TERRYTOWN TRAVEL CENTER has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN
401k plan membership statisitcs for TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2022: TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-06-01 | 304 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 140 |
| Number of retired or separated participants receiving benefits | 2022-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-06-01 | 0 |
| Total of all active and inactive participants | 2022-06-01 | 140 |
| Number of employers contributing to the scheme | 2022-06-01 | 0 |
| 2021: TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-06-01 | 325 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 304 |
| Number of retired or separated participants receiving benefits | 2021-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-06-01 | 0 |
| Total of all active and inactive participants | 2021-06-01 | 304 |
| 2020: TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-06-01 | 326 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-06-01 | 325 |
| Number of retired or separated participants receiving benefits | 2020-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-06-01 | 0 |
| Total of all active and inactive participants | 2020-06-01 | 325 |
| 2019: TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-06-01 | 335 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 326 |
| Number of retired or separated participants receiving benefits | 2019-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-06-01 | 0 |
| Total of all active and inactive participants | 2019-06-01 | 326 |
| 2018: TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-06-01 | 317 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 335 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
| Total of all active and inactive participants | 2018-06-01 | 335 |
| 2017: TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 283 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 317 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 317 |
| 2016: TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-06-01 | 247 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 283 |
| Number of retired or separated participants receiving benefits | 2016-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-06-01 | 0 |
| Total of all active and inactive participants | 2016-06-01 | 283 |
| 2015: TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 229 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 247 |
| Number of retired or separated participants receiving benefits | 2015-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-06-01 | 0 |
| Total of all active and inactive participants | 2015-06-01 | 247 |
| 2014: TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 229 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 229 |
| Number of retired or separated participants receiving benefits | 2014-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-06-01 | 0 |
| Total of all active and inactive participants | 2014-06-01 | 229 |
| Measure | Date | Value |
|---|
| 2022 : TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2022 401k financial data |
|---|
| Total income from all sources (including contributions) | 2022-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-05-31 | No |
| Was this plan covered by a fidelity bond | 2022-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2022-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-05-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2022-05-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-05-31 | No |
| Did the plan have assets held for investment | 2022-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-05-31 | No |
| 2021 : TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2021 401k financial data |
|---|
| Total income from all sources (including contributions) | 2021-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-05-31 | No |
| Was this plan covered by a fidelity bond | 2021-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2021-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-05-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2021-05-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-05-31 | No |
| Did the plan have assets held for investment | 2021-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-05-31 | No |
| 2020 : TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2020 401k financial data |
|---|
| Total income from all sources (including contributions) | 2020-05-31 | $0 |
| Total income from all sources (including contributions) | 2020-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-05-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-05-31 | No |
| Was this plan covered by a fidelity bond | 2020-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2020-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2020-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2020-05-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2020-05-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-05-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-05-31 | No |
| Did the plan have assets held for investment | 2020-05-31 | No |
| Did the plan have assets held for investment | 2020-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-05-31 | No |
| 2019 : TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-05-31 | No |
| Was this plan covered by a fidelity bond | 2019-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-05-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2019-05-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-05-31 | No |
| Did the plan have assets held for investment | 2019-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-05-31 | No |
| 2018 : TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2018 401k financial data |
|---|
| Total income from all sources (including contributions) | 2018-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-05-31 | No |
| Was this plan covered by a fidelity bond | 2018-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2018-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2018-05-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-05-31 | No |
| Did the plan have assets held for investment | 2018-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-05-31 | No |
| 2017 : TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2017 401k financial data |
|---|
| Total income from all sources (including contributions) | 2017-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-05-31 | No |
| Was this plan covered by a fidelity bond | 2017-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2017-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2017-05-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-05-31 | No |
| Did the plan have assets held for investment | 2017-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-05-31 | No |
| 2016 : TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2016 401k financial data |
|---|
| Total income from all sources (including contributions) | 2016-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-05-31 | No |
| Was this plan covered by a fidelity bond | 2016-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2016-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2016-05-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-05-31 | No |
| Did the plan have assets held for investment | 2016-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-05-31 | No |
| 2015 : TERRY TOWN TRAVEL CENTER GROUP INSURANCE PLAN 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-05-31 | No |
