HOURLY ACCOUNTING TRUST WELFARE PLAN has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HOURLY ACCOUNTING TRUST WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2022 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2022-12-31 | $8,194 |
| Total income from all sources | 2022-12-31 | $140 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $11,279 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $6,173 |
| Total plan assets at beginning of year | 2022-12-31 | $19,333 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $87 |
| Other income received | 2022-12-31 | $140 |
| Net income (gross income less expenses) | 2022-12-31 | $-11,139 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $11,139 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $5,019 |
| 2021 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $8,194 |
| Total plan liabilities at beginning of year | 2021-12-31 | $11,069 |
| Total income from all sources | 2021-12-31 | $3 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $12,455 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $3,330 |
| Total plan assets at end of year | 2021-12-31 | $19,333 |
| Total plan assets at beginning of year | 2021-12-31 | $34,660 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $0 |
| Other income received | 2021-12-31 | $3 |
| Net income (gross income less expenses) | 2021-12-31 | $-12,452 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $11,139 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $23,591 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $9,125 |
| 2020 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $11,069 |
| Total plan liabilities at beginning of year | 2020-12-31 | $4,910 |
| Total income from all sources | 2020-12-31 | $86,946 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $477,835 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $465,851 |
| Total plan assets at end of year | 2020-12-31 | $34,660 |
| Total plan assets at beginning of year | 2020-12-31 | $419,390 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $148 |
| Other income received | 2020-12-31 | $1,292 |
| Net income (gross income less expenses) | 2020-12-31 | $-390,889 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $23,591 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $414,480 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $85,654 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $11,836 |
| 2019 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $4,910 |
| Total plan liabilities at beginning of year | 2019-12-31 | $6,450 |
| Total income from all sources | 2019-12-31 | $330,086 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $158,322 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $139,399 |
| Total plan assets at end of year | 2019-12-31 | $419,390 |
| Total plan assets at beginning of year | 2019-12-31 | $249,166 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $104 |
| Other income received | 2019-12-31 | $7,715 |
| Net income (gross income less expenses) | 2019-12-31 | $171,764 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $414,480 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $242,716 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $322,371 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $18,819 |
| 2018 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $6,450 |
| Total plan liabilities at beginning of year | 2018-12-31 | $4,000 |
| Total income from all sources | 2018-12-31 | $303,440 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $276,932 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $251,599 |
| Total plan assets at end of year | 2018-12-31 | $249,166 |
| Total plan assets at beginning of year | 2018-12-31 | $220,208 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $231 |
| Other income received | 2018-12-31 | $5,239 |
| Net income (gross income less expenses) | 2018-12-31 | $26,508 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $242,716 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $216,208 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $298,201 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $25,102 |
| 2017 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $4,000 |
| Total plan liabilities at beginning of year | 2017-12-31 | $4,000 |
| Total income from all sources | 2017-12-31 | $134,766 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $122,201 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $105,164 |
| Total plan assets at end of year | 2017-12-31 | $220,208 |
| Total plan assets at beginning of year | 2017-12-31 | $207,643 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $36 |
| Other income received | 2017-12-31 | $1,494 |
| Net income (gross income less expenses) | 2017-12-31 | $12,565 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $216,208 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $203,643 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $133,272 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $17,001 |
| 2016 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $4,000 |
| Total plan liabilities at beginning of year | 2016-12-31 | $4,000 |
| Total income from all sources | 2016-12-31 | $169,178 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $110,584 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $96,983 |
| Total plan assets at end of year | 2016-12-31 | $207,643 |
| Total plan assets at beginning of year | 2016-12-31 | $149,049 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $100 |
| Other income received | 2016-12-31 | $452 |
| Net income (gross income less expenses) | 2016-12-31 | $58,594 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $203,643 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $145,049 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $168,726 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $13,501 |
| 2015 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $4,000 |
| Total plan liabilities at beginning of year | 2015-12-31 | $6,000 |
| Total income from all sources | 2015-12-31 | $204,883 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $304,458 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $288,060 |
| Total plan assets at end of year | 2015-12-31 | $149,049 |
| Total plan assets at beginning of year | 2015-12-31 | $250,624 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $30 |
| Other income received | 2015-12-31 | $20 |
| Net income (gross income less expenses) | 2015-12-31 | $-99,575 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $145,049 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $244,624 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $204,863 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $16,368 |
