BOARD OF TRUSTEES LOCAL 450A WELFARE FUND has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan AMALGAMATED UNION LOCAL 450 A WELFARE FUND
| Measure | Date | Value |
|---|
| 2022 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2022 401k financial data |
|---|
| Total income from all sources (including contributions) | 2022-12-31 | $7,034,401 |
| Total of all expenses incurred | 2022-12-31 | $7,050,778 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $6,903,207 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $7,034,401 |
| Value of total assets at end of year | 2022-12-31 | $549,553 |
| Value of total assets at beginning of year | 2022-12-31 | $565,930 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $147,571 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Administrative expenses professional fees incurred | 2022-12-31 | $34,800 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $6,100 |
| Administrative expenses (other) incurred | 2022-12-31 | $3,771 |
| Total non interest bearing cash at end of year | 2022-12-31 | $549,553 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $565,930 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-16,377 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $549,553 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $565,930 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Investment advisory and management fees | 2022-12-31 | $109,000 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $6,903,207 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $7,028,301 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-12-31 | No |
| Did the plan have assets held for investment | 2022-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | GETTRY MARCUS CPA PC |
| Accountancy firm EIN | 2022-12-31 | 133418879 |
| 2021 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2021 401k financial data |
|---|
| Total income from all sources (including contributions) | 2021-12-31 | $6,546,063 |
| Total of all expenses incurred | 2021-12-31 | $6,522,356 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $6,383,956 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $6,546,063 |
| Value of total assets at end of year | 2021-12-31 | $565,930 |
| Value of total assets at beginning of year | 2021-12-31 | $542,223 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $138,400 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Administrative expenses professional fees incurred | 2021-12-31 | $34,800 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $5,303 |
| Administrative expenses (other) incurred | 2021-12-31 | $3,600 |
| Total non interest bearing cash at end of year | 2021-12-31 | $565,930 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $542,223 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $23,707 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $565,930 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $542,223 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Investment advisory and management fees | 2021-12-31 | $100,000 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $6,383,956 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $6,540,760 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-12-31 | No |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | GETTRY MARCUS CPA PC |
| Accountancy firm EIN | 2021-12-31 | 133418879 |
| 2020 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2020 401k financial data |
|---|
| Total income from all sources (including contributions) | 2020-12-31 | $7,583,848 |
| Total of all expenses incurred | 2020-12-31 | $7,567,381 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $7,419,217 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $7,583,848 |
| Value of total assets at end of year | 2020-12-31 | $542,223 |
| Value of total assets at beginning of year | 2020-12-31 | $525,756 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $148,164 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Administrative expenses professional fees incurred | 2020-12-31 | $34,800 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Administrative expenses (other) incurred | 2020-12-31 | $3,364 |
| Total non interest bearing cash at end of year | 2020-12-31 | $542,223 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $525,756 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $16,467 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $542,223 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $525,756 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2020-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $7,419,217 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $7,583,848 |
| Contract administrator fees | 2020-12-31 | $110,000 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-12-31 | No |
| Did the plan have assets held for investment | 2020-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2020-12-31 | 112836481 |
| 2019 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-12-31 | $7,509,620 |
| Total of all expenses incurred | 2019-12-31 | $7,472,524 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $7,324,602 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $7,509,620 |
| Value of total assets at end of year | 2019-12-31 | $525,756 |
| Value of total assets at beginning of year | 2019-12-31 | $488,660 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $147,922 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $34,823 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Administrative expenses (other) incurred | 2019-12-31 | $3,099 |
| Total non interest bearing cash at end of year | 2019-12-31 | $525,756 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $488,660 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $37,096 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $525,756 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $488,660 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2019-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $7,324,602 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $7,509,620 |
| Contract administrator fees | 2019-12-31 | $110,000 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2019-12-31 | 112836481 |
| 2018 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2018 401k financial data |
|---|
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $22,295 |
| Total income from all sources (including contributions) | 2018-12-31 | $7,062,808 |
| Total of all expenses incurred | 2018-12-31 | $7,055,486 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $6,907,033 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $7,062,808 |
| Value of total assets at end of year | 2018-12-31 | $488,660 |
| Value of total assets at beginning of year | 2018-12-31 | $503,633 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $148,453 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Administrative expenses professional fees incurred | 2018-12-31 | $32,073 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $42,086 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $503,633 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-12-31 | $22,295 |
| Administrative expenses (other) incurred | 2018-12-31 | $2,880 |
| Total non interest bearing cash at end of year | 2018-12-31 | $488,660 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $7,322 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $488,660 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $481,338 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2018-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $6,907,033 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $7,020,722 |
