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SPEED WRENCH, INC. WELFARE BENEFIT PLAN 401k Plan overview

Plan NameSPEED WRENCH, INC. WELFARE BENEFIT PLAN
Plan identification number 501

SPEED WRENCH, INC. WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

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

Company Name:SPEED WRENCH, INC.
Employer identification number (EIN):382834301
NAIC Classification:811110
NAIC Description: Automotive Mechanical and Electrical Repair and Maintenance

Additional information about SPEED WRENCH, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 2005-09-21
Company Identification Number: 3259003
Legal Registered Office Address: 96 EAST MAIN STREET SUITE #4
Nassau
EAST ISLIP
United States of America (USA)
11730

More information about SPEED WRENCH, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SPEED WRENCH, INC. WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01EMILY KITCHEN2023-05-24
5012021-01-01
5012020-01-01
5012019-01-01
5012018-10-01
5012017-10-01
5012016-10-01JOHN VAN DYKE JOHN VAN DYKE2018-04-03
5012015-10-01JOHN VAN DYKE JOHN VAN DYKE2017-02-06
5012014-10-01JUSTIN KOOLE JOHN VAN DYKE2016-06-20

Plan Statistics for SPEED WRENCH, INC. WELFARE BENEFIT PLAN

401k plan membership statisitcs for SPEED WRENCH, INC. WELFARE BENEFIT PLAN

Measure Date Value
2022: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01177
Total number of active participants reported on line 7a of the Form 55002022-01-01176
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01176
Number of employers contributing to the scheme2022-01-010
2021: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01397
Total number of active participants reported on line 7a of the Form 55002021-01-01411
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01411
2020: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01423
Total number of active participants reported on line 7a of the Form 55002020-01-01397
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01397
Total participants2020-01-01397
2019: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01385
Total number of active participants reported on line 7a of the Form 55002019-01-01423
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01423
2018: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01292
Total number of active participants reported on line 7a of the Form 55002018-10-01385
Number of retired or separated participants receiving benefits2018-10-010
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01385
2017: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-010
Total number of active participants reported on line 7a of the Form 55002017-10-010
Number of retired or separated participants receiving benefits2017-10-010
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-010
2016: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-010
Total number of active participants reported on line 7a of the Form 55002016-10-010
Number of retired or separated participants receiving benefits2016-10-010
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-010
2015: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01116
Total number of active participants reported on line 7a of the Form 55002015-10-01361
Number of retired or separated participants receiving benefits2015-10-010
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01361
2014: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01116
Total number of active participants reported on line 7a of the Form 55002014-10-01137
Number of retired or separated participants receiving benefits2014-10-010
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01137

