UNIVERSITY PEDIATRICIANS has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN
401k plan membership statisitcs for UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN
Measure | Date | Value |
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2020: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-01-01 | 639 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 665 |
Total of all active and inactive participants | 2020-01-01 | 665 |
2019: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-01-01 | 454 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 639 |
Total of all active and inactive participants | 2019-01-01 | 639 |
2018: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-01-01 | 460 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 454 |
Total of all active and inactive participants | 2018-01-01 | 454 |
2017: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-01-01 | 444 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 460 |
Total of all active and inactive participants | 2017-01-01 | 460 |
2016: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-01-01 | 402 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 444 |
Total of all active and inactive participants | 2016-01-01 | 444 |
2015: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-01-01 | 385 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 402 |
Total of all active and inactive participants | 2015-01-01 | 402 |
2014: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-01-01 | 377 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 385 |
Total of all active and inactive participants | 2014-01-01 | 385 |
2013: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-01-01 | 370 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 377 |
Total of all active and inactive participants | 2013-01-01 | 377 |
2012: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-01-01 | 327 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 370 |
Total of all active and inactive participants | 2012-01-01 | 370 |
2011: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-01-01 | 345 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 327 |
Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
Total of all active and inactive participants | 2011-01-01 | 327 |
2010: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-01-01 | 257 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 345 |
Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
Total of all active and inactive participants | 2010-01-01 | 345 |
2009: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-01-01 | 238 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 257 |
Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
Total of all active and inactive participants | 2009-01-01 | 257 |
Measure | Date | Value |
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2020 : UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2020 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
Was this plan covered by a fidelity bond | 2020-12-31 | No |
If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-12-31 | No |
Did the plan have assets held for investment | 2020-12-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
2019 : UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2019 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
Was this plan covered by a fidelity bond | 2019-12-31 | No |
If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
Did the plan have assets held for investment | 2019-12-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
2018 : UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2018 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
Was this plan covered by a fidelity bond | 2018-12-31 | No |
If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-12-31 | No |
Did the plan have assets held for investment | 2018-12-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
2017 : UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2017 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
Was this plan covered by a fidelity bond | 2017-12-31 | No |
If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-12-31 | No |
Did the plan have assets held for investment | 2017-12-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
2016 : UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2016 401k financial data |
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Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
Was this plan covered by a fidelity bond | 2016-12-31 | No |
If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-12-31 | No |
Did the plan have assets held for investment | 2016-12-31 | No |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
2020: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2020 form 5500 responses |
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2020-01-01 | Type of plan entity | Single employer plan |
2020-01-01 | Plan funding arrangement – Insurance | Yes |
2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-01-01 | Plan benefit arrangement – Insurance | Yes |
2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2019 form 5500 responses |
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2019-01-01 | Type of plan entity | Single employer plan |
2019-01-01 | Plan funding arrangement – Insurance | Yes |
2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-01-01 | Plan benefit arrangement – Insurance | Yes |
2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2018 form 5500 responses |
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2018-01-01 | Type of plan entity | Single employer plan |
2018-01-01 | Plan funding arrangement – Insurance | Yes |
2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-01-01 | Plan benefit arrangement – Insurance | Yes |
2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2017 form 5500 responses |
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2017-01-01 | Type of plan entity | Single employer plan |
2017-01-01 | Plan funding arrangement – Insurance | Yes |
2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-01-01 | Plan benefit arrangement – Insurance | Yes |
2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2016 form 5500 responses |
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2016-01-01 | Type of plan entity | Single employer plan |
2016-01-01 | Plan funding arrangement – Insurance | Yes |
2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-01-01 | Plan benefit arrangement – Insurance | Yes |
2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2015 form 5500 responses |
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2015-01-01 | Type of plan entity | Single employer plan |
2015-01-01 | Plan funding arrangement – Insurance | Yes |
2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-01-01 | Plan benefit arrangement – Insurance | Yes |
2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2014 form 5500 responses |
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2014-01-01 | Type of plan entity | Single employer plan |
2014-01-01 | Plan funding arrangement – Insurance | Yes |
2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-01-01 | Plan benefit arrangement – Insurance | Yes |
2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2013 form 5500 responses |
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2013-01-01 | Type of plan entity | Single employer plan |
2013-01-01 | Plan funding arrangement – Insurance | Yes |
2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-01-01 | Plan benefit arrangement – Insurance | Yes |
2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2012 form 5500 responses |