| Contract administrator fees | 2018-12-31 | $113,500 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-12-31 | No |
| Did the plan have assets held for investment | 2018-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2018-12-31 | 112836481 |
| 2017 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $22,295 |
| Total income from all sources (including contributions) | 2017-12-31 | $6,050,734 |
| Total of all expenses incurred | 2017-12-31 | $6,075,332 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $5,891,057 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $6,050,734 |
| Value of total assets at end of year | 2017-12-31 | $503,633 |
| Value of total assets at beginning of year | 2017-12-31 | $505,936 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $184,275 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Administrative expenses professional fees incurred | 2017-12-31 | $30,123 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $67,005 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $503,633 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-12-31 | $22,295 |
| Administrative expenses (other) incurred | 2017-12-31 | $2,152 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $505,936 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $-24,598 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $481,338 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $505,936 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2017-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $5,891,057 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $5,983,729 |
| Contract administrator fees | 2017-12-31 | $152,000 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-12-31 | No |
| Did the plan have assets held for investment | 2017-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2017-12-31 | 112836481 |
| 2016 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2016 401k financial data |
|---|
| Total income from all sources (including contributions) | 2016-12-31 | $5,223,663 |
| Total of all expenses incurred | 2016-12-31 | $5,239,434 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $5,054,980 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $5,223,663 |
| Value of total assets at end of year | 2016-12-31 | $505,936 |
| Value of total assets at beginning of year | 2016-12-31 | $521,707 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $184,454 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Administrative expenses professional fees incurred | 2016-12-31 | $30,900 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $28,175 |
| Administrative expenses (other) incurred | 2016-12-31 | $2,554 |
| Total non interest bearing cash at end of year | 2016-12-31 | $505,936 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $521,707 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $-15,771 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $505,936 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $521,707 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2016-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $5,054,980 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $5,195,488 |
| Contract administrator fees | 2016-12-31 | $151,000 |
| Did the plan have assets held for investment | 2016-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2016-12-31 | 112836481 |
| 2015 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-12-31 | $5,777,116 |
| Total of all expenses incurred | 2015-12-31 | $5,745,045 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $5,597,814 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $5,777,116 |
| Value of total assets at end of year | 2015-12-31 | $521,707 |
| Value of total assets at beginning of year | 2015-12-31 | $489,636 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $147,231 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Administrative expenses professional fees incurred | 2015-12-31 | $30,623 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $53,673 |
| Administrative expenses (other) incurred | 2015-12-31 | $2,608 |
| Total non interest bearing cash at end of year | 2015-12-31 | $521,707 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $489,636 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $32,071 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $521,707 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $489,636 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2015-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $5,597,814 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $5,723,443 |
| Contract administrator fees | 2015-12-31 | $114,000 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2015-12-31 | 112836481 |
| 2014 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-12-31 | $7,574,196 |
| Total of all expenses incurred | 2014-12-31 | $7,393,141 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $7,251,658 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $7,574,196 |
| Value of total assets at end of year | 2014-12-31 | $489,636 |
| Value of total assets at beginning of year | 2014-12-31 | $308,581 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $141,483 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Administrative expenses professional fees incurred | 2014-12-31 | $30,373 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $75,913 |
| Administrative expenses (other) incurred | 2014-12-31 | $3,610 |
| Total non interest bearing cash at end of year | 2014-12-31 | $489,636 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $308,581 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $181,055 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $489,636 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $308,581 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2014-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $7,251,658 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $7,498,283 |
| Contract administrator fees | 2014-12-31 | $107,500 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2014-12-31 | 112836481 |
| 2013 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2013 401k financial data |
|---|
| Total income from all sources (including contributions) | 2013-12-31 | $7,644,030 |
| Total of all expenses incurred | 2013-12-31 | $7,469,794 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $7,336,267 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $7,644,030 |
| Value of total assets at end of year | 2013-12-31 | $308,581 |
| Value of total assets at beginning of year | 2013-12-31 | $134,345 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $133,527 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Administrative expenses professional fees incurred | 2013-12-31 | $27,346 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $100,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $21,636 |
| Administrative expenses (other) incurred | 2013-12-31 | $2,181 |
| Total non interest bearing cash at end of year | 2013-12-31 | $308,581 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $134,345 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $174,236 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $308,581 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $134,345 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2013-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $7,336,267 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $7,622,394 |
| Contract administrator fees | 2013-12-31 | $104,000 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2013-12-31 | 112836481 |
| 2012 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-12-31 | $6,451,356 |