| Was this plan covered by a fidelity bond | 2015-05-31 | No |
| If this is an individual account plan, was there a blackout period | 2015-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Value of net assets at end of year (total assets less liabilities) | 2015-05-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-05-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-05-31 | No |
| Did the plan have assets held for investment | 2015-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-05-31 | No |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10136325 |
| Policy instance | 6 |
| Insurance contract or identification number | 10136325 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $5,414 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $50,086 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,414 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30104314 |
| Policy instance | 5 |
| Insurance contract or identification number | 30104314 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-01 | | Total amount of commissions paid to insurance broker | USD $881 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $821 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 956359 |
| Policy instance | 4 |
| Insurance contract or identification number | 956359 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $962 | | Total amount of fees paid to insurance company | USD $309 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $10,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $962 | | Amount paid for insurance broker fees | 309 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 287582 |
| Policy instance | 3 |
| Insurance contract or identification number | 287582 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $8,081 | | Total amount of fees paid to insurance company | USD $590 | | 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 $8,081 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | FEES |
|
| PHYSICIANS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95849 ) |
| Policy contract number | L00023291000 |
| Policy instance | 2 |
| Insurance contract or identification number | L00023291000 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $3,682 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $92,043 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,682 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 797706-S003 |
| Policy instance | 1 |
| Insurance contract or identification number | 797706-S003 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $38,300 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $937,507 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,300 | | 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 | 287582 |
| Policy instance | 1 |
| Insurance contract or identification number | 287582 | | Number of Individuals Covered | 304 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $48,622 | | Are there contracts with allocated funds for individual policies? | 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 $45,397 | | Additional information about fees paid to insurance broker | VENDOR VENDOR | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 287582 |
| Policy instance | 2 |
| Insurance contract or identification number | 287582 | | Number of Individuals Covered | 111 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $21,538 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,781 | | Additional information about fees paid to insurance broker | VENDOR VENDOR | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00010136326 000 |
| Policy instance | 3 |
| Insurance contract or identification number | 00010136326 000 | | Number of Individuals Covered | 48 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $2,232 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,232 | | Additional information about fees paid to insurance broker | VENDOR VENDOR | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010136325 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010136325 | | Number of Individuals Covered | 37 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $2,526 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,526 | | Additional information about fees paid to insurance broker | VENDOR VENDOR | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30104314 |
| Policy instance | 5 |
| Insurance contract or identification number | 30104314 | | Number of Individuals Covered | 106 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $858 | | Additional information about fees paid to insurance broker | VENDOR VENDOR | | Insurance broker organization code? | 3 |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 956359 |
| Policy instance | 6 |
| Insurance contract or identification number | 956359 | | Number of Individuals Covered | 145 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $1,016 | | Total amount of fees paid to insurance company | USD $508 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,016 | | Amount paid for insurance broker fees | 508 | | Additional information about fees paid to insurance broker | VENDOR VENDOR | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 287582 |
| Policy instance | 1 |
| Insurance contract or identification number | 287582 | | Number of Individuals Covered | 172 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $63,189 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,189 | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 287582 |
| Policy instance | 2 |
| Insurance contract or identification number | 287582 | | Number of Individuals Covered | 119 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $33,998 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,998 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00010136324 000 |
| Policy instance | 3 |
| Insurance contract or identification number | 00010136324 000 | | Number of Individuals Covered | 139 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $1,561 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,561 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 880344 |
| Policy instance | 4 |
| Insurance contract or identification number | 880344 | | Number of Individuals Covered | 146 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $10,377 | | Total amount of fees paid to insurance company | USD $2,075 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,377 | | Amount paid for insurance broker fees | 2075 | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 287582 |
| Policy instance | 2 |
| Insurance contract or identification number | 287582 | | Number of Individuals Covered | 120 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $13,272 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,272 | | Insurance broker organization code? | 3 |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00010136324 000 |
| Policy instance | 3 |
| Insurance contract or identification number | 00010136324 000 | | Number of Individuals Covered | 147 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $1,626 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,626 | | Insurance broker organization code? | 3 |
|
| STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 ) |
| Policy contract number | 880344 |
| Policy instance | 4 |
| Insurance contract or identification number | 880344 | | Number of Individuals Covered | 188 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $12,064 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,064 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 287582 |
