FIAMM TECHNOLOGIES L.L.C. has sponsored the creation of one or more 401k plans.
Additional information about FIAMM TECHNOLOGIES L.L.C.
Submission information for form 5500 for 401k plan FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN
| Measure | Date | Value |
|---|
| 2022: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 188 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 188 |
| 2021: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 231 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 188 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 188 |
| 2020: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 279 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 231 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 231 |
| 2019: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 311 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 279 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 279 |
| 2018: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 339 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 311 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 311 |
| 2017: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 349 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 339 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 339 |
| 2016: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 299 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 349 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 349 |
| 2015: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-08-01 | 321 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-08-01 | 299 |
| Number of retired or separated participants receiving benefits | 2015-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-08-01 | 0 |
| Total of all active and inactive participants | 2015-08-01 | 299 |
| 2014: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-08-01 | 788 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-08-01 | 321 |
| Number of retired or separated participants receiving benefits | 2014-08-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-08-01 | 0 |
| Total of all active and inactive participants | 2014-08-01 | 321 |
| 2013: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-08-01 | 549 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-08-01 | 788 |
| Total of all active and inactive participants | 2013-08-01 | 788 |
| 2012: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-08-01 | 519 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-08-01 | 549 |
| Total of all active and inactive participants | 2012-08-01 | 549 |
| 2011: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-08-01 | 549 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-08-01 | 519 |
| Total of all active and inactive participants | 2011-08-01 | 519 |
| 2009: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-08-01 | 472 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-08-01 | 498 |
| Total of all active and inactive participants | 2009-08-01 | 498 |
| 2022: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2020 form 5500 responses |
|---|
| 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: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2019 form 5500 responses |
|---|
| 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: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2018 form 5500 responses |
|---|
| 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: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2017 form 5500 responses |
|---|
| 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: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2016 form 5500 responses |
|---|
| 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: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-08-01 | Type of plan entity | Single employer plan |
| 2015-08-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-08-01 | Plan funding arrangement – Insurance | Yes |
| 2015-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-08-01 | Type of plan entity | Single employer plan |
| 2014-08-01 | Plan funding arrangement – Insurance | Yes |
| 2014-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-08-01 | Type of plan entity | Single employer plan |
| 2013-08-01 | Plan funding arrangement – Insurance | Yes |
| 2013-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-08-01 | Type of plan entity | Single employer plan |
| 2012-08-01 | Plan funding arrangement – Insurance | Yes |
| 2012-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-08-01 | Type of plan entity | Single employer plan |
| 2011-08-01 | Plan funding arrangement – Insurance | Yes |
| 2011-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: FIAMM TECHNOLOGIES, LLC GROUP HEALTH PLAN 2009 form 5500 responses |
|---|
| 2009-08-01 | Type of plan entity | Single employer plan |
| 2009-08-01 | Plan funding arrangement – Insurance | Yes |
| 2009-08-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-08-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-08-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 239533 |
| Policy instance | 3 |
| Insurance contract or identification number | 239533 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $24,752 | | 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 $24,752 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $5,708 | | 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 $5,708 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 239533 |
| Policy instance | 1 |
| Insurance contract or identification number | 239533 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $746 | | 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 $746 | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 00239533 |
| Policy instance | 3 |
| Insurance contract or identification number | 00239533 | | Number of Individuals Covered | 186 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $23,676 | | 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 $23,676 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 185 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $6,650 | | 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 $6,650 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 239533 |
| Policy instance | 1 |
| Insurance contract or identification number | 239533 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $738 | | 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 $738 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 239533 |
| Policy instance | 1 |
| Insurance contract or identification number | 239533 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $567 | | Total amount of fees paid to insurance company | USD $4 | | 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 $567 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $7,256 | | 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 $7,256 | | Insurance broker organization code? | 3 |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A2869002 |
| Policy instance | 3 |
| Insurance contract or identification number | A2869002 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 00239533 |
| Policy instance | 4 |
| Insurance contract or identification number | 00239533 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $26,751 | | Total amount of fees paid to insurance company | USD $465 | | 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 $26,751 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 465 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 239533 |
| Policy instance | 1 |
| Insurance contract or identification number | 239533 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $438 | | 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 $438 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 283 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $8,833 | | 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 $8,833 | | Insurance broker organization code? | 3 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226191 |
| Policy instance | 3 |
| Insurance contract or identification number | 12226191 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,719 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A2869002 |
| Policy instance | 4 |
| Insurance contract or identification number | A2869002 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 00239533 |
| Policy instance | 5 |
| Insurance contract or identification number | 00239533 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $24,256 | | 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 $24,256 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $9,552 | | 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 $9,552 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 239533 |