| Total of all expenses incurred | 2012-12-31 | $6,384,086 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $6,251,720 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $6,451,356 |
| Value of total assets at end of year | 2012-12-31 | $134,345 |
| Value of total assets at beginning of year | 2012-12-31 | $67,075 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $132,366 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $30,100 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $100,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $20,925 |
| Administrative expenses (other) incurred | 2012-12-31 | $3,173 |
| Total non interest bearing cash at end of year | 2012-12-31 | $134,345 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $67,075 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $67,270 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $134,345 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $67,075 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2012-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $6,251,720 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $6,430,431 |
| Contract administrator fees | 2012-12-31 | $99,093 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2012-12-31 | 112836481 |
| 2011 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2011 401k financial data |
|---|
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $450 |
| Total income from all sources (including contributions) | 2011-12-31 | $2,731,568 |
| Total of all expenses incurred | 2011-12-31 | $2,730,271 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $2,671,199 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $2,731,568 |
| Value of total assets at end of year | 2011-12-31 | $67,075 |
| Value of total assets at beginning of year | 2011-12-31 | $66,228 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $59,072 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $18,000 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $100,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $9,016 |
| Administrative expenses (other) incurred | 2011-12-31 | $4,907 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $450 |
| Total non interest bearing cash at end of year | 2011-12-31 | $67,075 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $66,228 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $1,297 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $67,075 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $65,778 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $2,671,199 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $2,722,552 |
| Contract administrator fees | 2011-12-31 | $36,165 |
| Did the plan have assets held for investment | 2011-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2011-12-31 | 132635446 |
| 2010 : AMALGAMATED UNION LOCAL 450 A WELFARE FUND 2010 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $450 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $300 |
| Total income from all sources (including contributions) | 2010-12-31 | $1,585,997 |
| Total of all expenses incurred | 2010-12-31 | $1,580,923 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $1,508,275 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $1,585,997 |
| Value of total assets at end of year | 2010-12-31 | $66,228 |
| Value of total assets at beginning of year | 2010-12-31 | $61,004 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $72,648 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Administrative expenses professional fees incurred | 2010-12-31 | $21,550 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $100,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $3,874 |
| Administrative expenses (other) incurred | 2010-12-31 | $3,497 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $450 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $300 |
| Total non interest bearing cash at end of year | 2010-12-31 | $66,228 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $61,004 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $5,074 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $65,778 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $60,704 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $1,508,275 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $1,582,123 |
| Contract administrator fees | 2010-12-31 | $47,601 |
| Did the plan have assets held for investment | 2010-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | WAGNER & ZWERMAN LLP |
| Accountancy firm EIN | 2010-12-31 | 132635446 |
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271 1001 |
| Policy instance | 2 |
| Insurance contract or identification number | 1123271 1001 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $62,999 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,999 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0301875 |
| Policy instance | 6 |
| Insurance contract or identification number | 0301875 | | Number of Individuals Covered | 191 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $16,268 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,533 |
|
| SOLSTICE HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13971 ) |
| Policy contract number | 11642 |
| Policy instance | 5 |
| Insurance contract or identification number | 11642 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,690 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision 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 $3,690 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271 1003 |
| Policy instance | 4 |
| Insurance contract or identification number | 1123271 1003 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,572 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,572 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271 1002 |
| Policy instance | 3 |
| Insurance contract or identification number | 1123271 1002 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $77,235 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $77,235 | | Insurance broker organization code? | 3 |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 1 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $46,307 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,168 | | Insurance broker organization code? | 3 |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | |
| Policy instance | 7 |
| Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 1 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $10,520 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $533,227 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,210 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271 1001 |
| Policy instance | 2 |
| Insurance contract or identification number | 1123271 1001 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $69,939 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,800,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,939 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271 1003 |
| Policy instance | 4 |
| Insurance contract or identification number | 1123271 1003 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $5,278 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $143,821 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,278 | | Insurance broker organization code? | 3 |
|
| SOLSTICE HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13971 ) |
| Policy contract number | 11642 |
| Policy instance | 5 |
| Insurance contract or identification number | 11642 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,488 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,885 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,488 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0301875 |
| Policy instance | 6 |
