $167,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ULLIANCE, INC. (National Association of Insurance Commissioners NAIC id number: 62419 )

Policy contract number

Policy instance

Number of Individuals Covered	365
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $263
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
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $13,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $263
Insurance broker name	GALLAGHER BENEFIT SERVICES

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

Policy contract number

00117910/0002

Policy instance

Insurance contract or identification number	00117910/0002
Number of Individuals Covered	55
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $3,915
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $174,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,915
Insurance broker organization code?	3
Insurance broker name	THE RAINS GROUP, INC.

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

Policy contract number

001179710/0003

Policy instance

Insurance contract or identification number	001179710/0003
Number of Individuals Covered	30
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $2,516
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
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $111,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,516
Insurance broker organization code?	3
Insurance broker name	THE RAINS GROUP, INC.

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

Policy contract number

212311

Policy instance

Insurance contract or identification number	212311
Number of Individuals Covered	399
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $11,636
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 $105,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $11,636
Insurance broker organization code?	3
Insurance broker name	GALLAGHER BENEFIT SERVICES OF MI

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

Policy contract number

70892, 70893

Policy instance

Insurance contract or identification number	70892, 70893
Number of Individuals Covered	277
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	Yes
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	1
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	5
Insurance broker name	BLUE CROSS BLUE SHIELD OF MICHIGAN

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Company Name:	FRITZ ENTERPRISES, INC.
Employer identification number (EIN):	381960773
NAIC Classification:	331110
NAIC Description:	Iron and Steel Mills and Ferroalloy Manufacturing