| 2014 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-12-31 | $6,000 |
| Total plan liabilities at beginning of year | 2014-12-31 | $8,000 |
| Total income from all sources | 2014-12-31 | $1,467,674 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $1,406,106 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $1,325,926 |
| Total plan assets at end of year | 2014-12-31 | $250,624 |
| Total plan assets at beginning of year | 2014-12-31 | $191,056 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $132 |
| Other income received | 2014-12-31 | $32 |
| Net income (gross income less expenses) | 2014-12-31 | $61,568 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $244,624 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $183,056 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $1,467,642 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $80,048 |
| 2013 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-12-31 | $8,000 |
| Total plan liabilities at beginning of year | 2013-12-31 | $7,000 |
| Total income from all sources | 2013-12-31 | $301,783 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $385,428 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $366,334 |
| Total plan assets at end of year | 2013-12-31 | $191,056 |
| Total plan assets at beginning of year | 2013-12-31 | $273,701 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $36 |
| Other income received | 2013-12-31 | $23 |
| Net income (gross income less expenses) | 2013-12-31 | $-83,645 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $183,056 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $266,701 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $301,760 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $19,058 |
| 2012 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-12-31 | $7,000 |
| Total plan liabilities at beginning of year | 2012-12-31 | $5,388 |
| Total income from all sources | 2012-12-31 | $431,570 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $530,135 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $498,388 |
| Total plan assets at end of year | 2012-12-31 | $273,701 |
| Total plan assets at beginning of year | 2012-12-31 | $370,653 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $74 |
| Other income received | 2012-12-31 | $21 |
| Net income (gross income less expenses) | 2012-12-31 | $-98,565 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $266,701 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $365,265 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $431,549 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $31,673 |
| 2011 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-12-31 | $5,388 |
| Total plan liabilities at beginning of year | 2011-12-31 | $5,424 |
| Total income from all sources | 2011-12-31 | $591,818 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $588,391 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $553,454 |
| Total plan assets at end of year | 2011-12-31 | $370,653 |
| Total plan assets at beginning of year | 2011-12-31 | $367,262 |
| Other income received | 2011-12-31 | $5 |
| Net income (gross income less expenses) | 2011-12-31 | $3,427 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $365,265 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $361,838 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $591,813 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $34,937 |
| 2010 : HOURLY ACCOUNTING TRUST WELFARE PLAN 2010 401k financial data |
|---|
| Total plan liabilities at end of year | 2010-12-31 | $5,424 |
| Total plan liabilities at beginning of year | 2010-12-31 | $3,500 |
| Total income from all sources | 2010-12-31 | $398,585 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $384,227 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $357,156 |
| Total plan assets at end of year | 2010-12-31 | $367,262 |
| Total plan assets at beginning of year | 2010-12-31 | $350,980 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $27,071 |
| Other income received | 2010-12-31 | $2 |
| Net income (gross income less expenses) | 2010-12-31 | $14,358 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $361,838 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $347,480 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $398,583 |
| SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | G5C579521 |
| Policy instance | 2 |
| Insurance contract or identification number | G5C579521 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 337405794-1 |
| Policy instance | 3 |
| Insurance contract or identification number | 337405794-1 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | G5C579521 |
| Policy instance | 4 |
| Insurance contract or identification number | G5C579521 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $780 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | LIFESTYLE AND ADD | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Amount paid for insurance broker fees | 955 | | Commission paid to Insurance Broker | USD $955 |
|
| OXFORD HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 01182 ) |
| Policy contract number | LA11342 |
| Policy instance | 2 |
| Insurance contract or identification number | LA11342 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $91,169 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 09H7509 |
| Policy instance | 1 |
| Insurance contract or identification number | 09H7509 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 $7,967 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 337405794-1 |
| Policy instance | 5 |
| Insurance contract or identification number | 337405794-1 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 01182 ) |
| Policy contract number | LA11342 |
| Policy instance | 3 |
| Insurance contract or identification number | LA11342 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2018-03-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $94,414 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 09H7509 |
| Policy instance | 1 |
| Insurance contract or identification number | 09H7509 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 $14,258 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CARE CONNECT (National Association of Insurance Commissioners NAIC id number: 15309 ) |
| Policy contract number | B00782 |
| Policy instance | 2 |
| Insurance contract or identification number | B00782 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,917 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SILVERSCRIPT (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | G5C579521 |
