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STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 401k Plan overview

Plan NameSTONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN
Plan identification number 503

STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

STONE COAST FUND SERVICES, LLC has sponsored the creation of one or more 401k plans.

Company Name:STONE COAST FUND SERVICES, LLC
Employer identification number (EIN):061781234
NAIC Classification:523120
NAIC Description:Securities Brokerage

Form 5500 Filing Information

Submission information for form 5500 for 401k plan STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032022-02-01
5032021-02-01
5032020-02-01
5032019-02-01
5032018-02-01

Plan Statistics for STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN

401k plan membership statisitcs for STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN

Measure Date Value
2022: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-02-01162
Total number of active participants reported on line 7a of the Form 55002022-02-01175
Number of retired or separated participants receiving benefits2022-02-016
Total of all active and inactive participants2022-02-01181
Total participants2022-02-01181
2021: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-02-01154
Total number of active participants reported on line 7a of the Form 55002021-02-01168
Number of retired or separated participants receiving benefits2021-02-012
Total of all active and inactive participants2021-02-01170
Total participants2021-02-01170
2020: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-02-01156
Total number of active participants reported on line 7a of the Form 55002020-02-01143
Total of all active and inactive participants2020-02-01143
Total participants2020-02-01143
2019: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-02-01154
Total number of active participants reported on line 7a of the Form 55002019-02-01156
Number of retired or separated participants receiving benefits2019-02-013
Total of all active and inactive participants2019-02-01159
Total participants2019-02-01159
Number of participants with account balances2019-02-010
2018: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-02-01158
Total number of active participants reported on line 7a of the Form 55002018-02-01152
Number of retired or separated participants receiving benefits2018-02-015
Total of all active and inactive participants2018-02-01157
Total participants2018-02-01157