Form 5500 Responses for SPEED WRENCH, INC. WELFARE BENEFIT PLAN

2022: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan benefit arrangement – InsuranceYes
2017: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan benefit arrangement – InsuranceYes
2016: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan benefit arrangement – InsuranceYes
2015: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan benefit arrangement – InsuranceYes
2014: SPEED WRENCH, INC. WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01First time form 5500 has been submittedYes
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BGSR
Policy instance 6
Insurance contract or identification numberGLUG0BGSR
Number of Individuals Covered182
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,555
Total amount of fees paid to insurance companyUSD $3,987
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $51,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,555
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerOTHER COMPENSATION
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number783497
Policy instance 1
Insurance contract or identification number783497
Number of Individuals Covered399
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $44,595
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,486,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,595
Amount paid for insurance broker fees0
Insurance broker organization code?3
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number10482
Policy instance 2
Insurance contract or identification number10482
Number of Individuals Covered434
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,306
Total amount of fees paid to insurance companyUSD $690
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,306
Amount paid for insurance broker fees690
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10129631001
Policy instance 3
Insurance contract or identification number10129631001
Number of Individuals Covered374
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,884
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,884
Amount paid for insurance broker fees0
Insurance broker organization code?3
ASSURITY LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71439 )
Policy contract number800001022
Policy instance 4
Insurance contract or identification number800001022
Number of Individuals Covered117
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $42,400
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL
Welfare Benefit Premiums Paid to CarrierUSD $57,940
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,062
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )
Policy contract number783497
Policy instance 5
Insurance contract or identification number783497
Number of Individuals Covered7
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,215
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $40,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,215
Amount paid for insurance broker fees0
Insurance broker organization code?3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )
Policy contract number783497 S002
Policy instance 4
Insurance contract or identification number783497 S002
Number of Individuals Covered6
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,029
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,195
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,029
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BGSR
Policy instance 5
Insurance contract or identification numberGVTL0BGSR
Number of Individuals Covered97
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,902
Total amount of fees paid to insurance companyUSD $2,973
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,640
Additional information about fees paid to insurance brokerAGENT
Insurance broker organization code?3
Amount paid for insurance broker fees1982
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BGSR
Policy instance 2
Insurance contract or identification numberGLUG0BGSR
Number of Individuals Covered174
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $984
Total amount of fees paid to insurance companyUSD $874
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $748
Insurance broker organization code?3
Amount paid for insurance broker fees583
Additional information about fees paid to insurance brokerOTHER COMPENSATION
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10129631001
Policy instance 1
Insurance contract or identification number10129631001
Number of Individuals Covered330
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $1,078
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $610
Insurance broker organization code?3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number783497
Policy instance 3
Insurance contract or identification number783497
Number of Individuals Covered402
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $41,383
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,373,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,383
Insurance broker organization code?3
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 )
Policy contract number10482
Policy instance 6
Insurance contract or identification number10482
Number of Individuals Covered411
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $4,560
Total amount of fees paid to insurance companyUSD $4,560
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,560
Amount paid for insurance broker fees823
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BGSR
Policy instance 2
Insurance contract or identification numberGLUG0BGSR
Number of Individuals Covered166
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $897
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $897
Additional information about fees paid to insurance brokerAGENT
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10129631001
Policy instance 1
Insurance contract or identification number10129631001
Number of Individuals Covered295
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $1,754
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,501
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,754
Insurance broker organization code?3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number783497
Policy instance 3
Insurance contract or identification number783497
Number of Individuals Covered397
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $39,291
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,309,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,291
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BGSR
Policy instance 5
Insurance contract or identification numberGVTL0BGSR
Number of Individuals Covered95
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,384
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,384
Additional information about fees paid to insurance brokerAGENT
Insurance broker organization code?3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )
Policy contract number783497 S002
Policy instance 4
Insurance contract or identification number783497 S002
Number of Individuals Covered6
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $712
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,741
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $712
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5050001
Policy instance 6
Insurance contract or identification number5050001
Number of Individuals Covered320
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $12,648
Total amount of fees paid to insurance companyUSD $7,108
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,142
Amount paid for insurance broker fees2023
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMP
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5050001
Policy instance 7
Insurance contract or identification number5050001
Number of Individuals Covered307