| Insurance contract or identification number | 0301875 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $84,082 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,791,734 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,562 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271 1002 |
| Policy instance | 3 |
| Insurance contract or identification number | 1123271 1002 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $75,780 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,141,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $75,780 | | Insurance broker organization code? | 3 |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | G1922 |
| Policy instance | 1 |
| Insurance contract or identification number | G1922 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $16,487 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,666,965 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,487 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271001 |
| Policy instance | 2 |
| Insurance contract or identification number | 1123271001 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $53,453 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,389,788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,453 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271002 |
| Policy instance | 3 |
| Insurance contract or identification number | 1123271002 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $90,401 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,350,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $90,401 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271003 |
| Policy instance | 4 |
| Insurance contract or identification number | 1123271003 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $4,712 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $144,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,712 | | Insurance broker organization code? | 3 |
|
| SOLSTICE HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13971 ) |
| Policy contract number | 11642 |
| Policy instance | 5 |
| Insurance contract or identification number | 11642 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $2,274 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,742 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,274 | | Insurance broker organization code? | 3 |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 6 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $16,487 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $177,571 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,487 | | Insurance broker organization code? | 3 |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | AU6486 |
| Policy instance | 7 |
| Insurance contract or identification number | AU6486 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $62,682 | | Total amount of fees paid to insurance company | USD $17,010 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,677,498 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,682 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 17010 | | Additional information about fees paid to insurance broker | BONUS AND ADMINISTRATIVE SERVICES |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 6 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $16,940 | | Total amount of fees paid to insurance company | USD $6,600 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $197,555 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,940 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 6600 | | Additional information about fees paid to insurance broker | BONUS AND ADMINISTRATIVE SERVICES |
|
| SOLSTICE HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13971 ) |
| Policy contract number | 11642 |
| Policy instance | 5 |
| Insurance contract or identification number | 11642 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,249 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,509 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,249 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271003 |
| Policy instance | 4 |
| Insurance contract or identification number | 1123271003 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $4,895 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $122,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,895 | | Insurance broker organization code? | 3 |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | G1922 |
| Policy instance | 1 |
| Insurance contract or identification number | G1922 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $16,940 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,894,916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,940 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271002 |
| Policy instance | 3 |
| Insurance contract or identification number | 1123271002 | | Number of Individuals Covered | 143 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $88,727 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,306,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $88,727 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271001 |
| Policy instance | 2 |
| Insurance contract or identification number | 1123271001 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $48,312 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,256,125 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,312 | | Insurance broker organization code? | 3 |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | AU6486 |
| Policy instance | 7 |
| Insurance contract or identification number | AU6486 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $57,569 | | Total amount of fees paid to insurance company | USD $16,912 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,528,230 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,569 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 16912 | | Additional information about fees paid to insurance broker | BONUS AND ADMINISTRATIVE SERVICES |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | G1922 |
| Policy instance | 1 |
| Insurance contract or identification number | G1922 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $29,400 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,568,222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,400 | | Insurance broker organization code? | 3 |
|
| SOLSTICE HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13971 ) |
| Policy contract number | 11642 |
| Policy instance | 5 |
| Insurance contract or identification number | 11642 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,505 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,051 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,505 | | Insurance broker organization code? | 3 |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | AU6486 |
| Policy instance | 7 |
| Insurance contract or identification number | AU6486 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $55,831 | | Total amount of fees paid to insurance company | USD $16,828 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,517,367 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,831 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 16828 | | Additional information about fees paid to insurance broker | BONUS AND ADMINISTRATIVE SERVICES |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 6 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2017-11-01 | | Insurance policy end date | 2018-10-31 | | Total amount of commissions paid to insurance broker | USD $29,400 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $570,246 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,400 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271003 |
| Policy instance | 4 |