| Policy instance | 5 |
| Insurance contract or identification number | G5C579521 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $298 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 09H7509 |
| Policy instance | 1 |
| Insurance contract or identification number | 09H7509 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 $9,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CARE CONNECT (National Association of Insurance Commissioners NAIC id number: 15309 ) |
| Policy contract number | B00782 |
| Policy instance | 2 |
| Insurance contract or identification number | B00782 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $91,870 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD BENEFIT MANAGEMENT (National Association of Insurance Commissioners NAIC id number: 60093 ) |
| Policy contract number | 0173390 |
| Policy instance | 6 |
| Insurance contract or identification number | 0173390 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,448 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P-2153-1 |
| Policy instance | 1 |
| Insurance contract or identification number | P-2153-1 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MORGAN WHITE ADMINISTRATORS, INC. (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 8881 |
| Policy instance | 2 |
| Insurance contract or identification number | 8881 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,112 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 09H7509 |
| Policy instance | 3 |
| Insurance contract or identification number | 09H7509 | | 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 $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,654 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | NAY70 |
| Policy instance | 4 |
| Insurance contract or identification number | NAY70 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G220461 |
| Policy instance | 5 |
| Insurance contract or identification number | G220461 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $730 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 90549527 |
| Policy instance | 7 |
| Insurance contract or identification number | 90549527 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,501 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | W730245-10-930 |
| Policy instance | 8 |
| Insurance contract or identification number | W730245-10-930 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 9048611 |
| Policy instance | 9 |
| Insurance contract or identification number | 9048611 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CARE CONNECT (National Association of Insurance Commissioners NAIC id number: 15309 ) |
| Policy contract number | B00782 |
| Policy instance | 10 |
| Insurance contract or identification number | B00782 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2015-12-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,436 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EMBLEM HEALTH SERVICES CO, LLC (National Association of Insurance Commissioners NAIC id number: 60094 ) |
| Policy contract number | 1P01535000 |
| Policy instance | 11 |
| Insurance contract or identification number | 1P01535000 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2015-12-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH REPUBLIC INSURANCE OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 15273 ) |
| Policy contract number | 013341 |
| Policy instance | 12 |
| Insurance contract or identification number | 013341 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63,050 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 90549527 |
| Policy instance | 8 |
| Insurance contract or identification number | 90549527 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $86,502 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 9048611 |
| Policy instance | 10 |
| Insurance contract or identification number | 9048611 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $107,579 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | W730245-10-930 |
| Policy instance | 9 |
| Insurance contract or identification number | W730245-10-930 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,968 | | 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: 95479 ) |
| Policy contract number | VV1017 |
| Policy instance | 1 |
| Insurance contract or identification number | VV1017 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,275 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P-2153-1 |
| Policy instance | 2 |
| Insurance contract or identification number | P-2153-1 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $847 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MORGAN WHITE ADMINISTRATORS, INC. (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 8881 |
| Policy instance | 3 |
| Insurance contract or identification number | 8881 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 09H7509 |
| Policy instance | 4 |
| Insurance contract or identification number | 09H7509 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | NAY70 |
| Policy instance | 5 |
| Insurance contract or identification number | NAY70 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G220461 |
| Policy instance | 6 |
| Insurance contract or identification number | G220461 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $813 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD BENEFIT MANAGEMENT (National Association of Insurance Commissioners NAIC id number: 60093 ) |
| Policy contract number | 0173390 |
| Policy instance | 7 |
| Insurance contract or identification number | 0173390 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,046 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P-2153-1 |
| Policy instance | 2 |
| Insurance contract or identification number | P-2153-1 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $693 | | 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: 95479 ) |
| Policy contract number | VV1017 |
| Policy instance | 1 |
| Insurance contract or identification number | VV1017 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $141,660 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MORGAN WHITE ADMINISTRATORS, INC. (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 8881 |
| Policy instance | 4 |
| Insurance contract or identification number | 8881 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,577 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EMBLEM HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 86HN1WIXQ |
| Policy instance | 3 |
