CAPITAL DISTRICT YMCA has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CAPITAL DISTRICT YMCA CAFETERIA PLAN
| Measure | Date | Value |
|---|
| 2022: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 1,057 |
| Total of all active and inactive participants | 2022-04-01 | 1,057 |
| 2021: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 247 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 214 |
| Total of all active and inactive participants | 2021-04-01 | 214 |
| 2020: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 248 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 247 |
| Total of all active and inactive participants | 2020-04-01 | 247 |
| 2019: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 254 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 248 |
| Total of all active and inactive participants | 2019-04-01 | 248 |
| 2018: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 270 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 254 |
| Total of all active and inactive participants | 2018-04-01 | 254 |
| 2017: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 269 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 270 |
| Total of all active and inactive participants | 2017-04-01 | 270 |
| 2016: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 274 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 269 |
| Total of all active and inactive participants | 2016-04-01 | 269 |
| 2015: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 257 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 274 |
| Total of all active and inactive participants | 2015-04-01 | 274 |
| 2014: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-01 | 266 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 257 |
| Total of all active and inactive participants | 2014-04-01 | 257 |
| 2013: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-01 | 265 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 266 |
| Total of all active and inactive participants | 2013-04-01 | 266 |
| 2012: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-01 | 268 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 265 |
| Total of all active and inactive participants | 2012-04-01 | 265 |
| 2011: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-01 | 247 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 268 |
| Total of all active and inactive participants | 2011-04-01 | 268 |
| 2010: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-04-01 | 251 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-04-01 | 247 |
| Total of all active and inactive participants | 2010-04-01 | 247 |
| 2009: CAPITAL DISTRICT YMCA CAFETERIA PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-04-01 | 281 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 251 |
| Total of all active and inactive participants | 2009-04-01 | 251 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 615259D |
| Policy instance | 5 |
| Insurance contract or identification number | 615259D | | Number of Individuals Covered | 1057 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $6,764 | | Total amount of fees paid to insurance company | USD $705 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,764 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 705 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00028036 |
| Policy instance | 4 |
| Insurance contract or identification number | 00028036 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $11,953 | | Total amount of fees paid to insurance company | USD $0 | | 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 $122,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,953 | | Insurance broker organization code? | 3 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 11445379 |
| Policy instance | 3 |
| Insurance contract or identification number | 11445379 | | Number of Individuals Covered | 159 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $37,394 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | HYBRID EPO | | Welfare Benefit Premiums Paid to Carrier | USD $1,072,667 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,394 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
| Policy contract number | 540171 0010DVIO |
| Policy instance | 2 |
| Insurance contract or identification number | 540171 0010DVIO | | Number of Individuals Covered | 101 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $878 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $878 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5980823 |
| Policy instance | 1 |
| Insurance contract or identification number | 5980823 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,996 | | Total amount of fees paid to insurance company | USD $3,207 | | 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 $28 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,708 | | Amount paid for insurance broker fees | 3207 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
| Policy contract number | 540171 0010DVIO |
| Policy instance | 3 |
| Insurance contract or identification number | 540171 0010DVIO | | Number of Individuals Covered | 104 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $958 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,578 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $958 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5980823 |
| Policy instance | 2 |
| Insurance contract or identification number | 5980823 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $8,698 | | Total amount of fees paid to insurance company | USD $1,266 | | 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 $116,606 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,698 | | Amount paid for insurance broker fees | 1266 | | Insurance broker organization code? | 3 |
|
| MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 ) |
| Policy contract number | 490350 |
| Policy instance | 1 |
| Insurance contract or identification number | 490350 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $38,953 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $957,348 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,953 | | Insurance broker organization code? | 3 |
|
| MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 ) |
| Policy contract number | 490350 |
| Policy instance | 1 |
| Insurance contract or identification number | 490350 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $47,318 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,144,462 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,318 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5980823 |
| Policy instance | 2 |
| Insurance contract or identification number | 5980823 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $9,314 | | Total amount of fees paid to insurance company | USD $26 | | 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 $123,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,314 | | Amount paid for insurance broker fees | 26 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
| Policy contract number | 540171 0010DVIO |
| Policy instance | 3 |
| Insurance contract or identification number | 540171 0010DVIO | | Number of Individuals Covered | 93 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $851 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,514 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $851 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
| Policy contract number | 540171 0010DVIO |
| Policy instance | 3 |
| Insurance contract or identification number | 540171 0010DVIO | | Number of Individuals Covered | 143 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,121 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,121 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5980823 |
| Policy instance | 2 |
| Insurance contract or identification number | 5980823 | | Number of Individuals Covered | 453 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $9,238 | | Total amount of fees paid to insurance company | USD $0 | | 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 $165,978 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,238 | | Insurance broker organization code? | 3 |
|
| MVP HEALTH CARE (National Association of Insurance Commissioners NAIC id number: 95521 ) |
| Policy contract number | 490350 |
| Policy instance | 1 |
| Insurance contract or identification number | 490350 | | Number of Individuals Covered | 248 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $50,669 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,344,568 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,669 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
| Policy contract number | 540171 0010DVIO |
| Policy instance | 3 |