| Insurance contract or identification number | 1123271003 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $3,747 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $97,474 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,747 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271002 |
| Policy instance | 3 |
| Insurance contract or identification number | 1123271002 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $74,189 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,935,352 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $74,189 | | Insurance broker organization code? | 3 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1123271001 |
| Policy instance | 2 |
| Insurance contract or identification number | 1123271001 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $41,679 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,193,321 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,679 | | Insurance broker organization code? | 3 |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | G1922 |
| Policy instance | 1 |
| Insurance contract or identification number | G1922 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2016-11-01 | | Insurance policy end date | 2017-10-31 | | Total amount of commissions paid to insurance broker | USD $16,937 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,495,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,847 | | Insurance broker organization code? | 3 | | Insurance broker name | JOHN H. BLASCH |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231000 |
| Policy instance | 2 |
| Insurance contract or identification number | 1GA0231000 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $34,420 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $894,916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,420 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231001 |
| Policy instance | 3 |
| Insurance contract or identification number | 1GA0231001 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $53,043 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,494,622 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,043 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231002 |
| Policy instance | 4 |
| Insurance contract or identification number | 1GA0231002 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,463 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $86,580 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,463 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231900 |
| Policy instance | 5 |
| Insurance contract or identification number | 1GA0231900 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,151 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SOLSTICE BENEFITS, INC (National Association of Insurance Commissioners NAIC id number: 12341 ) |
| Policy contract number | 11642 |
| Policy instance | 6 |
| Insurance contract or identification number | 11642 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,279 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,279 | | Insurance broker organization code? | 3 | | Insurance broker name | FAGE BENEFITS SOLUTIONS LLC |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 7 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2016-11-01 | | Insurance policy end date | 2017-10-31 | | Total amount of commissions paid to insurance broker | USD $16,937 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $440,560 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,937 | | Insurance broker organization code? | 3 | | Insurance broker name | FAGE BENEFITS SOLUTIONS LLC |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | AU6486 |
| Policy instance | 8 |
| Insurance contract or identification number | AU6486 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $46,127 | | Total amount of fees paid to insurance company | USD $17,407 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,419,517 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,127 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 17407 | | Additional information about fees paid to insurance broker | BONUS AND ADMINISTRATIVE SERVICES | | Insurance broker name | PROFESSIONAL GROUP PLANS, INC |
|
| AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
| Policy contract number | 0000959625 |
| Policy instance | 6 |
| Insurance contract or identification number | 0000959625 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | PROFESSIONAL GROUP PLANS, INC |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 8 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $3,045 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $243,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,045 | | Insurance broker organization code? | 3 | | Insurance broker name | FAGE BENEFITS SOLUTIONS LLC |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231002 |
| Policy instance | 4 |
| Insurance contract or identification number | 1GA0231002 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $7,267 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $149,926 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,267 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231900 |
| Policy instance | 7 |
| Insurance contract or identification number | 1GA0231900 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $47,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231001 |
| Policy instance | 3 |
| Insurance contract or identification number | 1GA0231001 | | Number of Individuals Covered | 236 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $60,614 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT-MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,519,916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,614 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN |
|
| SOLSTICE BENEFITS, INC (National Association of Insurance Commissioners NAIC id number: 12341 ) |
| Policy contract number | 11642 |
| Policy instance | 9 |
| Insurance contract or identification number | 11642 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,934 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,341 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,934 | | Insurance broker organization code? | 3 | | Insurance broker name | FAGE BENEFIT SOLUTIONS LLC |
|
| EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 ) |
| Policy contract number | 915J15761 |
| Policy instance | 10 |
| Insurance contract or identification number | 915J15761 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $511 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,396 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $511 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231000 |
| Policy instance | 2 |
| Insurance contract or identification number | 1GA0231000 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $22,173 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $555,277 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,173 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID S. FEINSTEIN |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | G1922 |
| Policy instance | 1 |
| Insurance contract or identification number | G1922 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2014-11-01 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $33,442 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,335,543 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,442 | | Insurance broker organization code? | 3 | | Insurance broker name | PROFESSIONAL GROUP PLANS INC |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | AU6486 |
| Policy instance | 5 |
