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GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 401k Plan overview

Plan NameGREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN
Plan identification number 526

GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision

401k Sponsoring company profile

GREAT LAKES ENERGY COOPERATIVE has sponsored the creation of one or more 401k plans.

Company Name:GREAT LAKES ENERGY COOPERATIVE
Employer identification number (EIN):383321875
NAIC Classification:221100

Additional information about GREAT LAKES ENERGY COOPERATIVE

Jurisdiction of Incorporation: Michigan Secretary of State
Incorporation Date: 0000-00-00
Company Identification Number: 744697
Legal Registered Office Address: 1323 BOYNE AVE BOYNE CITY


United States of America (USA)
49712

More information about GREAT LAKES ENERGY COOPERATIVE

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5262022-01-01
5262021-01-01
5262020-01-01
5262019-01-01
5262018-01-01
5262017-01-01JANICE CHEW
5262017-01-01JANICE CHEW
5262016-01-01JANICE CHEW
5262015-01-01JANICE CHEW
5262014-01-01JANICE CHEW
5262013-01-01JANICE CHEW
5262012-01-01ALISON YOUNG
5262011-01-01BRIDGET FORD
5262010-01-01BRIDGET FORD
5262009-01-01BRIDGET FORD

Plan Statistics for GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN

401k plan membership statisitcs for GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN

Measure Date Value
2022: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0134
Number of retired or separated participants receiving benefits2022-01-0134
Total of all active and inactive participants2022-01-0134
Total participants2022-01-0134
2021: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0140
Number of retired or separated participants receiving benefits2021-01-0140
Total of all active and inactive participants2021-01-0140
Total participants2021-01-0140
2020: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0142
Number of retired or separated participants receiving benefits2020-01-0140
Total of all active and inactive participants2020-01-0140
Total participants2020-01-0140
2019: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0144
Number of retired or separated participants receiving benefits2019-01-0142
Total of all active and inactive participants2019-01-0142
Total participants2019-01-0142
2018: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0156
Number of retired or separated participants receiving benefits2018-01-0144
Total of all active and inactive participants2018-01-0144
Total participants2018-01-0144
2017: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0159
Number of retired or separated participants receiving benefits2017-01-0156
Total of all active and inactive participants2017-01-0156
Total participants2017-01-0156
2016: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0162
Number of retired or separated participants receiving benefits2016-01-0159
Total of all active and inactive participants2016-01-0159
Total participants2016-01-0159
2015: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0168
Number of retired or separated participants receiving benefits2015-01-0162
Total of all active and inactive participants2015-01-0162
Total participants2015-01-0162
2014: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0168
Number of retired or separated participants receiving benefits2014-01-0170
Total of all active and inactive participants2014-01-0170
Total participants2014-01-0170
2013: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0164
Number of retired or separated participants receiving benefits2013-01-0168
Total of all active and inactive participants2013-01-0168
Total participants2013-01-0168
2012: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0175
Number of retired or separated participants receiving benefits2012-01-0164
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0164
Total participants2012-01-0164
2011: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0164
Total number of active participants reported on line 7a of the Form 55002011-01-0174
Number of other retired or separated participants entitled to future benefits2011-01-011
Total of all active and inactive participants2011-01-0175
Total participants2011-01-0175
2010: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0164
Number of retired or separated participants receiving benefits2010-01-0164
Total of all active and inactive participants2010-01-0164
Total participants2010-01-0164
2009: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01294
Total number of active participants reported on line 7a of the Form 55002009-01-01231
Number of retired or separated participants receiving benefits2009-01-0163
Total of all active and inactive participants2009-01-01294
Total participants2009-01-01294

