FACULTY STUDENT ASSOCIATION OF THE STATE OF NEW YORK AT BUFFALO, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL
401k plan membership statisitcs for BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL
| Measure | Date | Value |
|---|
| 2023: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 129 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 137 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 137 |
| 2022: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 231 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 128 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 1 |
| Total of all active and inactive participants | 2022-01-01 | 129 |
| 2021: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 138 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 156 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 1 |
| Total of all active and inactive participants | 2021-01-01 | 157 |
| 2020: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 180 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 133 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 5 |
| Total of all active and inactive participants | 2020-01-01 | 138 |
| 2019: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 176 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 3 |
| Total of all active and inactive participants | 2019-01-01 | 179 |
| 2018: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 185 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 174 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 2 |
| Total of all active and inactive participants | 2018-01-01 | 176 |
| 2017: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 190 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 187 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 2 |
| Total of all active and inactive participants | 2017-01-01 | 189 |
| 2016: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 196 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 191 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 2 |
| Total of all active and inactive participants | 2016-01-01 | 193 |
| 2015: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 192 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 196 |
| Total of all active and inactive participants | 2015-01-01 | 196 |
| 2014: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 192 |
| Total of all active and inactive participants | 2014-01-01 | 192 |
| 2013: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 187 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 193 |
| Total of all active and inactive participants | 2013-01-01 | 193 |
| 2012: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 190 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 187 |
| Total of all active and inactive participants | 2012-01-01 | 187 |
| 2011: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 193 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 190 |
| Total of all active and inactive participants | 2011-01-01 | 190 |
| 2010: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 187 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 193 |
| Total of all active and inactive participants | 2010-01-01 | 193 |
| 2009: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 183 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 187 |
| Total of all active and inactive participants | 2009-01-01 | 187 |
| 2023: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 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: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 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: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 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: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 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: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 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: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: BLUE CROSS-BLUE SHIELD HOSPITALIZATION MEDICAL 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5946559 |
| Policy instance | 1 |
| Insurance contract or identification number | 5946559 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2022-10-01 | | Insurance policy end date | 2023-09-30 | | Total amount of commissions paid to insurance broker | USD $1,997 | | Total amount of fees paid to insurance company | USD $748 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,829 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5946559 |
| Policy instance | 1 |
| Insurance contract or identification number | 5946559 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $2,240 | | Total amount of fees paid to insurance company | USD $655 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,202 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,240 | | Amount paid for insurance broker fees | 17 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5946559 |
| Policy instance | 1 |
| Insurance contract or identification number | 5946559 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $2,210 | | Total amount of fees paid to insurance company | USD $598 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,271 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,210 | | Amount paid for insurance broker fees | 16 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5946559 |
| Policy instance | 1 |
| Insurance contract or identification number | 5946559 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $2,524 | | Total amount of fees paid to insurance company | USD $1,020 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,951 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,524 | | Amount paid for insurance broker fees | 180 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5946559 |
| Policy instance | 1 |
| Insurance contract or identification number | 5946559 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $2,383 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $49,990 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,383 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5946559 |
| Policy instance | 1 |
| Insurance contract or identification number | 5946559 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $1,740 | | Total amount of fees paid to insurance company | USD $127 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,399 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,740 | | Amount paid for insurance broker fees | 127 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| NOVA (National Association of Insurance Commissioners NAIC id number: 56199 ) |
| Policy contract number | 403868 0010 |
| Policy instance | 1 |
| Insurance contract or identification number | 403868 0010 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $20,835 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $177,769 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,835 | | Insurance broker name | PREMIER CONSULTING ASSOCIATES, LLC |
|
| NOVA (National Association of Insurance Commissioners NAIC id number: 56199 ) |
| Policy contract number | 403868 0010 |
| Policy instance | 1 |
| Insurance contract or identification number | 403868 0010 | | Number of Individuals Covered | 192 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $20,781 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $178,675 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,781 | | Insurance broker name | PREMIER CONSULTING ASSOCIATES, LLC |
|
| NOVA (National Association of Insurance Commissioners NAIC id number: 56199 ) |
| Policy contract number | 403868 0010 |
| Policy instance | 1 |
| Insurance contract or identification number | 403868 0010 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $20,295 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $186,660 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,295 | | Insurance broker name | PREMIER CONSULTING ASSOCIATES, LLC |
|
| HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
| Policy contract number | 403868 0010 |
| Policy instance | 1 |
| Insurance contract or identification number | 403868 0010 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $20,376 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $191,240 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,376 | | Insurance broker organization code? | 3 | | Insurance broker name | PREMIER CONSULTING ASSOCIATES, LLC |
|
| HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
| Policy contract number | 403868 0010 |
| Policy instance | 3 |
| Insurance contract or identification number | 403868 0010 | | Number of Individuals Covered | 190 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $7,099 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,328 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 95308 ) |
| Policy contract number | 12199H &17704F |
| Policy instance | 1 |
| Insurance contract or identification number | 12199H &17704F | | Number of Individuals Covered | 120 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $638,319 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: 55204 ) |
| Policy contract number | 301051 |
| Policy instance | 2 |
| Insurance contract or identification number | 301051 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $386,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: 55204 ) |
| Policy contract number | 301051 |
| Policy instance | 2 |
| Insurance contract or identification number | 301051 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $474,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 95308 ) |
| Policy contract number | 12199H & 17704F |
| Policy instance | 1 |
| Insurance contract or identification number | 12199H & 17704F | | Number of Individuals Covered | 122 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $818,339 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
