FRANKENMUTH BAVARIAN INN, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST
401k plan membership statisitcs for FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST
Measure | Date | Value |
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2022: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2022 401k membership |
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Total participants, beginning-of-year | 2022-03-01 | 128 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 136 |
Number of retired or separated participants receiving benefits | 2022-03-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
Total of all active and inactive participants | 2022-03-01 | 138 |
2021: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2021 401k membership |
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Total participants, beginning-of-year | 2021-03-01 | 128 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 127 |
Number of retired or separated participants receiving benefits | 2021-03-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
Total of all active and inactive participants | 2021-03-01 | 128 |
2020: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2020 401k membership |
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Total participants, beginning-of-year | 2020-03-01 | 136 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-03-01 | 127 |
Number of retired or separated participants receiving benefits | 2020-03-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2020-03-01 | 0 |
Total of all active and inactive participants | 2020-03-01 | 128 |
2019: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2019 401k membership |
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Total participants, beginning-of-year | 2019-03-01 | 141 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-03-01 | 136 |
Number of retired or separated participants receiving benefits | 2019-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-03-01 | 0 |
Total of all active and inactive participants | 2019-03-01 | 136 |
2018: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2018 401k membership |
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Total participants, beginning-of-year | 2018-03-01 | 126 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 138 |
Number of retired or separated participants receiving benefits | 2018-03-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2018-03-01 | 2 |
Total of all active and inactive participants | 2018-03-01 | 141 |
2017: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2017 401k membership |
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Total participants, beginning-of-year | 2017-03-01 | 140 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 126 |
Number of retired or separated participants receiving benefits | 2017-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-03-01 | 0 |
Total of all active and inactive participants | 2017-03-01 | 126 |
2016: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2016 401k membership |
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Total participants, beginning-of-year | 2016-03-01 | 136 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 138 |
Number of retired or separated participants receiving benefits | 2016-03-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2016-03-01 | 0 |
Total of all active and inactive participants | 2016-03-01 | 140 |
2015: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2015 401k membership |
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Total participants, beginning-of-year | 2015-03-01 | 130 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 134 |
Number of retired or separated participants receiving benefits | 2015-03-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2015-03-01 | 0 |
Total of all active and inactive participants | 2015-03-01 | 136 |
2014: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2014 401k membership |
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Total participants, beginning-of-year | 2014-03-01 | 106 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 128 |
Number of retired or separated participants receiving benefits | 2014-03-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2014-03-01 | 0 |
Total of all active and inactive participants | 2014-03-01 | 130 |
2013: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2013 401k membership |
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Total participants, beginning-of-year | 2013-03-01 | 102 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 106 |
Number of retired or separated participants receiving benefits | 2013-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-03-01 | 0 |
Total of all active and inactive participants | 2013-03-01 | 106 |
2012: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2012 401k membership |
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Total participants, beginning-of-year | 2012-03-01 | 98 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-03-01 | 102 |
Number of retired or separated participants receiving benefits | 2012-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-03-01 | 0 |
Total of all active and inactive participants | 2012-03-01 | 102 |
2011: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2011 401k membership |
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Total participants, beginning-of-year | 2011-03-01 | 114 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-03-01 | 98 |
Number of retired or separated participants receiving benefits | 2011-03-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-03-01 | 0 |
Total of all active and inactive participants | 2011-03-01 | 98 |
2009: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2009 401k membership |
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Total participants, beginning-of-year | 2009-03-01 | 149 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-03-01 | 118 |
Number of retired or separated participants receiving benefits | 2009-03-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2009-03-01 | 0 |
Total of all active and inactive participants | 2009-03-01 | 123 |
2022: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2022 form 5500 responses |
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2022-03-01 | Type of plan entity | Single employer plan |
2022-03-01 | Submission has been amended | No |
2022-03-01 | This submission is the final filing | No |
2022-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-03-01 | Plan is a collectively bargained plan | No |
2022-03-01 | Plan funding arrangement – Insurance | Yes |
2022-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-03-01 | Plan benefit arrangement – Insurance | Yes |
2022-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2021 form 5500 responses |
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2021-03-01 | Type of plan entity | Single employer plan |
2021-03-01 | Submission has been amended | No |
2021-03-01 | This submission is the final filing | No |
2021-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-03-01 | Plan is a collectively bargained plan | No |
2021-03-01 | Plan funding arrangement – Insurance | Yes |
2021-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-03-01 | Plan benefit arrangement – Insurance | Yes |
2021-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2020 form 5500 responses |
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2020-03-01 | Type of plan entity | Single employer plan |