Financial Data on GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN

Measure Date Value
2022 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2022 401k financial data
Total income from all sources2022-12-31$-386,977
Expenses. Total of all expenses incurred2022-12-31$0
Benefits paid (including direct rollovers)2022-12-31$0
Total plan assets at end of year2022-12-31$6,729,405
Total plan assets at beginning of year2022-12-31$7,116,382
Value of fidelity bond covering the plan2022-12-31$500,000
Other income received2022-12-31$-1,002,742
Net income (gross income less expenses)2022-12-31$-386,977
Net plan assets at end of year (total assets less liabilities)2022-12-31$6,729,405
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$7,116,382
Total contributions received or receivable from employer(s)2022-12-31$615,765
2021 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2021 401k financial data
Total income from all sources2021-12-31$1,321,073
Expenses. Total of all expenses incurred2021-12-31$0
Benefits paid (including direct rollovers)2021-12-31$0
Total plan assets at end of year2021-12-31$7,116,382
Total plan assets at beginning of year2021-12-31$5,795,309
Value of fidelity bond covering the plan2021-12-31$500,000
Other income received2021-12-31$784,653
Net income (gross income less expenses)2021-12-31$1,321,073
Net plan assets at end of year (total assets less liabilities)2021-12-31$7,116,382
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$5,795,309
Total contributions received or receivable from employer(s)2021-12-31$536,420
2020 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2020 401k financial data
Total income from all sources2020-12-31$395,927
Expenses. Total of all expenses incurred2020-12-31$0
Benefits paid (including direct rollovers)2020-12-31$0
Total plan assets at end of year2020-12-31$5,795,308
Total plan assets at beginning of year2020-12-31$5,399,381
Value of fidelity bond covering the plan2020-12-31$500,000
Other income received2020-12-31$-382,157
Net income (gross income less expenses)2020-12-31$395,927
Net plan assets at end of year (total assets less liabilities)2020-12-31$5,795,308
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$5,399,381
Total contributions received or receivable from employer(s)2020-12-31$778,084
2019 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2019 401k financial data
Total income from all sources2019-12-31$1,082,015
Expenses. Total of all expenses incurred2019-12-31$0
Benefits paid (including direct rollovers)2019-12-31$0
Total plan assets at end of year2019-12-31$5,399,381
Total plan assets at beginning of year2019-12-31$4,317,366
Value of fidelity bond covering the plan2019-12-31$500,000
Other income received2019-12-31$410,469
Net income (gross income less expenses)2019-12-31$1,082,015
Net plan assets at end of year (total assets less liabilities)2019-12-31$5,399,381
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$4,317,366
Total contributions received or receivable from employer(s)2019-12-31$671,546
2018 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2018 401k financial data
Total income from all sources2018-12-31$-254,164
Expenses. Total of all expenses incurred2018-12-31$0
Benefits paid (including direct rollovers)2018-12-31$0
Total plan assets at end of year2018-12-31$4,317,366
Total plan assets at beginning of year2018-12-31$4,571,530
Value of fidelity bond covering the plan2018-12-31$500,000
Other income received2018-12-31$-647,574
Net income (gross income less expenses)2018-12-31$-254,164
Net plan assets at end of year (total assets less liabilities)2018-12-31$4,317,366
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$4,571,530
Total contributions received or receivable from employer(s)2018-12-31$393,410
2017 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2017 401k financial data
Total income from all sources2017-12-31$752,075
Expenses. Total of all expenses incurred2017-12-31$0
Benefits paid (including direct rollovers)2017-12-31$0
Total plan assets at end of year2017-12-31$4,571,530
Total plan assets at beginning of year2017-12-31$3,819,455
Value of fidelity bond covering the plan2017-12-31$500,000
Other income received2017-12-31$536,009
Net income (gross income less expenses)2017-12-31$752,075
Net plan assets at end of year (total assets less liabilities)2017-12-31$4,571,530
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$3,819,455
Total contributions received or receivable from employer(s)2017-12-31$216,066
2016 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2016 401k financial data
Total income from all sources2016-12-31$373,847
Expenses. Total of all expenses incurred2016-12-31$0
Total plan assets at end of year2016-12-31$3,819,455
Total plan assets at beginning of year2016-12-31$3,445,608
Value of fidelity bond covering the plan2016-12-31$500,000
Other income received2016-12-31$59,981
Net income (gross income less expenses)2016-12-31$373,847
Net plan assets at end of year (total assets less liabilities)2016-12-31$3,819,455
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$3,445,608
Total contributions received or receivable from employer(s)2016-12-31$313,866
2015 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2015 401k financial data
Total income from all sources2015-12-31$-37,143
Expenses. Total of all expenses incurred2015-12-31$0
Benefits paid (including direct rollovers)2015-12-31$0
Total plan assets at end of year2015-12-31$3,445,607
Total plan assets at beginning of year2015-12-31$3,482,750
Value of fidelity bond covering the plan2015-12-31$500,000