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $12,604
Total amount of fees paid to insurance companyUSD $5,087
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $100,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,261
Amount paid for insurance broker fees5046
Additional information about fees paid to insurance brokerADMINISTRATIVE FEE
Insurance broker organization code?3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 12208 )
Policy contract number783497 S002
Policy instance 5
Insurance contract or identification number783497 S002
Number of Individuals Covered3
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $463
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $463
Insurance broker organization code?3
PRIORITY HEALTH (National Association of Insurance Commissioners NAIC id number: 95561 )
Policy contract number783497
Policy instance 4
Insurance contract or identification number783497
Number of Individuals Covered423
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $36,509
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,191,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,509
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BGSR
Policy instance 3
Insurance contract or identification numberGLUG0BGSR
Number of Individuals Covered166
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $897
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $897
Additional information about fees paid to insurance brokerAGENT
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10129631001
Policy instance 2
Insurance contract or identification number10129631001
Number of Individuals Covered318
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $1,958
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $969
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number151627
Policy instance 1
Insurance contract or identification number151627
Number of Individuals Covered155
Insurance policy start date2018-10-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $325
Total amount of fees paid to insurance companyUSD $57
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,263
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $213
Amount paid for insurance broker fees37
Additional information about fees paid to insurance brokerAGENT
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0BGSR
Policy instance 6
Insurance contract or identification numberGVTL0BGSR
Number of Individuals Covered95
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,384
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,384
Additional information about fees paid to insurance brokerAGENT
Insurance broker organization code?3
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00179508/0001
Policy instance 5
Insurance contract or identification number00179508/0001
Number of Individuals Covered372
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $26,380
Welfare Benefit Premiums Paid to CarrierUSD $828,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number151628
Policy instance 4
Insurance contract or identification number151628
Number of Individuals Covered92
Insurance policy start date2018-01-01
Insurance policy end date2019-01-01
Total amount of commissions paid to insurance brokerUSD $4,150
Total amount of fees paid to insurance companyUSD $484
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,633
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30015968
Policy instance 3
Insurance contract or identification number30015968
Number of Individuals Covered88
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $112
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5050001
Policy instance 2
Insurance contract or identification number5050001
Number of Individuals Covered292
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $12,384
Total amount of fees paid to insurance companyUSD $5,697
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $99,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number151627
Policy instance 1
Insurance contract or identification number151627
Number of Individuals Covered150
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $1,258
Total amount of fees paid to insurance companyUSD $220
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number151627
Policy instance 1
Insurance contract or identification number151627
Number of Individuals Covered140
Insurance policy start date2014-10-01
Insurance policy end date2015-10-01
Total amount of commissions paid to insurance brokerUSD $1,277
Total amount of fees paid to insurance companyUSD $223
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,277
Amount paid for insurance broker fees223
Additional information about fees paid to insurance brokerAGENT
Insurance broker organization code?3
Insurance broker nameBERENDS HENDRICKS STUIT INS AGENCY
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number45703
Policy instance 2
Insurance contract or identification number45703
Number of Individuals Covered361
Insurance policy start date2015-10-01
Insurance policy end date2016-09-30
Total amount of commissions paid to insurance brokerUSD $48,596
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,083
Insurance broker organization code?3
Insurance broker nameBRAD J. DEVRIES
STARMOUNT LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68985 )
Policy contract numberSPEED615
Policy instance 3
Insurance contract or identification numberSPEED615
Number of Individuals Covered106
Insurance policy start date2015-06-01
Insurance policy end date2016-05-30
Total amount of commissions paid to insurance brokerUSD $9,069
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,069
Insurance broker nameBERENDS HENDRICKS STUIT
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number30015968
Policy instance 4
Insurance contract or identification number30015968
Number of Individuals Covered83
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $903
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $903
Insurance broker organization code?3
Insurance broker nameBERENDS HENDRICKS STUIT INS
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number151628
Policy instance 5
Insurance contract or identification number151628
Number of Individuals Covered77
Insurance policy end date2016-10-01
Total amount of commissions paid to insurance brokerUSD $3,881
Total amount of fees paid to insurance companyUSD $453
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,069
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,881
Amount paid for insurance broker fees453
Insurance broker organization code?3
Insurance broker nameBERENDS HENDRICKS STUIT INS AGENCY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number151627
Policy instance 1
Insurance contract or identification number151627
Number of Individuals Covered130
Insurance policy start date2014-10-01
Insurance policy end date2015-10-01
Total amount of commissions paid to insurance brokerUSD $884
Total amount of fees paid to insurance companyUSD $155
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $884
Amount paid for insurance broker fees155
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameBERENDS HENDRICKS STUIT INS AGENCY
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number151628
Policy instance 2
Insurance contract or identification number151628
Number of Individuals Covered72
Insurance policy start date2014-10-01
Insurance policy end date2015-10-01
Total amount of commissions paid to insurance brokerUSD $2,965
Total amount of fees paid to insurance companyUSD $346
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,570
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,965
Amount paid for insurance broker fees346
Additional information about fees paid to insurance brokerBROKER
Insurance broker organization code?3
Insurance broker nameBERENDS HENDRICKS STUIT INS AGENCY

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