| Insurance contract or identification number | 540171 0010DVIO | | Number of Individuals Covered | 153 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,186 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,186 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05980823 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05980823 | | Number of Individuals Covered | 448 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $8,579 | | Total amount of fees paid to insurance company | USD $31 | | 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 $148,534 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,579 | | Amount paid for insurance broker fees | 31 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 10001476 |
| Policy instance | 1 |
| Insurance contract or identification number | 10001476 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $50,068 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,417,387 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,068 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
| Policy contract number | 540171 0010DVIO |
| Policy instance | 3 |
| Insurance contract or identification number | 540171 0010DVIO | | Number of Individuals Covered | 141 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,075 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,075 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05980823 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05980823 | | Number of Individuals Covered | 428 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $8,305 | | Total amount of fees paid to insurance company | USD $23 | | 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 $148,845 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,305 | | Amount paid for insurance broker fees | 23 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 10001476 |
| Policy instance | 1 |
| Insurance contract or identification number | 10001476 | | Number of Individuals Covered | 270 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $41,452 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,081,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,452 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 10001476 |
| Policy instance | 1 |
| Insurance contract or identification number | 10001476 | | Number of Individuals Covered | 274 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $41,867 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,139,069 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,867 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05980823 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05980823 | | Number of Individuals Covered | 378 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $7,445 | | Total amount of fees paid to insurance company | USD $0 | | 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 $130,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,445 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
|
| HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
| Policy contract number | 540171 0010DVIO |
| Policy instance | 3 |
| Insurance contract or identification number | 540171 0010DVIO | | Number of Individuals Covered | 114 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $899 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,990 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $899 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05980823 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05980823 | | Number of Individuals Covered | 380 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $7,186 | | Total amount of fees paid to insurance company | USD $30 | | 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 | | 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 $121,444 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,186 | | Amount paid for insurance broker fees | 30 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
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| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 10001476 |
| Policy instance | 1 |
| Insurance contract or identification number | 10001476 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $37,836 | | 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 $1,003,993 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,836 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
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| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 10001476 |
| Policy instance | 1 |
| Insurance contract or identification number | 10001476 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $37,180 | | 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 $562,475 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,180 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05980823 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05980823 | | Number of Individuals Covered | 393 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $7,445 | | 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 | | 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 $129,963 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,445 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
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| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 994095 |
| Policy instance | 2 |
| Insurance contract or identification number | 994095 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $261 | | 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 $12,487 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $261 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05980823 |
| Policy instance | 3 |
| Insurance contract or identification number | TM05980823 | | Number of Individuals Covered | 385 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,288 | | 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 | | 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 $128,297 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,288 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
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| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 10001476 |
| Policy instance | 1 |
| Insurance contract or identification number | 10001476 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $36,550 | | 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 $1,003,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,550 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN, INC. |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05980823 |
| Policy instance | 3 |
| Insurance contract or identification number | TM05980823 | | Number of Individuals Covered | 395 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $7,061 | | 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 | | 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 $136,962 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 994095 |
| Policy instance | 2 |
| Insurance contract or identification number | 994095 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $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 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,579 | | 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 | 10001476 |
| Policy instance | 1 |
| Insurance contract or identification number | 10001476 | | Number of Individuals Covered | 268 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $36,904 | | 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 $874,926 | | 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 | 012208 |
| Policy instance | 1 |
| Insurance contract or identification number | 012208 | | Number of Individuals Covered | 213 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $40,138 | | 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 $857,222 | | 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 | 00383696 |
| Policy instance | 2 |
| Insurance contract or identification number | 00383696 | | Number of Individuals Covered | 247 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $6,810 | | 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 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 994095 |
| Policy instance | 3 |
| Insurance contract or identification number | 994095 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $782 | | 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 $19,555 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05980823 |
| Policy instance | 4 |
| Insurance contract or identification number | TM05980823 | | Number of Individuals Covered | 422 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $1,103 | | 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 | | 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 $35,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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