Other income received2015-12-31$-245,609
Net income (gross income less expenses)2015-12-31$-37,143
Net plan assets at end of year (total assets less liabilities)2015-12-31$3,445,607
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$3,482,750
Total contributions received or receivable from employer(s)2015-12-31$208,466
2014 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2014 401k financial data
Total income from all sources2014-12-31$370,444
Expenses. Total of all expenses incurred2014-12-31$0
Total plan assets at end of year2014-12-31$3,482,750
Total plan assets at beginning of year2014-12-31$3,112,306
Value of fidelity bond covering the plan2014-12-31$500,000
Other income received2014-12-31$314,628
Net income (gross income less expenses)2014-12-31$370,444
Net plan assets at end of year (total assets less liabilities)2014-12-31$3,482,750
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$3,112,306
Total contributions received or receivable from employer(s)2014-12-31$55,816
2013 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2013 401k financial data
Total income from all sources2013-12-31$708,907
Expenses. Total of all expenses incurred2013-12-31$0
Total plan assets at end of year2013-12-31$3,112,306
Total plan assets at beginning of year2013-12-31$2,403,399
Value of fidelity bond covering the plan2013-12-31$500,000
Other income received2013-12-31$659,194
Net income (gross income less expenses)2013-12-31$708,907
Net plan assets at end of year (total assets less liabilities)2013-12-31$3,112,306
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$2,403,399
Total contributions received or receivable from employer(s)2013-12-31$49,713
2012 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2012 401k financial data
Total income from all sources2012-12-31$247,752
Total plan assets at end of year2012-12-31$2,403,399
Total plan assets at beginning of year2012-12-31$2,155,647
Value of fidelity bond covering the plan2012-12-31$500,000
Other income received2012-12-31$198,566
Net income (gross income less expenses)2012-12-31$247,752
Net plan assets at end of year (total assets less liabilities)2012-12-31$2,403,399
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$2,155,647
Total contributions received or receivable from employer(s)2012-12-31$49,186
2011 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2011 401k financial data
Total income from all sources2011-12-31$38,692
Expenses. Total of all expenses incurred2011-12-31$4,953
Total plan assets at end of year2011-12-31$2,155,647
Total plan assets at beginning of year2011-12-31$2,121,908
Value of fidelity bond covering the plan2011-12-31$500,000
Expenses. Other expenses not covered elsewhere2011-12-31$4,953
Net income (gross income less expenses)2011-12-31$33,739
Net plan assets at end of year (total assets less liabilities)2011-12-31$2,155,647
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$2,121,908
Total contributions received or receivable from employer(s)2011-12-31$38,692
2010 : GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2010 401k financial data
Total income from all sources2010-12-31$215,256
Total plan assets at end of year2010-12-31$2,121,908
Total plan assets at beginning of year2010-12-31$1,906,653
Value of fidelity bond covering the plan2010-12-31$500,000
Other income received2010-12-31$215,256
Net income (gross income less expenses)2010-12-31$215,256
Net plan assets at end of year (total assets less liabilities)2010-12-31$2,121,908
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,906,653

Form 5500 Responses for GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN

2022: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
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: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedYes
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement - TrustYes
2015: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2010: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement - TrustYes
2009: GREAT LAKES ENERGY COOPERATIVE RETIREE WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number57096-600
Policy instance 1
Insurance contract or identification number57096-600
Number of Individuals Covered34
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $283
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number57096-600
Policy instance 1
Insurance contract or identification number57096-600
Number of Individuals Covered38
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,783
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $3,783
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number57096600
Policy instance 1
Insurance contract or identification number57096600
Number of Individuals Covered41
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $4,092
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $4,092
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number57096-600
Policy instance 1
Insurance contract or identification number57096-600
Number of Individuals Covered43
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,283
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $4,283
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number57096-600
Policy instance 1
Insurance contract or identification number57096-600
Number of Individuals Covered49
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $5,717
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 BrokerUSD $5,717
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
Insurance broker nameDENISE A LEWANIAK/KORTHASE FLINN

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