| Insurance contract or identification number | AU6486 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $60,006 | | Total amount of fees paid to insurance company | USD $11,242 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,471,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,006 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 11242 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker name | PROFESSIONAL GROUP PLANS, INC. |
|
| SOLSTICE BENEFITS, INC (National Association of Insurance Commissioners NAIC id number: 12341 ) |
| Policy contract number | 11642 |
| Policy instance | 10 |
| Insurance contract or identification number | 11642 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,783 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $37,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,783 | | Insurance broker organization code? | 3 | | Insurance broker name | FAGE BENEFIT SOLUTIONS LLC |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231900 |
| Policy instance | 9 |
| Insurance contract or identification number | 1GA0231900 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $40,060 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 8 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-11-30 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $307,746 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231901 |
| Policy instance | 7 |
| Insurance contract or identification number | 1GA0231901 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $5,344 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | AU6486 |
| Policy instance | 5 |
| Insurance contract or identification number | AU6486 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $77,243 | | Total amount of fees paid to insurance company | USD $16,100 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,907,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $77,243 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 16100 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker name | PROFESSIONAL GROUP PLANS INC. |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | G1922 |
| Policy instance | 1 |
| Insurance contract or identification number | G1922 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $32,640 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,433,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,640 | | Insurance broker organization code? | 3 | | Insurance broker name | PROFESSIONAL GROUP PLANS INC |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231002 |
| Policy instance | 4 |
| Insurance contract or identification number | 1GA0231002 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $19,538 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $486,234 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,538 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN FOR CONTRACT 002 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231000 |
| Policy instance | 2 |
| Insurance contract or identification number | 1GA0231000 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $22,272 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $525,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,272 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN FOR CONTRACT 000 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231001 |
| Policy instance | 3 |
| Insurance contract or identification number | 1GA0231001 | | Number of Individuals Covered | 369 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $77,718 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT-MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,915,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $77,718 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN FOR CONTRACT 001 |
|
| AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
| Policy contract number | 0000959625 |
| Policy instance | 6 |
| Insurance contract or identification number | 0000959625 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $282,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | PROFESSIONAL GROUP PLANS, INC |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | G1922 |
| Policy instance | 1 |
| Insurance contract or identification number | G1922 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $29,613 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,213,509 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,613 | | Insurance broker organization code? | 3 | | Insurance broker name | PROFESSIONAL GROUP PLANS INC |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231000 |
| Policy instance | 2 |
| Insurance contract or identification number | 1GA0231000 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $29,064 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $726,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,064 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN FOR CONTRACT 000 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231002 |
| Policy instance | 4 |
| Insurance contract or identification number | 1GA0231002 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $24,290 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $607,246 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,290 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN FOR CONTRACT 002 |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | AU6486 |
| Policy instance | 5 |
| Insurance contract or identification number | AU6486 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $60,829 | | Total amount of fees paid to insurance company | USD $16,772 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,581,621 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $60,829 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 16772 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker name | PROFESSIONAL GROUP PLANS INC. |
|
| AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
| Policy contract number | 0000959625 |
| Policy instance | 6 |
| Insurance contract or identification number | 0000959625 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Insurance broker organization code? | 3 | | Insurance broker name | PROFESSIONAL GROUP PLANS, INC |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231901 |
| Policy instance | 7 |
| Insurance contract or identification number | 1GA0231901 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $5,996 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 8 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $14,639 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $443,512 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,639 | | Insurance broker organization code? | 3 | | Insurance broker name | FAGE BENEFIT SOLUTIONS LLC |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231900 |
| Policy instance | 9 |
| Insurance contract or identification number | 1GA0231900 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $5,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SOLSTICE BENEFITS, INC (National Association of Insurance Commissioners NAIC id number: 12341 ) |
| Policy contract number | 11642 |
| Policy instance | 10 |
| Insurance contract or identification number | 11642 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $6,686 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,742 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,686 | | Insurance broker organization code? | 3 | | Insurance broker name | FAGE BENEFITS SOLUTIONS |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231001 |
| Policy instance | 3 |