| Policy instance | 1 |
| Insurance contract or identification number | 239533 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $397 | | Total amount of fees paid to insurance company | USD $6 | | 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 $397 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 6 |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226191 |
| Policy instance | 3 |
| Insurance contract or identification number | 12226191 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A2869002 |
| Policy instance | 4 |
| Insurance contract or identification number | A2869002 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 00239533 |
| Policy instance | 5 |
| Insurance contract or identification number | 00239533 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $31,319 | | Total amount of fees paid to insurance company | USD $918 | | 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 $31,319 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 918 |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 00239533/0001 |
| Policy instance | 5 |
| Insurance contract or identification number | 00239533/0001 | | Number of Individuals Covered | 337 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $30,855 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | HEARING | | Welfare Benefit Premiums Paid to Carrier | USD $1,114,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,855 | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A2869002 |
| Policy instance | 4 |
| Insurance contract or identification number | A2869002 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226191 |
| Policy instance | 3 |
| Insurance contract or identification number | 12226191 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 341 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,207 | | 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 $9,207 | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 239533 |
| Policy instance | 1 |
| Insurance contract or identification number | 239533 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $414 | | Total amount of fees paid to insurance company | USD $14 | | 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 $414 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 14 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A2869002 |
| Policy instance | 4 |
| Insurance contract or identification number | A2869002 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2015-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 36971 |
| Policy instance | 1 |
| Insurance contract or identification number | 36971 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $191 | | 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 $191 | | Insurance broker organization code? | 3 | | Insurance broker name | BRIAN T COTE |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,844 | | 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 $4,844 | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226191 |
| Policy instance | 3 |
| Insurance contract or identification number | 12226191 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2015-12-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 00239533/0001 |
| Policy instance | 5 |
| Insurance contract or identification number | 00239533/0001 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2015-08-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $12,699 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $290,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,699 | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $13,881 | | 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 $13,881 | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226191 |
| Policy instance | 3 |
| Insurance contract or identification number | 12226191 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A2869002 |
| Policy instance | 4 |
| Insurance contract or identification number | A2869002 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 ) |
| Policy contract number | 00239533/0001 |
| Policy instance | 5 |
| Insurance contract or identification number | 00239533/0001 | | Number of Individuals Covered | 319 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $31,798 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $822,496 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,798 | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 36971 |
| Policy instance | 1 |
| Insurance contract or identification number | 36971 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-07-31 | | Total amount of commissions paid to insurance broker | USD $20,993 | | 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 $20,993 | | Insurance broker organization code? | 3 | | Insurance broker name | BRIAN T COTE |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226191 |
| Policy instance | 3 |
| Insurance contract or identification number | 12226191 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 0001753 |
| Policy instance | 2 |
| Insurance contract or identification number | 0001753 | | Number of Individuals Covered | 788 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 36971 |
| Policy instance | 1 |
| Insurance contract or identification number | 36971 | | Number of Individuals Covered | 526 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Total amount of commissions paid to insurance broker | USD $37,924 | | Total amount of fees paid to insurance company | USD $7,044 | | 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 $37,924 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7044 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A2869002 |
| Policy instance | 4 |
| Insurance contract or identification number | A2869002 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-07-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A2869002 |
| Policy instance | 4 |
| Insurance contract or identification number | A2869002 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226191 |
| Policy instance | 3 |
| Insurance contract or identification number | 12226191 | | Number of Individuals Covered | 226 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| DELTA DENTAL OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54305 ) |
| Policy contract number | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 549 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $15,337 | | 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 $15,337 | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS, INC |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 36971 |
| Policy instance | 1 |
| Insurance contract or identification number | 36971 | | Number of Individuals Covered | 542 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $36,169 | | Total amount of fees paid to insurance company | USD $8,295 | | 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 $36,169 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 8295 | | Insurance broker name | ADVANCED BENEFIT SOLUTIONS INC |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 36971 |
| Policy instance | 1 |
| Insurance contract or identification number | 36971 | | Number of Individuals Covered | 508 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $34,468 | | Health Insurance Welfare Benefit | Yes | | 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 | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 519 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $16,690 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226191 |
| Policy instance | 3 |
| Insurance contract or identification number | 12226191 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A25014384 |
| Policy instance | 4 |
| Insurance contract or identification number | A25014384 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 12226191 |
| Policy instance | 3 |
| Insurance contract or identification number | 12226191 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Vision Insurance Welfare Benefit | Yes | | 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 | 5889 |
| Policy instance | 2 |
| Insurance contract or identification number | 5889 | | Number of Individuals Covered | 549 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $14,302 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CVS PHARMACY, INC. (National Association of Insurance Commissioners NAIC id number: 44611 ) |
| Policy contract number | A25014384 |
| Policy instance | 4 |
| Insurance contract or identification number | A25014384 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
