CENTURY LINEN & UNIFORM, INC. has sponsored the creation of one or more 401k plans.
Additional information about CENTURY LINEN & UNIFORM, INC.
Submission information for form 5500 for 401k plan CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN
401k plan membership statisitcs for CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN
Measure | Date | Value |
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2021: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-10-01 | 231 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-10-01 | 241 |
Number of retired or separated participants receiving benefits | 2021-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-10-01 | 0 |
Total of all active and inactive participants | 2021-10-01 | 241 |
2020: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-10-01 | 237 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 231 |
Number of retired or separated participants receiving benefits | 2020-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
Total of all active and inactive participants | 2020-10-01 | 231 |
2019: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-10-01 | 218 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 237 |
Total of all active and inactive participants | 2019-10-01 | 237 |
2018: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-10-01 | 221 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 218 |
Total of all active and inactive participants | 2018-10-01 | 218 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-10-01 | 0 |
2017: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-10-01 | 210 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 221 |
Total of all active and inactive participants | 2017-10-01 | 221 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-10-01 | 0 |
2016: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-10-01 | 219 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 210 |
Total of all active and inactive participants | 2016-10-01 | 210 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-10-01 | 0 |
2015: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-10-01 | 231 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 219 |
Total of all active and inactive participants | 2015-10-01 | 219 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-10-01 | 0 |
2014: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-10-01 | 259 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 231 |
Total of all active and inactive participants | 2014-10-01 | 231 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-10-01 | 0 |
2013: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-10-01 | 220 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 259 |
Total of all active and inactive participants | 2013-10-01 | 259 |
2012: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-10-01 | 201 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 220 |
Total of all active and inactive participants | 2012-10-01 | 220 |
2011: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-10-01 | 188 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 201 |
Total of all active and inactive participants | 2011-10-01 | 201 |
2009: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-10-01 | 234 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 202 |
Number of retired or separated participants receiving benefits | 2009-10-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 0 |
Total of all active and inactive participants | 2009-10-01 | 202 |
2021: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2021 form 5500 responses |
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2021-10-01 | Type of plan entity | Single employer plan |
2021-10-01 | Plan funding arrangement – Insurance | Yes |
2021-10-01 | Plan benefit arrangement – Insurance | Yes |
2020: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2020 form 5500 responses |
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2020-10-01 | Type of plan entity | Single employer plan |
2020-10-01 | Plan funding arrangement – Insurance | Yes |
2020-10-01 | Plan benefit arrangement – Insurance | Yes |
2019: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2019 form 5500 responses |
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2019-10-01 | Type of plan entity | Single employer plan |
2019-10-01 | Submission has been amended | No |
2019-10-01 | This submission is the final filing | No |
2019-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-10-01 | Plan is a collectively bargained plan | No |
2019-10-01 | Plan funding arrangement – Insurance | Yes |
2019-10-01 | Plan benefit arrangement – Insurance | Yes |
2018: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2018 form 5500 responses |
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2018-10-01 | Type of plan entity | Single employer plan |
2018-10-01 | Submission has been amended | No |
2018-10-01 | This submission is the final filing | No |
2018-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-10-01 | Plan is a collectively bargained plan | No |
2018-10-01 | Plan funding arrangement – Insurance | Yes |
2018-10-01 | Plan benefit arrangement – Insurance | Yes |
2017: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2017 form 5500 responses |
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2017-10-01 | Type of plan entity | Single employer plan |
2017-10-01 | Submission has been amended | No |
2017-10-01 | This submission is the final filing | No |
2017-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-10-01 | Plan is a collectively bargained plan | No |
2017-10-01 | Plan funding arrangement – Insurance | Yes |
2017-10-01 | Plan benefit arrangement – Insurance | Yes |
2016: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2016 form 5500 responses |
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2016-10-01 | Type of plan entity | Single employer plan |
2016-10-01 | Submission has been amended | No |
2016-10-01 | This submission is the final filing | No |
2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-10-01 | Plan is a collectively bargained plan | No |
2016-10-01 | Plan funding arrangement – Insurance | Yes |
2016-10-01 | Plan benefit arrangement – Insurance | Yes |
2015: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2015 form 5500 responses |
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2015-10-01 | Type of plan entity | Single employer plan |
2015-10-01 | Submission has been amended | No |
2015-10-01 | This submission is the final filing | No |
2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-10-01 | Plan is a collectively bargained plan | No |
2015-10-01 | Plan funding arrangement – Insurance | Yes |
2015-10-01 | Plan benefit arrangement – Insurance | Yes |
2014: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2014 form 5500 responses |
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2014-10-01 | Type of plan entity | Single employer plan |
2014-10-01 | Submission has been amended | No |
2014-10-01 | This submission is the final filing | No |
2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-10-01 | Plan is a collectively bargained plan | No |
2014-10-01 | Plan funding arrangement – Insurance | Yes |
2014-10-01 | Plan benefit arrangement – Insurance | Yes |