2020-03-01 | Submission has been amended | No |
2020-03-01 | This submission is the final filing | No |
2020-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-03-01 | Plan is a collectively bargained plan | No |
2020-03-01 | Plan funding arrangement – Insurance | Yes |
2020-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-03-01 | Plan benefit arrangement – Insurance | Yes |
2020-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2019 form 5500 responses |
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2019-03-01 | Type of plan entity | Single employer plan |
2019-03-01 | Submission has been amended | No |
2019-03-01 | This submission is the final filing | No |
2019-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-03-01 | Plan is a collectively bargained plan | No |
2019-03-01 | Plan funding arrangement – Insurance | Yes |
2019-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-03-01 | Plan benefit arrangement – Insurance | Yes |
2019-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2018 form 5500 responses |
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2018-03-01 | Type of plan entity | Single employer plan |
2018-03-01 | Submission has been amended | No |
2018-03-01 | This submission is the final filing | No |
2018-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-03-01 | Plan is a collectively bargained plan | No |
2018-03-01 | Plan funding arrangement – Insurance | Yes |
2018-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-03-01 | Plan benefit arrangement – Insurance | Yes |
2018-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2017 form 5500 responses |
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2017-03-01 | Type of plan entity | Single employer plan |
2017-03-01 | Submission has been amended | No |
2017-03-01 | This submission is the final filing | No |
2017-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-03-01 | Plan is a collectively bargained plan | No |
2017-03-01 | Plan funding arrangement – Insurance | Yes |
2017-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-03-01 | Plan benefit arrangement – Insurance | Yes |
2017-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2016 form 5500 responses |
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2016-03-01 | Type of plan entity | Single employer plan |
2016-03-01 | Submission has been amended | No |
2016-03-01 | This submission is the final filing | No |
2016-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-03-01 | Plan is a collectively bargained plan | No |
2016-03-01 | Plan funding arrangement – Insurance | Yes |
2016-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-03-01 | Plan benefit arrangement – Insurance | Yes |
2016-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2015 form 5500 responses |
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2015-03-01 | Type of plan entity | Single employer plan |
2015-03-01 | Submission has been amended | No |
2015-03-01 | This submission is the final filing | No |
2015-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-03-01 | Plan is a collectively bargained plan | No |
2015-03-01 | Plan funding arrangement – Insurance | Yes |
2015-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-03-01 | Plan benefit arrangement – Insurance | Yes |
2015-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2014 form 5500 responses |
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2014-03-01 | Type of plan entity | Single employer plan |
2014-03-01 | Submission has been amended | No |
2014-03-01 | This submission is the final filing | No |
2014-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-03-01 | Plan is a collectively bargained plan | No |
2014-03-01 | Plan funding arrangement – Insurance | Yes |
2014-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-03-01 | Plan benefit arrangement – Insurance | Yes |
2014-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2013 form 5500 responses |
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2013-03-01 | Type of plan entity | Single employer plan |
2013-03-01 | Submission has been amended | No |
2013-03-01 | This submission is the final filing | No |
2013-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-03-01 | Plan is a collectively bargained plan | No |
2013-03-01 | Plan funding arrangement – Insurance | Yes |
2013-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-03-01 | Plan benefit arrangement – Insurance | Yes |
2013-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2012 form 5500 responses |
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2012-03-01 | Type of plan entity | Single employer plan |
2012-03-01 | Submission has been amended | No |
2012-03-01 | This submission is the final filing | No |
2012-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-03-01 | Plan is a collectively bargained plan | No |
2012-03-01 | Plan funding arrangement – Insurance | Yes |
2012-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-03-01 | Plan benefit arrangement – Insurance | Yes |
2012-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2011 form 5500 responses |
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2011-03-01 | Type of plan entity | Single employer plan |
2011-03-01 | Submission has been amended | No |
2011-03-01 | This submission is the final filing | No |
2011-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-03-01 | Plan is a collectively bargained plan | No |
2011-03-01 | Plan funding arrangement – Insurance | Yes |
2011-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-03-01 | Plan benefit arrangement – Insurance | Yes |
2011-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: FRANKENMUTH BAVARIAN INN, INC. EMPLOYEE HEALTH BENEFIT PLAN & TRUST 2009 form 5500 responses |
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2009-03-01 | Type of plan entity | Single employer plan |
2009-03-01 | Submission has been amended | No |
2009-03-01 | This submission is the final filing | No |
2009-03-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-03-01 | Plan is a collectively bargained plan | No |
2009-03-01 | Plan funding arrangement – Insurance | Yes |
2009-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-03-01 | Plan benefit arrangement – Insurance | Yes |
2009-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 100340 |
Policy instance | 2 |
Insurance contract or identification number | 100340 | Number of Individuals Covered | 195 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $5,848 | Total amount of fees paid to insurance company | USD $771 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,848 | Amount paid for insurance broker fees | 771 | Additional information about fees paid to insurance broker | FEES AND OTHER COMMISSIONS | Insurance broker organization code? | 3 |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | EAB1000087 |
Policy instance | 1 |
Insurance contract or identification number | EAB1000087 | Number of Individuals Covered | 174 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $9,996 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $91,279 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,996 | Insurance broker organization code? | 3 |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | EAB1000087 |
Policy instance | 2 |