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2012-01-01 | Type of plan entity | Single employer plan |
2012-01-01 | Submission has been amended | Yes |
2012-01-01 | Plan funding arrangement – Insurance | Yes |
2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-01-01 | Plan benefit arrangement – Insurance | Yes |
2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2011 form 5500 responses |
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2011-01-01 | Type of plan entity | Single employer plan |
2011-01-01 | Submission has been amended | Yes |
2011-01-01 | Plan funding arrangement – Insurance | Yes |
2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-01-01 | Plan benefit arrangement – Insurance | Yes |
2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2010: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2010 form 5500 responses |
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2010-01-01 | Type of plan entity | Single employer plan |
2010-01-01 | Submission has been amended | Yes |
2010-01-01 | Plan funding arrangement – Insurance | Yes |
2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2010-01-01 | Plan benefit arrangement – Insurance | Yes |
2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2009: UNIVERSITY PEDIATRICIANS LIFE, AD&D, & DISABILITY VISION, AND HEALTH PLAN 2009 form 5500 responses |
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2009-01-01 | Type of plan entity | Single employer plan |
2009-01-01 | This submission is the final filing | No |
2009-01-01 | Plan funding arrangement – Insurance | Yes |
2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2009-01-01 | Plan benefit arrangement – Insurance | Yes |
2009-01-01 | 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 | 158769 |
Policy instance | 3 |
Insurance contract or identification number | 158769 | Number of Individuals Covered | 358 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $64,452 | Total amount of fees paid to insurance company | USD $1,550 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $64,452 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | FEES AND OTHER COMMISSIONS |
|
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 158769 |
Policy instance | 4 |
Insurance contract or identification number | 158769 | Number of Individuals Covered | 269 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $40,608 | Total amount of fees paid to insurance company | USD $1,494 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $40,608 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | FEES AND OTHER COMMISSIONS |
|
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 9289 |
Policy instance | 2 |
Insurance contract or identification number | 9289 | Number of Individuals Covered | 689 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $13,839 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,839 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 97534681001 |
Policy instance | 1 |
Insurance contract or identification number | 97534681001 | Number of Individuals Covered | 679 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $41,982 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409960 |
Policy instance | 5 |
Insurance contract or identification number | 409960 | Number of Individuals Covered | 350 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $88,560 | Total amount of fees paid to insurance company | USD $5,882 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $433,847 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $88,560 | Amount paid for insurance broker fees | 5882 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409960 |
Policy instance | 5 |
Insurance contract or identification number | 409960 | Number of Individuals Covered | 342 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $72,105 | Total amount of fees paid to insurance company | USD $4,841 | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $396,105 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $72,105 | Amount paid for insurance broker fees | 4841 | Additional information about fees paid to insurance broker | FEES | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 97534681001 |
Policy instance | 1 |
Insurance contract or identification number | 97534681001 | Number of Individuals Covered | 665 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,063 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 9289 |
Policy instance | 2 |
Insurance contract or identification number | 9289 | Number of Individuals Covered | 660 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $12,777 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,641 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 158769 |
Policy instance | 3 |
Insurance contract or identification number | 158769 | Number of Individuals Covered | 358 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $32,505 | Total amount of fees paid to insurance company | USD $1,688 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,505 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | FEES |
|
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 158769 |
Policy instance | 4 |
Insurance contract or identification number | 158769 | Number of Individuals Covered | 271 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | 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 number | 409960 |
Policy instance | 2 |
Insurance contract or identification number | 409960 | Number of Individuals Covered | 342 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-07-01 | Total amount of commissions paid to insurance broker | USD $62,479 | Total amount of fees paid to insurance company | USD $3,981 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $325,822 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $62,479 | Amount paid for insurance broker fees | 3981 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409959 |
Policy instance | 4 |
Insurance contract or identification number | 409959 | Number of Individuals Covered | 299 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-07-01 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $14,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
Policy contract number | 9289 |
Policy instance | 5 |
Insurance contract or identification number | 9289 | Number of Individuals Covered | 660 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $12,777 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,641 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 97534681001 |
Policy instance | 1 |
Insurance contract or identification number | 97534681001 | Number of Individuals Covered | 665 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,063 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409961 |
Policy instance | 3 |
Insurance contract or identification number | 409961 | Number of Individuals Covered | 109 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-07-01 | Total amount of commissions paid to insurance broker | USD $9,626 | Total amount of fees paid to insurance company | USD $860 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE AD&D, LIFESTYLE LIFE | Welfare Benefit Premiums Paid to Carrier | USD $70,283 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,626 | Amount paid for insurance broker fees | 860 | Insurance broker organization code? | 1 |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 158769 |
Policy instance | 6 |
Insurance contract or identification number | 158769 | Number of Individuals Covered | 309 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $21,834 | Total amount of fees paid to insurance company | USD $1,661 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,834 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1661 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409961 |