2013: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2013 form 5500 responses |
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2013-10-01 | Type of plan entity | Single employer plan |
2013-10-01 | Submission has been amended | No |
2013-10-01 | This submission is the final filing | No |
2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-10-01 | Plan is a collectively bargained plan | No |
2013-10-01 | Plan funding arrangement – Insurance | Yes |
2013-10-01 | Plan benefit arrangement – Insurance | Yes |
2012: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2012 form 5500 responses |
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2012-10-01 | Type of plan entity | Single employer plan |
2012-10-01 | Submission has been amended | No |
2012-10-01 | This submission is the final filing | No |
2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-10-01 | Plan is a collectively bargained plan | No |
2012-10-01 | Plan funding arrangement – Insurance | Yes |
2012-10-01 | Plan benefit arrangement – Insurance | Yes |
2011: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2011 form 5500 responses |
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2011-10-01 | Type of plan entity | Single employer plan |
2011-10-01 | Submission has been amended | No |
2011-10-01 | This submission is the final filing | No |
2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-10-01 | Plan is a collectively bargained plan | No |
2011-10-01 | Plan funding arrangement – Insurance | Yes |
2011-10-01 | Plan benefit arrangement – Insurance | Yes |
2009: CENTURY LINEN & UNIFORM, INC. HEALTH & LIFE PLAN 2009 form 5500 responses |
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2009-10-01 | Type of plan entity | Single employer plan |
2009-10-01 | Submission has been amended | No |
2009-10-01 | This submission is the final filing | No |
2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-10-01 | Plan is a collectively bargained plan | No |
2009-10-01 | Plan funding arrangement – Insurance | Yes |
2009-10-01 | Plan benefit arrangement – Insurance | Yes |
THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
Policy contract number | E4131678 |
Policy instance | 3 |
Insurance contract or identification number | E4131678 | Number of Individuals Covered | 51 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $9,535 | Total amount of fees paid to insurance company | USD $1,644 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $50,073 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,950 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 972 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00581635 |
Policy instance | 2 |
Insurance contract or identification number | 00581635 | Number of Individuals Covered | 241 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $6,388 | Total amount of fees paid to insurance company | USD $2,224 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $35,961 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,567 | Amount paid for insurance broker fees | 2224 | Insurance broker organization code? | 3 |
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CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
Policy contract number | 20031985 |
Policy instance | 1 |
Insurance contract or identification number | 20031985 | Number of Individuals Covered | 75 | Insurance policy start date | 2021-10-01 | Insurance policy end date | 2022-09-30 | Total amount of commissions paid to insurance broker | USD $22,225 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $468,665 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,048 | Insurance broker organization code? | 3 |
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CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
Policy contract number | 20031985 |
Policy instance | 1 |
Insurance contract or identification number | 20031985 | Number of Individuals Covered | 52 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $16,935 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $423,382 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,935 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010214191 |
Policy instance | 2 |
Insurance contract or identification number | 000010214191 | Number of Individuals Covered | 13 | Insurance policy start date | 2020-10-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $201 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $1,340 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $201 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010214190 |
Policy instance | 3 |
Insurance contract or identification number | 000010214190 | Number of Individuals Covered | 231 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,401 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $27,331 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,228 | Insurance broker organization code? | 3 |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | 00581635 |
Policy instance | 4 |
Insurance contract or identification number | 00581635 | Number of Individuals Covered | 225 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-09-30 | Total amount of commissions paid to insurance broker | USD $3,324 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $29,799 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,212 | Insurance broker organization code? | 3 |
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THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
Policy contract number | E4131678 |
Policy instance | 5 |
Insurance contract or identification number | E4131678 | Number of Individuals Covered | 55 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $14,864 | Total amount of fees paid to insurance company | USD $3,745 | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $64,151 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,985 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 2358 |
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THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
Policy contract number | E4131678 |
Policy instance | 6 |
Insurance contract or identification number | E4131678 | Number of Individuals Covered | 56 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $8,452 | Total amount of fees paid to insurance company | USD $862 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $29,006 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,698 | Amount paid for insurance broker fees | 112 | Additional information about fees paid to insurance broker | MISCELLANEOUS | Insurance broker organization code? | 3 |
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PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68209 ) |
Policy contract number | 651362 |
Policy instance | 5 |
Insurance contract or identification number | 651362 | Number of Individuals Covered | 55 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $1,158 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $11,548 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $840 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010214190 |
Policy instance | 4 |