Form 5500 Responses for STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN

2022: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2022 form 5500 responses
2022-02-01Type of plan entitySingle employer plan
2022-02-01Plan funding arrangement – InsuranceYes
2022-02-01Plan funding arrangement – General assets of the sponsorYes
2022-02-01Plan benefit arrangement – InsuranceYes
2022-02-01Plan benefit arrangement – General assets of the sponsorYes
2021: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2021 form 5500 responses
2021-02-01Type of plan entitySingle employer plan
2021-02-01Plan funding arrangement – InsuranceYes
2021-02-01Plan funding arrangement – General assets of the sponsorYes
2021-02-01Plan benefit arrangement – InsuranceYes
2021-02-01Plan benefit arrangement – General assets of the sponsorYes
2020: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2020 form 5500 responses
2020-02-01Type of plan entitySingle employer plan
2020-02-01Plan funding arrangement – InsuranceYes
2020-02-01Plan funding arrangement – General assets of the sponsorYes
2020-02-01Plan benefit arrangement – InsuranceYes
2020-02-01Plan benefit arrangement – General assets of the sponsorYes
2019: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2019 form 5500 responses
2019-02-01Type of plan entitySingle employer plan
2019-02-01Plan funding arrangement – InsuranceYes
2019-02-01Plan benefit arrangement – InsuranceYes
2018: STONE COAST FUND SERVICES LLC CONSOLIDATED WELFARE BENEFITS PLAN 2018 form 5500 responses
2018-02-01Type of plan entitySingle employer plan
2018-02-01First time form 5500 has been submittedYes
2018-02-01Plan funding arrangement – InsuranceYes
2018-02-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number000000619455
Policy instance 12
Insurance contract or identification number000000619455
Number of Individuals Covered50
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $948
Total amount of fees paid to insurance companyUSD $316
Other welfare benefits providedCRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $6,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $948
Insurance broker organization code?3
Amount paid for insurance broker fees316
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135130
Policy instance 1
Insurance contract or identification number135130
Number of Individuals Covered212
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $7,907
Total amount of fees paid to insurance companyUSD $1,872
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $102,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,907
Insurance broker organization code?3
Amount paid for insurance broker fees1872
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135131
Policy instance 2
Insurance contract or identification number135131
Number of Individuals Covered92
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $4,972
Total amount of fees paid to insurance companyUSD $663
Other welfare benefits providedVOLUNTARY LIFESTYLE ADD AND LIFE
Welfare Benefit Premiums Paid to CarrierUSD $33,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,972
Insurance broker organization code?3
Amount paid for insurance broker fees663
Additional information about fees paid to insurance brokerOTHER COMPENSATION
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0874990000
Policy instance 3
Insurance contract or identification number0874990000
Number of Individuals Covered16
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $6,172
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $152,393
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,566
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number1062220000
Policy instance 4
Insurance contract or identification number1062220000
Number of Individuals Covered192
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $37,945
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA
Welfare Benefit Premiums Paid to CarrierUSD $936,905
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,070
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number1062230000
Policy instance 5
Insurance contract or identification number1062230000
Number of Individuals Covered82
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $19,060
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA
Welfare Benefit Premiums Paid to CarrierUSD $470,616
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,100
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0874990001
Policy instance 6
Insurance contract or identification number0874990001
Number of Individuals Covered2
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $468
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOBRA
Welfare Benefit Premiums Paid to CarrierUSD $11,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $346
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number106222
Policy instance 7
Insurance contract or identification number106222
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $18
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA/COBRA
Welfare Benefit Premiums Paid to CarrierUSD $437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number1062230001
Policy instance 8
Insurance contract or identification number1062230001
Number of Individuals Covered2
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $630
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA/COBRA
Welfare Benefit Premiums Paid to CarrierUSD $15,537
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $466
Insurance broker organization code?3
DELTA DENTAL PLAN OF MAINE (National Association of Insurance Commissioners NAIC id number: 14369 )
Policy contract number000060757
Policy instance 9
Insurance contract or identification number000060757
Number of Individuals Covered230
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $6,535
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $112,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,587
Insurance broker organization code?3
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number619456
Policy instance 10
Insurance contract or identification number619456
Number of Individuals Covered20
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $709
Total amount of fees paid to insurance companyUSD $236
Other welfare benefits providedHOSPITAL EE PAID
Welfare Benefit Premiums Paid to CarrierUSD $5,141
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $709
Insurance broker organization code?3
Amount paid for insurance broker fees236
Additional information about fees paid to insurance brokerOTHER COMPENSATION
PAUL REVERE VARIABLE ANNUITY INS. CO. (National Association of Insurance Commissioners NAIC id number: 67601 )
Policy contract number000000619457
Policy instance 11
Insurance contract or identification number000000619457
Number of Individuals Covered36
Insurance policy start date2022-02-01
Insurance policy end date2023-01-31
Total amount of commissions paid to insurance brokerUSD $662
Total amount of fees paid to insurance companyUSD $225
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $662
Insurance broker organization code?3
Amount paid for insurance broker fees225
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135130
Policy instance 1
Insurance contract or identification number135130
Number of Individuals Covered378
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $8,887
Total amount of fees paid to insurance companyUSD $2,170
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,493
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,887
Insurance broker organization code?3
Amount paid for insurance broker fees2170
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135131
Policy instance 2
Insurance contract or identification number135131
Number of Individuals Covered82
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $6,322
Total amount of fees paid to insurance companyUSD $843
Other welfare benefits providedLIFESTYLE ADD, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $42,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,322
Insurance broker organization code?3
Amount paid for insurance broker fees843
Additional information about fees paid to insurance brokerOTHER COMPENSATION
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0874990000
Policy instance 3
Insurance contract or identification number0874990000
Number of Individuals Covered23
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $6,853
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $155,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,457
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number1062220000
Policy instance 4
Insurance contract or identification number1062220000
Number of Individuals Covered188
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $36,304
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA
Welfare Benefit Premiums Paid to CarrierUSD $830,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,910
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number1062230000
Policy instance 5
Insurance contract or identification number1062230000