Insurance contract or identification number | EAB1000087 | Number of Individuals Covered | 167 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $9,015 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $79,646 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,015 | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 100340 |
Policy instance | 1 |
Insurance contract or identification number | 100340 | Number of Individuals Covered | 195 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $5,347 | Total amount of fees paid to insurance company | USD $1,365 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,347 | Amount paid for insurance broker fees | 1365 | Additional information about fees paid to insurance broker | FEES AND OTHER COMMISSIONS | Insurance broker organization code? | 3 |
|
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | EAB1000087 |
Policy instance | 2 |
Insurance contract or identification number | EAB1000087 | Number of Individuals Covered | 173 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $8,707 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $76,083 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,707 | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 100340 |
Policy instance | 1 |
Insurance contract or identification number | 100340 | Number of Individuals Covered | 177 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $5,610 | Total amount of fees paid to insurance company | USD $932 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,610 | Amount paid for insurance broker fees | 932 | Additional information about fees paid to insurance broker | FEES AND OTHER COMMISSIONS | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 100340 |
Policy instance | 3 |
Insurance contract or identification number | 100340 | Number of Individuals Covered | 159 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $6,241 | Total amount of fees paid to insurance company | USD $3,454 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,241 | Amount paid for insurance broker fees | 3454 | Additional information about fees paid to insurance broker | OTHER FEES | Insurance broker organization code? | 3 |
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CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
Policy contract number | 0000025201 |
Policy instance | 2 |
Insurance contract or identification number | 0000025201 | Number of Individuals Covered | 136 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $5,755 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | 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 | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $38,364 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,755 | Insurance broker organization code? | 3 |
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DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
Policy contract number | EAB1000087 |
Policy instance | 1 |
Insurance contract or identification number | EAB1000087 | Number of Individuals Covered | 171 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $4,581 | Total amount of fees paid to insurance company | USD $4,183 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $29,962 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,581 | Amount paid for insurance broker fees | 4183 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
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UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 5479798 |
Policy instance | 1 |
Insurance contract or identification number | 5479798 | Number of Individuals Covered | 201 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $18,611 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | 0 | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $160,834 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $18,611 | Insurance broker organization code? | 3 | Insurance broker name | CREATIVE BENEFITS & INS. SOLUTIONS |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 212098 |
Policy instance | 2 |
Insurance contract or identification number | 212098 | Number of Individuals Covered | 106 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $5,384 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $71,625 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,384 | Insurance broker organization code? | 3 | Insurance broker name | CREATIVE BENEFITS & INS. SOLUTIONS |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 38029 |
Policy instance | 1 |
Insurance contract or identification number | 38029 | Number of Individuals Covered | 139 | Insurance policy start date | 2015-03-01 | Insurance policy end date | 2016-02-29 | Total amount of commissions paid to insurance broker | USD $14,920 | Total amount of fees paid to insurance company | USD $2,174 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,920 | Amount paid for insurance broker fees | 2174 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | CREATIVE BENEFITS & INS. SOLUTIONS |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 212098 |
Policy instance | 2 |
Insurance contract or identification number | 212098 | Number of Individuals Covered | 120 | Insurance policy start date | 2014-01-01 | Insurance policy end date | 2014-12-31 | Total amount of commissions paid to insurance broker | USD $8,898 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $59,323 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,898 | Insurance broker organization code? | 3 | Insurance broker name | CREATIVE BENEFITS & INS. SOLUTIONS |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 38029 |
Policy instance | 1 |
Insurance contract or identification number | 38029 | Number of Individuals Covered | 163 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $4,439 | Total amount of fees paid to insurance company | USD $549 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,439 | Amount paid for insurance broker fees | 549 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 | Insurance broker name | PATRICIA A. SHALL |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 212098 |
Policy instance | 1 |
Insurance contract or identification number | 212098 | Number of Individuals Covered | 117 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $6,834 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $45,558 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,834 | Insurance broker organization code? | 3 | Insurance broker name | CREATIVE BENEFITS & INS. SOLUTIONS |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 212098 |
Policy instance | 1 |
Insurance contract or identification number | 212098 | Number of Individuals Covered | 113 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $5,850 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $39,003 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,850 | Insurance broker organization code? | 3 | Insurance broker name | CREATIVE BENEFITS & INS. SOLUTIONS |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 212098 |
Policy instance | 1 |
Insurance contract or identification number | 212098 | Number of Individuals Covered | 119 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $5,205 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $34,700 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 212098 |
Policy instance | 1 |
Insurance contract or identification number | 212098 | Number of Individuals Covered | 133 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $5,638 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $37,583 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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