| Insurance contract or identification number | 1GA0231001 | | Number of Individuals Covered | 472 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $90,312 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT-MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $2,258,811 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $90,312 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN FOR CONTRACT 001 |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 1 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $19,572 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $481,078 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,572 | | Insurance broker organization code? | 3 | | Insurance broker name | FAGE BENEFIT SOLUTIONS LLC |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | G1922 |
| Policy instance | 10 |
| Insurance contract or identification number | G1922 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $25,776 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $983,543 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,776 | | Insurance broker organization code? | 3 | | Insurance broker name | PROFESSIONAL GROUP PLANS INC |
|
| AMALGAMATED LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 60216 ) |
| Policy contract number | 26OC12 |
| Policy instance | 9 |
| Insurance contract or identification number | 26OC12 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $499 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231000 |
| Policy instance | 8 |
| Insurance contract or identification number | 1GA0231000 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $18,582 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $569,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,007 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN FOR CONTRACT 000 |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231002 |
| Policy instance | 6 |
| Insurance contract or identification number | 1GA0231002 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $14,134 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $384,607 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $565 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN FOR CONTRACT 002 |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | AU6486 |
| Policy instance | 5 |
| Insurance contract or identification number | AU6486 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $46,174 | | Total amount of fees paid to insurance company | USD $13,958 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,139,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 13958 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $46,174 | | Insurance broker name | LISA PECONE |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 098814 |
| Policy instance | 4 |
| Insurance contract or identification number | 098814 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,507 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $78,243 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,368 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN |
|
| AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
| Policy contract number | 0000959625 |
| Policy instance | 3 |
| Insurance contract or identification number | 0000959625 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $15,599 | | 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 $15,599 | | Insurance broker organization code? | 3 | | Insurance broker name | PROFESSIONAL GROUP PLANS, INC |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231901 |
| Policy instance | 2 |
| Insurance contract or identification number | 1GA0231901 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $2,186 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231001 |
| Policy instance | 7 |
| Insurance contract or identification number | 1GA0231001 | | Number of Individuals Covered | 455 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $50,573 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT-MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $1,615,962 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,347 | | Insurance broker organization code? | 3 | | Insurance broker name | DAVID FEINSTEIN FOR CONTRACT 001 |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | AU6486 |
| Policy instance | 3 |
| Insurance contract or identification number | AU6486 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $28,403 | | Total amount of fees paid to insurance company | USD $9,478 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $857,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231002 |
| Policy instance | 4 |
| Insurance contract or identification number | 1GA0231002 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,377 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $45,056 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
| Policy contract number | 0000959625 |
| Policy instance | 1 |
| Insurance contract or identification number | 0000959625 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $8,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | 376414 |
| Policy instance | 8 |
| Insurance contract or identification number | 376414 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $18,600 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $605,565 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMALGAMATED LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 60216 ) |
| Policy contract number | 26OC12 |
| Policy instance | 7 |
| Insurance contract or identification number | 26OC12 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $605 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231000 |
| Policy instance | 6 |
| Insurance contract or identification number | 1GA0231000 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $9,143 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT - MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $214,646 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 1GA0231001 |
| Policy instance | 5 |
| Insurance contract or identification number | 1GA0231001 | | Number of Individuals Covered | 187 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $18,526 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | POS CONTRACT-MEDICAL & SURGICAL | | Welfare Benefit Premiums Paid to Carrier | USD $517,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 098814 |
| Policy instance | 2 |
| Insurance contract or identification number | 098814 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $5,196 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| WELLCHOICE HMO OF NEW JERSEY (National Association of Insurance Commissioners NAIC id number: 95433 ) |
| Policy contract number | 376414 |
| Policy instance | 2 |
| Insurance contract or identification number | 376414 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $24,414 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $610,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,414 | | Insurance broker organization code? | 3 | | Insurance broker name | PROFESSIONAL GROUP PLANS INC. |
|
| AMALGAMATED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60216 ) |
| Policy contract number | 26OC12 |
| Policy instance | 1 |
| Insurance contract or identification number | 26OC12 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2009-10-01 | | Insurance policy end date | 2010-09-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,101 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH NET OF NY (National Association of Insurance Commissioners NAIC id number: 95305 ) |
| Policy contract number | 057228 |
| Policy instance | 3 |
| Insurance contract or identification number | 057228 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $41,448 | | Total amount of fees paid to insurance company | USD $16,579 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $856,808 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 16579 | | Insurance broker organization code? | 3 | | Commission paid to Insurance Broker | USD $41,448 | | Insurance broker name | ANTHONY A. PECONE |
|