| Policy instance | 1 |
| Insurance contract or identification number | 287582 | | Number of Individuals Covered | 206 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $18,589 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,589 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 785956 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 785956 S001 | | Number of Individuals Covered | 4 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $683 | | Are there contracts with allocated funds for individual policies? | 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 $683 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S001 |
| Policy instance | 2 |
| Insurance contract or identification number | 785956 S001 | | Number of Individuals Covered | 170 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $29,932 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,932 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S003 |
| Policy instance | 4 |
| Insurance contract or identification number | 785956 S003 | | Number of Individuals Covered | 18 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $4,253 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,253 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S007 |
| Policy instance | 5 |
| Insurance contract or identification number | 785956 S007 | | Number of Individuals Covered | 24 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $4,503 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,503 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S004 |
| Policy instance | 6 |
| Insurance contract or identification number | 785956 S004 | | Number of Individuals Covered | 42 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $10,136 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,136 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S006 |
| Policy instance | 7 |
| Insurance contract or identification number | 785956 S006 | | Number of Individuals Covered | 15 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $4,193 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,193 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S008 |
| Policy instance | 8 |
| Insurance contract or identification number | 785956 S008 | | Number of Individuals Covered | 7 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $1,067 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,067 | | Insurance broker organization code? | 3 |
|
| PHYSICIANS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95849 ) |
| Policy contract number | L0001859-1000 |
| Policy instance | 9 |
| Insurance contract or identification number | L0001859-1000 | | Number of Individuals Covered | 28 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $3,787 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,787 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S009 |
| Policy instance | 10 |
| Insurance contract or identification number | 785956 S009 | | Number of Individuals Covered | 6 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $1,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,679 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S005 |
| Policy instance | 3 |
| Insurance contract or identification number | 785956 S005 | | Number of Individuals Covered | 21 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $4,984 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,984 | | Insurance broker organization code? | 3 |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S009 |
| Policy instance | 10 |
| Insurance contract or identification number | 785956 S009 | | Number of Individuals Covered | 6 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $1,084 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,084 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 785956 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 785956 S001 | | Number of Individuals Covered | 4 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $644 | | Are there contracts with allocated funds for individual policies? | 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 $644 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S001 |
| Policy instance | 2 |
| Insurance contract or identification number | 785956 S001 | | Number of Individuals Covered | 162 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $26,430 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,430 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S003 |
| Policy instance | 4 |
| Insurance contract or identification number | 785956 S003 | | Number of Individuals Covered | 22 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $3,938 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,938 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S005 |
| Policy instance | 3 |
| Insurance contract or identification number | 785956 S005 | | Number of Individuals Covered | 15 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $3,194 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,194 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S007 |
| Policy instance | 5 |
| Insurance contract or identification number | 785956 S007 | | Number of Individuals Covered | 17 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $3,668 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,668 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S004 |
| Policy instance | 6 |
| Insurance contract or identification number | 785956 S004 | | Number of Individuals Covered | 42 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $10,038 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,038 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S006 |
| Policy instance | 7 |
| Insurance contract or identification number | 785956 S006 | | Number of Individuals Covered | 17 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $3,805 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,805 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S008 |
| Policy instance | 8 |
| Insurance contract or identification number | 785956 S008 | | Number of Individuals Covered | 9 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $2,070 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,070 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PHYSICIANS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95849 ) |
| Policy contract number | L0001859-1000 |
| Policy instance | 9 |
| Insurance contract or identification number | L0001859-1000 | | Number of Individuals Covered | 23 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $3,326 | | Are there contracts with allocated funds for individual policies? | 1 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,314 | | Insurance broker organization code? | 3 | | Insurance broker name | JEANETTE PUNG |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 785956 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 785956 S001 | | Number of Individuals Covered | 4 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $681 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $681 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S001 |
| Policy instance | 2 |
| Insurance contract or identification number | 785956 S001 | | Number of Individuals Covered | 112 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $16,212 | | Are there contracts with allocated funds for individual policies? | 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 $16,212 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S005 |
| Policy instance | 3 |