| Insurance contract or identification number | 86HN1WIXQ | | Number of Individuals Covered | 10 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $131,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 09H7509 |
| Policy instance | 5 |
| Insurance contract or identification number | 09H7509 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | NAY70 |
| Policy instance | 6 |
| Insurance contract or identification number | NAY70 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD BENEFIT MANAGEMENT (National Association of Insurance Commissioners NAIC id number: 60093 ) |
| Policy contract number | 0173390 |
| Policy instance | 8 |
| Insurance contract or identification number | 0173390 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,832 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G220461 |
| Policy instance | 7 |
| Insurance contract or identification number | G220461 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $954 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P-2153-1 |
| Policy instance | 2 |
| Insurance contract or identification number | P-2153-1 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,012 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD BENEFIT MANAGEMENT (National Association of Insurance Commissioners NAIC id number: 60093 ) |
| Policy contract number | 0173390 |
| Policy instance | 8 |
| Insurance contract or identification number | 0173390 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| J. PEAT AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | |
| Policy instance | 9 |
| Number of Individuals Covered | 0 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $5,638 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G220461 |
| Policy instance | 7 |
| Insurance contract or identification number | G220461 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $988 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | NAY70 |
| Policy instance | 6 |
| Insurance contract or identification number | NAY70 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 09H7509 |
| Policy instance | 5 |
| Insurance contract or identification number | 09H7509 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MORGAN WHITE ADMINISTRATORS, INC. (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 8881 |
| Policy instance | 4 |
| Insurance contract or identification number | 8881 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,457 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EMBLEM HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 86HN1WIXQ |
| Policy instance | 3 |
| Insurance contract or identification number | 86HN1WIXQ | | Number of Individuals Covered | 11 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $146,950 | | 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: 95479 ) |
| Policy contract number | VV1017 |
| Policy instance | 1 |
| Insurance contract or identification number | VV1017 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $154,988 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| J. PEAT AND ASSOCIATES (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | |
| Policy instance | 9 |
| Number of Individuals Covered | 12 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $43,818 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OXFORD BENEFIT MANAGEMENT (National Association of Insurance Commissioners NAIC id number: 60093 ) |
| Policy contract number | 0173390 |
| Policy instance | 8 |
| Insurance contract or identification number | 0173390 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,288 | | 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: 95479 ) |
| Policy contract number | VV1017 |
| Policy instance | 1 |
| Insurance contract or identification number | VV1017 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $150,522 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P-2153-1 |
| Policy instance | 2 |
| Insurance contract or identification number | P-2153-1 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,189 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EMBLEM HEALTH INSURANCE (National Association of Insurance Commissioners NAIC id number: 55247 ) |
| Policy contract number | 86HN1WIXQ |
| Policy instance | 3 |
| Insurance contract or identification number | 86HN1WIXQ | | Number of Individuals Covered | 12 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $142,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MORGAN WHITE ADMINISTRATORS, INC. (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | 8881 |
| Policy instance | 4 |
| Insurance contract or identification number | 8881 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,445 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
| Policy contract number | NAY70 |
| Policy instance | 6 |
| Insurance contract or identification number | NAY70 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,246 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,246 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G220461 |
| Policy instance | 7 |
| Insurance contract or identification number | G220461 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SPECTERA, INC. (National Association of Insurance Commissioners NAIC id number: 74950 ) |
| Policy contract number | 09H7509 |
| Policy instance | 5 |
| Insurance contract or identification number | 09H7509 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,049 | | 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: 95479 ) |
| Policy contract number | VV1017 |
| Policy instance | 11 |
| Insurance contract or identification number | VV1017 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,570 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00340186 |
| Policy instance | 10 |
| Insurance contract or identification number | 00340186 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,955 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | P-2153-1 |
| Policy instance | 9 |
| Insurance contract or identification number | P-2153-1 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $745 | | 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 | 866-422-2583 |
| Policy instance | 7 |
| Insurance contract or identification number | 866-422-2583 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,022 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNITED STATES LIFE INSURANCE COMPANY IN THE CITY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 70106 ) |
| Policy contract number | G220461 |
| Policy instance | 6 |
| Insurance contract or identification number | G220461 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,216 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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