THE FORUM SCHOOL has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan THE FORUM SCHOOL HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-07-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 78 |
| Total of all active and inactive participants | 2022-07-01 | 78 |
| 2021: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 86 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 78 |
| Total of all active and inactive participants | 2021-07-01 | 78 |
| 2020: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 86 |
| Total of all active and inactive participants | 2020-07-01 | 86 |
| 2019: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 90 |
| Total of all active and inactive participants | 2019-07-01 | 90 |
| 2018: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 76 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 100 |
| Total of all active and inactive participants | 2018-07-01 | 100 |
| 2017: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 79 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 76 |
| Total of all active and inactive participants | 2017-07-01 | 76 |
| 2016: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 83 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 79 |
| Total of all active and inactive participants | 2016-07-01 | 79 |
| 2015: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 94 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 83 |
| Total of all active and inactive participants | 2015-07-01 | 83 |
| 2014: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 91 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 94 |
| Total of all active and inactive participants | 2014-07-01 | 94 |
| 2012: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 89 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 92 |
| Total of all active and inactive participants | 2012-07-01 | 92 |
| 2011: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 93 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 89 |
| Total of all active and inactive participants | 2011-07-01 | 89 |
| 2009: THE FORUM SCHOOL HEALTH AND WELFARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 99 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 2 |
| Total of all active and inactive participants | 2009-07-01 | 101 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 04L9327 |
| Policy instance | 3 |
| Insurance contract or identification number | 04L9327 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $904 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,506 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $452 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 269878 |
| Policy instance | 2 |
| Insurance contract or identification number | 269878 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $52,810 | | Total amount of fees paid to insurance company | USD $7,774 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,110,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,160 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7774 | | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $8,539 | | Total amount of fees paid to insurance company | USD $1,224 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $82,413 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,533 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1224 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $14,821 | | Total amount of fees paid to insurance company | USD $3,763 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $76,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,401 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3763 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 269878 |
| Policy instance | 2 |
| Insurance contract or identification number | 269878 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $54,668 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $988,737 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,972 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 04L9327 |
| Policy instance | 3 |
| Insurance contract or identification number | 04L9327 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $1,194 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $739 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 04L9327 |
| Policy instance | 3 |
| Insurance contract or identification number | 04L9327 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $986 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,329 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $493 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0269878 |
| Policy instance | 2 |
| Insurance contract or identification number | 0269878 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $59,734 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,152,599 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,050 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $6,683 | | Total amount of fees paid to insurance company | USD $3,602 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $79,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,541 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 3602 | | Additional information about fees paid to insurance broker | FEES CHARGED IN CONNECTION WITH CONTRACT 000WH594. |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | FS18284 |
| Policy instance | 2 |
| Insurance contract or identification number | FS18284 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $52,624 | | Total amount of fees paid to insurance company | USD $11,276 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $996,679 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,624 | | Amount paid for insurance broker fees | 222 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $7,381 | | Total amount of fees paid to insurance company | USD $1,786 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $90,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,710 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1786 | | Additional information about fees paid to insurance broker | FEES CHARGED IN CONNECTION WITH CONTRACT. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $7,158 | | Total amount of fees paid to insurance company | USD $4,197 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $89,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,507 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 4197 | | Additional information about fees paid to insurance broker | FEES CHARGED IN CONNECTION WITH CONTRACT ID 000UD661. |
|
| OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | FS18284 |
| Policy instance | 2 |
| Insurance contract or identification number | FS18284 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $47,751 | | Total amount of fees paid to insurance company | USD $9,582 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,073,418 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $47,751 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 9582 | | Additional information about fees paid to insurance broker | BONUS & ADMINISTRATIVE SERVICES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $7,174 | | 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 AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $94,485 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 97660111 |
| Policy instance | 2 |
| Insurance contract or identification number | 97660111 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $54,406 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $988,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $7,566 | | Total amount of fees paid to insurance company | USD $1,525 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $103,271 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,878 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1525 | | Additional information about fees paid to insurance broker | FEES CHARGED IN CONNECTION WITH CONTRACT ID 000UD661. | | Insurance broker name | INTERNL PLANNING ALL LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 3 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $9,977 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $205,488 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,977 | | Insurance broker organization code? | 3 | | Insurance broker name | THE TARPEY GROUP LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 2 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $39,691 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $833,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,691 | | Insurance broker organization code? | 3 | | Insurance broker name | THE TARPEY GROUP LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 2 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $40,004 | | 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 $836,551 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,004 | | Insurance broker organization code? | 3 | | Insurance broker name | THE TARPEY GROUP LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 3 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $10,115 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $207,167 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,115 | | Insurance broker organization code? | 3 | | Insurance broker name | THE TARPEY GROUP LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $7,658 | | Total amount of fees paid to insurance company | USD $6,418 | | 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 AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $107,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,962 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 6418 | | Additional information about fees paid to insurance broker | FEES CHARGED IN CONNECTION WITH CONTRACT ID 000UD661. | | Insurance broker name | INTERNL PLANNING ALL LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 3 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $9,379 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $187,854 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,379 | | Insurance broker organization code? | 3 | | Insurance broker name | THE TARPEY GROUP LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 2 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $38,345 | | 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 $780,915 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,345 | | Insurance broker name | THE TARPEY GROUP LLC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $7,106 | | Total amount of fees paid to insurance company | USD $5,656 | | 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 AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $103,779 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,460 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 5656 | | Insurance broker name | INTERNL PLANNING ALL LLC |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 3 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $10,999 | | 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 | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $212,943 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 2 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $38,301 | | 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 | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $748,534 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $6,866 | | Total amount of fees paid to insurance company | USD $6,368 | | 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 AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $96,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00459331 |
| Policy instance | 1 |
| Insurance contract or identification number | 00459331 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $6,831 | | Total amount of fees paid to insurance company | USD $3,820 | | 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 AND OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $112,939 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 2 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $62,774 | | 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 $1,156,974 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
| Policy contract number | 82297 |
| Policy instance | 3 |
| Insurance contract or identification number | 82297 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $16,202 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $295,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
