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DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 401k Plan overview

Plan NameDAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN
Plan identification number 501

DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

DAKKOTA INTEGRATED SYSTEMS, LLC has sponsored the creation of one or more 401k plans.

Company Name:DAKKOTA INTEGRATED SYSTEMS, LLC
Employer identification number (EIN):383609324
NAIC Classification:493100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01GARY CALDWELL2023-10-10
5012021-01-01GARY CALDWELL2022-10-07
5012020-01-01TINA LEWIS2021-10-11
5012019-01-01GARY CALDWELL2020-09-29
5012018-01-01GARY CALDWELL2019-08-27
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01MARK MCCAULEY
5012011-01-01MARK MCCAULEY
5012009-01-01MARK MCCAULEY

Plan Statistics for DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN

401k plan membership statisitcs for DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN

Measure Date Value
2022: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,364
Total number of active participants reported on line 7a of the Form 55002022-01-011,553
Number of other retired or separated participants entitled to future benefits2022-01-01312
Total of all active and inactive participants2022-01-011,865
2021: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,266
Total number of active participants reported on line 7a of the Form 55002021-01-011,364
Number of other retired or separated participants entitled to future benefits2021-01-01370
Total of all active and inactive participants2021-01-011,734
2020: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-012,329
Total number of active participants reported on line 7a of the Form 55002020-01-011,266
Total of all active and inactive participants2020-01-011,266
2019: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-012,314
Total number of active participants reported on line 7a of the Form 55002019-01-012,329
Total of all active and inactive participants2019-01-012,329
2018: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-012,278
Total number of active participants reported on line 7a of the Form 55002018-01-012,314
Total of all active and inactive participants2018-01-012,314
2017: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-012,535
Total number of active participants reported on line 7a of the Form 55002017-01-012,535
Total of all active and inactive participants2017-01-012,535
2016: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-012,301
Number of retired or separated participants receiving benefits2016-01-012,535
Total of all active and inactive participants2016-01-012,535
2015: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,937
Total number of active participants reported on line 7a of the Form 55002015-01-012,301
Total of all active and inactive participants2015-01-012,301
2014: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,852
Total number of active participants reported on line 7a of the Form 55002014-01-011,937
Total of all active and inactive participants2014-01-011,937
2013: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,497
Total number of active participants reported on line 7a of the Form 55002013-01-011,852
Total of all active and inactive participants2013-01-011,852
2012: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,125
Total number of active participants reported on line 7a of the Form 55002012-01-011,497
Total of all active and inactive participants2012-01-011,497
2011: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,081
Total number of active participants reported on line 7a of the Form 55002011-01-011,125
Total of all active and inactive participants2011-01-011,125
2009: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01582
Total number of active participants reported on line 7a of the Form 55002009-01-01591
Total of all active and inactive participants2009-01-01591