| Insurance contract or identification number | 785956 S005 | | Number of Individuals Covered | 8 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $2,341 | | Are there contracts with allocated funds for individual policies? | 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 $2,341 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S003 |
| Policy instance | 4 |
| Insurance contract or identification number | 785956 S003 | | Number of Individuals Covered | 19 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $3,562 | | Are there contracts with allocated funds for individual policies? | 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 $3,562 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S007 |
| Policy instance | 5 |
| Insurance contract or identification number | 785956 S007 | | Number of Individuals Covered | 12 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $1,542 | | Are there contracts with allocated funds for individual policies? | 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 $1,542 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S004 |
| Policy instance | 6 |
| Insurance contract or identification number | 785956 S004 | | Number of Individuals Covered | 29 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $6,821 | | Are there contracts with allocated funds for individual policies? | 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 $6,821 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S006 |
| Policy instance | 7 |
| Insurance contract or identification number | 785956 S006 | | Number of Individuals Covered | 16 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $3,225 | | Are there contracts with allocated funds for individual policies? | 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 $3,225 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S008 |
| Policy instance | 8 |
| Insurance contract or identification number | 785956 S008 | | Number of Individuals Covered | 10 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $1,933 | | Are there contracts with allocated funds for individual policies? | 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 $1,933 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PHYSICIANS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95849 ) |
| Policy contract number | L0001859-1000 |
| Policy instance | 9 |
| Insurance contract or identification number | L0001859-1000 | | Number of Individuals Covered | 27 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $3,663 | | Are there contracts with allocated funds for individual policies? | 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 $208 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G1015557 1001 |
| Policy instance | 10 |
| Insurance contract or identification number | G1015557 1001 | | Number of Individuals Covered | 10 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $2,721 | | Are there contracts with allocated funds for individual policies? | 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 $2,721 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWEST GROUP MARKETING |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S001 |
| Policy instance | 2 |
| Insurance contract or identification number | 785956 S001 | | Number of Individuals Covered | 90 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $12,221 | | Are there contracts with allocated funds for individual policies? | 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 $12,221 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S005 |
| Policy instance | 3 |
| Insurance contract or identification number | 785956 S005 | | Number of Individuals Covered | 18 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $1,498 | | Are there contracts with allocated funds for individual policies? | 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 $1,498 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S003 |
| Policy instance | 4 |
| Insurance contract or identification number | 785956 S003 | | Number of Individuals Covered | 18 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $2,531 | | Are there contracts with allocated funds for individual policies? | 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 $2,531 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S007 |
| Policy instance | 5 |
| Insurance contract or identification number | 785956 S007 | | Number of Individuals Covered | 11 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $1,356 | | Are there contracts with allocated funds for individual policies? | 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 $1,356 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 785956 S004 |
| Policy instance | 6 |
| Insurance contract or identification number | 785956 S004 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $1,183 | | Are there contracts with allocated funds for individual policies? | 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 $1,183 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S004 |
| Policy instance | 7 |
| Insurance contract or identification number | 785956 S004 | | Number of Individuals Covered | 40 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $5,884 | | Are there contracts with allocated funds for individual policies? | 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 $5,884 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 ) |
| Policy contract number | 785956 S006 |
| Policy instance | 8 |
| Insurance contract or identification number | 785956 S006 | | Number of Individuals Covered | 12 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $1,820 | | Are there contracts with allocated funds for individual policies? | 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 $1,820 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
|
| MCLAREN HEALTH (National Association of Insurance Commissioners NAIC id number: 95562 ) |
| Policy contract number | 500467 |
| Policy instance | 9 |
| Insurance contract or identification number | 500467 | | Number of Individuals Covered | 26 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $2,963 | | Are there contracts with allocated funds for individual policies? | 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 $2,963 | | Insurance broker organization code? | 3 | | Insurance broker name | STRATEGIC EMP. BENEFIT SERVICE |
|
| SELECTHEALTH (National Association of Insurance Commissioners NAIC id number: 95153 ) |
| Policy contract number | G1015557 1001 |
| Policy instance | 10 |
| Insurance contract or identification number | G1015557 1001 | | Number of Individuals Covered | 10 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $1,582 | | Total amount of fees paid to insurance company | USD $348 | | Are there contracts with allocated funds for individual policies? | 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 $1,582 | | Amount paid for insurance broker fees | 348 | | Insurance broker organization code? | 3 | | Insurance broker name | NORTHWEST GROUP MARKETING |
|
| PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 ) |
| Policy contract number | 785956 S001 |
| Policy instance | 1 |
| Insurance contract or identification number | 785956 S001 | | Number of Individuals Covered | 4 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $678 | | Are there contracts with allocated funds for individual policies? | Yes | | 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 $678 | | Insurance broker organization code? | 3 | | Insurance broker name | SCOTT BLOEM |
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