Number of Individuals Covered86
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $18,255
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA
Welfare Benefit Premiums Paid to CarrierUSD $423,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,537
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0874990001
Policy instance 6
Insurance contract or identification number0874990001
Number of Individuals Covered2
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $177
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOBRA
Welfare Benefit Premiums Paid to CarrierUSD $3,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $141
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number1062230000
Policy instance 6
Insurance contract or identification number1062230000
Number of Individuals Covered80
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $13,765
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA
Welfare Benefit Premiums Paid to CarrierUSD $360,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,765
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number1062220000
Policy instance 5
Insurance contract or identification number1062220000
Number of Individuals Covered194
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $27,444
Health Insurance Welfare BenefitYes
Other welfare benefits providedHSA
Welfare Benefit Premiums Paid to CarrierUSD $719,076
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,444
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number1062220001
Policy instance 4
Insurance contract or identification number1062220001
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $75
Health Insurance Welfare BenefitYes
Other welfare benefits providedCOBRA
Welfare Benefit Premiums Paid to CarrierUSD $1,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75
Insurance broker organization code?3
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0874990000
Policy instance 3
Insurance contract or identification number0874990000
Number of Individuals Covered14
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $4,156
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $108,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,156
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135131
Policy instance 2
Insurance contract or identification number135131
Number of Individuals Covered80
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $5,457
Total amount of fees paid to insurance companyUSD $728
Other welfare benefits providedLIFESTYLE ADD, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $36,383
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,457
Insurance broker organization code?3
Amount paid for insurance broker fees728
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135130
Policy instance 1
Insurance contract or identification number135130
Number of Individuals Covered176
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $8,265
Total amount of fees paid to insurance companyUSD $2,013
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $100,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,265
Insurance broker organization code?3
Amount paid for insurance broker fees2013
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135130
Policy instance 1
Insurance contract or identification number135130
Number of Individuals Covered187
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $8,600
Total amount of fees paid to insurance companyUSD $2,119
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,930
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,600
Insurance broker organization code?3
Amount paid for insurance broker fees2119
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135131
Policy instance 2
Insurance contract or identification number135131
Number of Individuals Covered72
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $4,974
Total amount of fees paid to insurance companyUSD $663
Other welfare benefits providedLIFESTYLE ADD, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $33,161
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,974
Insurance broker organization code?3
Amount paid for insurance broker fees663
Additional information about fees paid to insurance brokerOTHER COMPENSATION
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0874990000
Policy instance 3
Insurance contract or identification number0874990000
Number of Individuals Covered17
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $4,959
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $123,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,949
Insurance broker organization code?3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number0247480000
Policy instance 4
Insurance contract or identification number0247480000
Number of Individuals Covered88
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $13,525
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $341,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,498
Insurance broker organization code?3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number02474800001
Policy instance 5
Insurance contract or identification number02474800001
Number of Individuals Covered3
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $713
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $712
Insurance broker organization code?3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number0431350000
Policy instance 6
Insurance contract or identification number0431350000
Number of Individuals Covered203
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $27,686
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $691,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,632
Insurance broker organization code?3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number0431350001
Policy instance 7
Insurance contract or identification number0431350001
Number of Individuals Covered1
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $-55
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-55
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135131
Policy instance 2
Insurance contract or identification number135131
Number of Individuals Covered70
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $4,487
Total amount of fees paid to insurance companyUSD $598
Other welfare benefits providedLIFESTYLE ADD, LIFESTYLE LIFE
Welfare Benefit Premiums Paid to CarrierUSD $32,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,304
Insurance broker organization code?3
Amount paid for insurance broker fees494
Additional information about fees paid to insurance brokerNONMONETARY COMPENSATION
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number0874990000
Policy instance 3
Insurance contract or identification number0874990000
Number of Individuals Covered17
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $3,795
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $97,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,795
Insurance broker organization code?3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number0247480000
Policy instance 4
Insurance contract or identification number0247480000
Number of Individuals Covered78
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $11,896
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $306,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,896
Insurance broker organization code?3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number02474800001
Policy instance 5
Insurance contract or identification number02474800001
Number of Individuals Covered3
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $503
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $503
Insurance broker organization code?3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number0431350000
Policy instance 6
Insurance contract or identification number0431350000
Number of Individuals Covered190
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $23,497
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $606,275
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,497
Insurance broker organization code?3
HPHC INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 18975 )
Policy contract number0431350001
Policy instance 7
Insurance contract or identification number0431350001
Number of Individuals Covered6
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $745
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,227
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $745
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number135130
Policy instance 1
Insurance contract or identification number135130
Number of Individuals Covered150
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $4,382
Total amount of fees paid to insurance companyUSD $845
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $45,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,393
Insurance broker organization code?3
Amount paid for insurance broker fees693
Additional information about fees paid to insurance brokerOTHER COMPENSATION

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