Insurance contract or identification number | 000010214190 | Number of Individuals Covered | 237 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $2,416 | Total amount of fees paid to insurance company | USD $0 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $26,821 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,851 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010214191 |
Policy instance | 3 |
Insurance contract or identification number | 000010214191 | Number of Individuals Covered | 14 | Insurance policy start date | 2019-10-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $565 | Total amount of fees paid to insurance company | USD $0 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $3,761 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $371 | Insurance broker organization code? | 3 |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCL34174 |
Policy instance | 2 |
Insurance contract or identification number | HCL34174 | Number of Individuals Covered | 95 | Insurance policy start date | 2019-10-01 | 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 $28,233 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $47,129 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 8745 | Additional information about fees paid to insurance broker | CONTRACT ADMINISTRATOR FEES | Insurance broker organization code? | 3 |
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CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
Policy contract number | 20031985 |
Policy instance | 1 |
Insurance contract or identification number | 20031985 | Number of Individuals Covered | 65 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-09-30 | Total amount of commissions paid to insurance broker | USD $14,939 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $373,465 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,939 | Insurance broker organization code? | 3 |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | HCL34174 |
Policy instance | 1 |
Insurance contract or identification number | HCL34174 | Number of Individuals Covered | 84 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $93,360 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $185,012 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 32915 | Additional information about fees paid to insurance broker | CONTRACT ADMINISTRATOR FEES | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010214191 |
Policy instance | 2 |
Insurance contract or identification number | 000010214191 | Number of Individuals Covered | 15 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $559 | Total amount of fees paid to insurance company | USD $0 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $3,726 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $559 | Insurance broker organization code? | 3 |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010214190 |
Policy instance | 3 |
Insurance contract or identification number | 000010214190 | Number of Individuals Covered | 218 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $1,922 | Total amount of fees paid to insurance company | USD $0 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $19,260 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,922 | Insurance broker organization code? | 3 |
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PROVIDENT LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68209 ) |
Policy contract number | 651362 |
Policy instance | 4 |
Insurance contract or identification number | 651362 | Number of Individuals Covered | 58 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $936 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $10,304 | Commission paid to Insurance Broker | USD $936 | Insurance broker organization code? | 3 |
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THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
Policy contract number | E4131678 |
Policy instance | 5 |
Insurance contract or identification number | E4131678 | Number of Individuals Covered | 25 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $2,446 | Total amount of fees paid to insurance company | USD $99 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $20,196 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $570 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 70 | Additional information about fees paid to insurance broker | MISCELLANEOUS |
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UNITED CONCORDIA (National Association of Insurance Commissioners NAIC id number: 60222 ) |
Policy contract number | 908557 |
Policy instance | 6 |
Insurance contract or identification number | 908557 | Number of Individuals Covered | 51 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-01-01 | Total amount of commissions paid to insurance broker | USD $136 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,055 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $136 | Insurance broker organization code? | 3 |
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UNITED CONCORDIA (National Association of Insurance Commissioners NAIC id number: 60222 ) |
Policy contract number | 908557 |
Policy instance | 6 |
Insurance contract or identification number | 908557 | Number of Individuals Covered | 56 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-10-01 | Total amount of commissions paid to insurance broker | USD $744 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $12,398 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
Policy contract number | E4131678 |
Policy instance | 5 |
Insurance contract or identification number | E4131678 | Number of Individuals Covered | 36 | Insurance policy start date | 2018-10-01 | Insurance policy end date | 2019-09-30 | Total amount of commissions paid to insurance broker | USD $6,475 | Total amount of fees paid to insurance company | USD $524 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $22,854 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010214190 |
Policy instance | 3 |
Insurance contract or identification number | 000010214190 | Number of Individuals Covered | 221 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $1,732 | Total amount of fees paid to insurance company | USD $336 | 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 | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $16,529 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010214191 |
Policy instance | 4 |
Insurance contract or identification number | 000010214191 | Number of Individuals Covered | 16 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $533 | Total amount of fees paid to insurance company | USD $76 | 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $3,552 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | |
Policy instance | 2 |
Number of Individuals Covered | 99 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2018-09-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $76,582 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
Policy contract number | 20031625 |
Policy instance | 1 |
Insurance contract or identification number | 20031625 | Number of Individuals Covered | 103 | Insurance policy start date | 2017-10-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $17,676 | 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 | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $348,886 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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