Form 5500 Responses for DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN

2022: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: DAKKOTA INTEGRATED SYSTEMS CAFETERIA 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: DAKKOTA INTEGRATED SYSTEMS CAFETERIA 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: DAKKOTA INTEGRATED SYSTEMS CAFETERIA 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: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: DAKKOTA INTEGRATED SYSTEMS CAFETERIA PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number402464
Policy instance 8
Insurance contract or identification number402464
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $38,379
Total amount of fees paid to insurance companyUSD $269,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,379
Amount paid for insurance broker fees250380
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AI2P
Policy instance 1
Insurance contract or identification numberGLUG0AI2P
Number of Individuals Covered2248
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $29,139
Total amount of fees paid to insurance companyUSD $4,115
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $182,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,695
Amount paid for insurance broker fees4115
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDS0AI2P
Policy instance 2
Insurance contract or identification numberGUDS0AI2P
Number of Individuals Covered1203
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $16,266
Total amount of fees paid to insurance companyUSD $10,625
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $813,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,266
Amount paid for insurance broker fees10625
Insurance broker organization code?4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG 0AI2P
Policy instance 3
Insurance contract or identification numberGUG 0AI2P
Number of Individuals Covered1621
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $42,686
Total amount of fees paid to insurance companyUSD $21,250
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $992,707
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,686
Amount paid for insurance broker fees21250
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0AI2P
Policy instance 4
Insurance contract or identification numberGUPR0AI2P
Number of Individuals Covered536
Insurance policy start date2022-01-01
Insurance policy end date2023-01-01
Total amount of commissions paid to insurance brokerUSD $5,668
Total amount of fees paid to insurance companyUSD $9,446
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $166,819
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,668
Amount paid for insurance broker fees9446
Insurance broker organization code?5
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0AI2P
Policy instance 5
Insurance contract or identification numberAI 961396
Number of Individuals Covered155
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $2,327
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 BenefitNo
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
Other welfare benefits providedACCIDENT INJURY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $15,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,327
Insurance broker organization code?3
Amount paid for insurance broker fees16233
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDE0AI2P
Policy instance 6
Insurance contract or identification numberGUDE0AI2P
Number of Individuals Covered303
Insurance policy start date2022-07-02
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,526
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCRITICAL ILLNESS VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $15,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,526
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDH0AI2P
Policy instance 7
Insurance contract or identification numberGUDH0AI2P
Number of Individuals Covered347
Insurance policy start date2022-07-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $1,917
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENT ONLY VOLUNTARY
Welfare Benefit Premiums Paid to CarrierUSD $19,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,917
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AI2P
Policy instance 1
Insurance contract or identification numberGLUG0AI2P
Number of Individuals Covered2018
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $23,679
Total amount of fees paid to insurance companyUSD $3,108
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $147,995
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,129
Amount paid for insurance broker fees3108
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDS0AI2P
Policy instance 2
Insurance contract or identification numberGUDS0AI2P
Number of Individuals Covered1161
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $15,176
Total amount of fees paid to insurance companyUSD $10,625
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $758,821
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,176
Amount paid for insurance broker fees10625
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?4
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG 0AI2P
Policy instance 3
Insurance contract or identification numberGUG 0AI2P
Number of Individuals Covered1395
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $33,755
Total amount of fees paid to insurance companyUSD $21,250
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $784,996
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,755
Amount paid for insurance broker fees21250
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0AI2P
Policy instance 4
Insurance contract or identification numberGUPR0AI2P
Number of Individuals Covered415
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $5,595
Total amount of fees paid to insurance companyUSD $9,668
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $159,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,595
Amount paid for insurance broker fees9668
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0AI2P
Policy instance 5
Insurance contract or identification numberGVTL0AI2P
Number of Individuals Covered663
Insurance policy start date2021-01-01
Insurance policy end date2022-01-01
Total amount of commissions paid to insurance brokerUSD $14,884
Total amount of fees paid to insurance companyUSD $16,195
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $301,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,884
Amount paid for insurance broker fees16195
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
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
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENT INJURY
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AI2P
Policy instance 1
Insurance contract or identification numberGLUG0AI2P
Number of Individuals Covered1196
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $17,243
Total amount of fees paid to insurance companyUSD $2,832
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $107,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,104
Amount paid for insurance broker fees2832
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDS0AI2P
Policy instance 2
Insurance contract or identification numberGUDS0AI2P
Number of Individuals Covered1110
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $14,115
Total amount of fees paid to insurance companyUSD $10,625
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $705,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,115
Amount paid for insurance broker fees10625
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG 0AI2P
Policy instance 3
Insurance contract or identification numberGUG 0AI2P
Number of Individuals Covered1101
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $30,975
Total amount of fees paid to insurance companyUSD $21,250
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $720,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,975
Amount paid for insurance broker fees21250
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0AI2P
Policy instance 4
Insurance contract or identification numberGUPR0AI2P
Number of Individuals Covered480
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $5,597
Total amount of fees paid to insurance companyUSD $8,915
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $159,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,597
Amount paid for insurance broker fees8915
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0AI2P
Policy instance 5
Insurance contract or identification numberGVTL0AI2P
Number of Individuals Covered674
Insurance policy start date2020-01-01
Insurance policy end date2021-01-01
Total amount of commissions paid to insurance brokerUSD $14,867
Total amount of fees paid to insurance companyUSD $16,198
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $300,816
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,867
Amount paid for insurance broker fees16198
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGVTL0AI2P
Policy instance 5
Insurance contract or identification numberGVTL0AI2P
Number of Individuals Covered659
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $14,625
Total amount of fees paid to insurance companyUSD $15,797
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $293,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,625
Amount paid for insurance broker fees15797
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUPR0AI2P
Policy instance 4
Insurance contract or identification numberGUPR0AI2P
Number of Individuals Covered456
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $5,489
Total amount of fees paid to insurance companyUSD $8,843
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $148,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,489
Amount paid for insurance broker fees8843
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUG 0AI2P
Policy instance 3
Insurance contract or identification numberGUG 0AI2P
Number of Individuals Covered1100
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $30,271
Total amount of fees paid to insurance companyUSD $21,250
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $703,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,271
Amount paid for insurance broker fees21250
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGUDS0AI2P
Policy instance 2
Insurance contract or identification numberGUDS0AI2P
Number of Individuals Covered1050
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $13,803