Policy instance | 4 |
Insurance contract or identification number | 409961 | Number of Individuals Covered | 97 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-07-01 | Total amount of commissions paid to insurance broker | USD $5,356 | Total amount of fees paid to insurance company | USD $478 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE AD&D, LIFESTYLE LIFE | Welfare Benefit Premiums Paid to Carrier | USD $41,650 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,356 | Amount paid for insurance broker fees | 478 | Insurance broker organization code? | 1 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409960 |
Policy instance | 3 |
Insurance contract or identification number | 409960 | Number of Individuals Covered | 324 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-07-01 | Total amount of commissions paid to insurance broker | USD $54,295 | Total amount of fees paid to insurance company | USD $3,497 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $287,938 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54,295 | Amount paid for insurance broker fees | 3497 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | 158769 |
Policy instance | 2 |
Insurance contract or identification number | 158769 | Number of Individuals Covered | 288 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $17,299 | Total amount of fees paid to insurance company | USD $667 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,299 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 667 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 97534681001 |
Policy instance | 1 |
Insurance contract or identification number | 97534681001 | Number of Individuals Covered | 639 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $32,407 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409959 |
Policy instance | 5 |
Insurance contract or identification number | 409959 | Number of Individuals Covered | 299 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-07-01 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $14,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 158769 |
Policy instance | 6 |
Insurance contract or identification number | 158769 | Number of Individuals Covered | 350 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $28,026 | Total amount of fees paid to insurance company | USD $2,019 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,026 | Amount paid for insurance broker fees | 2019 | Insurance broker organization code? | 3 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409959 |
Policy instance | 5 |
Insurance contract or identification number | 409959 | Number of Individuals Covered | 299 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-07-01 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $14,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409961 |
Policy instance | 4 |
Insurance contract or identification number | 409961 | Number of Individuals Covered | 33 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-07-01 | Total amount of commissions paid to insurance broker | USD $1,956 | Total amount of fees paid to insurance company | USD $175 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE AD&D, LIFESTYLE LIFE | Welfare Benefit Premiums Paid to Carrier | USD $14,067 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,956 | Amount paid for insurance broker fees | 175 | Insurance broker organization code? | 1 |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409960 |
Policy instance | 3 |
Insurance contract or identification number | 409960 | Number of Individuals Covered | 346 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-07-01 | Total amount of commissions paid to insurance broker | USD $37,742 | Total amount of fees paid to insurance company | USD $2,463 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $198,258 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $37,742 | Amount paid for insurance broker fees | 2463 |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | GROUP 38154 |
Policy instance | 2 |
Insurance contract or identification number | GROUP 38154 | Number of Individuals Covered | 458 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $14,836 | Total amount of fees paid to insurance company | USD $399 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,836 | Amount paid for insurance broker fees | 399 | Insurance broker organization code? | 3 |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 97534681001 |
Policy instance | 1 |
Insurance contract or identification number | 97534681001 | Number of Individuals Covered | 454 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,176 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
Policy contract number | GROUP 38154 |
Policy instance | 2 |
Insurance contract or identification number | GROUP 38154 | Insurance policy start date | 2016-07-01 | Insurance policy end date | 2017-06-30 | Total amount of commissions paid to insurance broker | USD $26,308 | Total amount of fees paid to insurance company | USD $600 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,308 | Amount paid for insurance broker fees | 600 | Insurance broker organization code? | 3 | Insurance broker name | GALLAGHER BENEFIT SERVICES |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409960 |
Policy instance | 3 |
Insurance contract or identification number | 409960 | Number of Individuals Covered | 327 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-07-01 | Total amount of commissions paid to insurance broker | USD $39,613 | Total amount of fees paid to insurance company | USD $2,585 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $222,484 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,295 | Amount paid for insurance broker fees | 2368 | Insurance broker name | JS CLARK AGENCY INC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409961 |
Policy instance | 4 |
Insurance contract or identification number | 409961 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-07-01 | Total amount of commissions paid to insurance broker | USD $1,849 | Total amount of fees paid to insurance company | USD $165 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE AD&D, LIFESTYLE LIFE | Welfare Benefit Premiums Paid to Carrier | USD $14,461 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,682 | Amount paid for insurance broker fees | 150 | Insurance broker organization code? | 1 | Insurance broker name | JS CLARK AGENCY INC |
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UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 409959 |
Policy instance | 5 |
Insurance contract or identification number | 409959 | Number of Individuals Covered | 299 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-07-01 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $14,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
Policy contract number | 158769 |
Policy instance | 6 |
Insurance contract or identification number | 158769 | Number of Individuals Covered | 350 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $28,026 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,026 | Insurance broker name | KELLEY A. DEMIRYAN |
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EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 97534681001 |
Policy instance | 1 |
Insurance contract or identification number | 97534681001 | Number of Individuals Covered | 460 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,075 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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