Total amount of fees paid to insurance companyUSD $10,625
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $690,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,803
Amount paid for insurance broker fees10625
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AI2P
Policy instance 1
Insurance contract or identification numberGLUG0AI2P
Number of Individuals Covered1118
Insurance policy start date2019-01-01
Insurance policy end date2020-01-01
Total amount of commissions paid to insurance brokerUSD $16,168
Total amount of fees paid to insurance companyUSD $2,369
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,599
Amount paid for insurance broker fees2369
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2P
Policy instance 1
Insurance contract or identification numberG000AI2P
Number of Individuals Covered1200
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $79,609
Total amount of fees paid to insurance companyUSD $54,082
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,969,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $72,123
Amount paid for insurance broker fees54082
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00402464/01-133
Policy instance 1
Insurance contract or identification number00402464/01-133
Number of Individuals Covered1372
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $222,835
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,092,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $222,835
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2P
Policy instance 2
Insurance contract or identification numberG000AI2P
Number of Individuals Covered1347
Insurance policy start date2015-01-01
Insurance policy end date2016-01-01
Total amount of commissions paid to insurance brokerUSD $80,973
Total amount of fees paid to insurance companyUSD $49,948
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $1,908,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $74,070
Amount paid for insurance broker fees49948
Insurance broker organization code?3
Insurance broker nameROY LAMPHIER
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number38077
Policy instance 3
Insurance contract or identification number38077
Number of Individuals Covered2301
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $377,377
Total amount of fees paid to insurance companyUSD $6,364
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 $377,377
Amount paid for insurance broker fees6364
Insurance broker organization code?3
Insurance broker nameANTHONY J DARE JR
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2P
Policy instance 3
Insurance contract or identification numberG000AI2P
Number of Individuals Covered1400
Insurance policy start date2014-01-01
Insurance policy end date2015-01-01
Total amount of commissions paid to insurance brokerUSD $77,929
Total amount of fees paid to insurance companyUSD $46,960
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $1,780,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,907
Amount paid for insurance broker fees46960
Insurance broker organization code?3
Insurance broker nameROY LAMPHIER
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number708438
Policy instance 1
Insurance contract or identification number708438
Number of Individuals Covered165
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $49,158
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,602,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $49,158
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00402464/01-133
Policy instance 2
Insurance contract or identification number00402464/01-133
Number of Individuals Covered1425
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $141,395
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,760,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $141,395
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number38077
Policy instance 4
Insurance contract or identification number38077
Number of Individuals Covered1937
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $98,400
Total amount of fees paid to insurance companyUSD $8,155
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $98,400
Amount paid for insurance broker fees8155
Insurance broker organization code?3
Insurance broker nameANTHONY J DARE JR
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number38077
Policy instance 4
Insurance contract or identification number38077
Number of Individuals Covered1852
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $105,507
Total amount of fees paid to insurance companyUSD $8,887
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $105,507
Amount paid for insurance broker fees8887
Insurance broker organization code?3
Insurance broker nameANTHONY J DARE JR
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number708438
Policy instance 1
Insurance contract or identification number708438
Number of Individuals Covered161
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $41,946
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,368,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,946
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00402464/01-093
Policy instance 2
Insurance contract or identification number00402464/01-093
Number of Individuals Covered1283
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $140,978
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,054,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $140,978
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2P
Policy instance 3
Insurance contract or identification numberG000AI2P
Number of Individuals Covered1250
Insurance policy start date2013-01-01
Insurance policy end date2014-01-01
Total amount of commissions paid to insurance brokerUSD $74,392
Total amount of fees paid to insurance companyUSD $35,267
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $1,570,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $74,392
Amount paid for insurance broker fees35267
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00402464/01-03
Policy instance 2
Insurance contract or identification number00402464/01-03
Number of Individuals Covered1027
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $183,217
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,618,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $183,217
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2P
Policy instance 3
Insurance contract or identification numberG000AI2P
Number of Individuals Covered1091
Insurance policy start date2012-01-01
Insurance policy end date2013-01-01
Total amount of commissions paid to insurance brokerUSD $70,355
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $1,229,829
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,355
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number38077
Policy instance 4
Insurance contract or identification number38077
Number of Individuals Covered1497
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $95,233
Total amount of fees paid to insurance companyUSD $4,164
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $95,233
Amount paid for insurance broker fees4164
Insurance broker organization code?3
Insurance broker nameANTHONY J DARE JR
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number708438
Policy instance 1
Insurance contract or identification number708438
Number of Individuals Covered157
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $41,781
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,264,704
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $41,781
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number38077
Policy instance 4
Insurance contract or identification number38077
Number of Individuals Covered1125
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $59,431
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AI2P
Policy instance 3
Insurance contract or identification numberG000AI2P
Number of Individuals Covered704
Insurance policy start date2011-01-01
Insurance policy end date2012-01-01
Total amount of commissions paid to insurance brokerUSD $43,209
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedADD
Welfare Benefit Premiums Paid to CarrierUSD $960,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00402464/01-03
Policy instance 2
Insurance contract or identification number00402464/01-03
Number of Individuals Covered823
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $136,766
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,419,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number708438
Policy instance 1
Insurance contract or identification number708438
Number of Individuals Covered163
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $58,298
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,242,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00402464
Policy instance 4
Insurance contract or identification number00402464
Number of Individuals Covered835
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $74,463
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,593,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $74,463
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE AGENCY
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number473193
Policy instance 3
Insurance contract or identification number473193
Number of Individuals Covered299
Insurance policy start date2010-02-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $14,664
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $393,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,664
Insurance broker organization code?3
Insurance broker nameBSI CORPORATE BENEFITS LLC
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number708438
Policy instance 2
Insurance contract or identification number708438
Number of Individuals Covered137
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $18,888
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $989,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,822
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE AGENCY
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number38077
Policy instance 1
Insurance contract or identification number38077
Number of Individuals Covered1081
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $115,926
Total amount of fees paid to insurance companyUSD $4,374
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Long Term Disability 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 $85,124
Insurance broker organization code?3
Amount paid for insurance broker fees4374
Insurance broker nameWELLS FARGO INSURANCE AGENCY

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