SUMMIT MEDICAL GROUP, P.A. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SUMMIT MEDICAL GROUP, PA EMPLOYEES' BENEFIT TRUST
401k plan membership statisitcs for SUMMIT MEDICAL GROUP, PA EMPLOYEES' BENEFIT TRUST
| Measure | Date | Value |
|---|
| 2015 : SUMMIT MEDICAL GROUP, PA EMPLOYEES' BENEFIT TRUST 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-12-31 | $19,844,037 |
| Total of all expenses incurred | 2015-12-31 | $19,892,755 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $18,801,442 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $19,844,037 |
| Value of total assets at end of year | 2015-12-31 | $0 |
| Value of total assets at beginning of year | 2015-12-31 | $48,718 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $1,091,313 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | Yes |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2015-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $7,502,609 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-48,718 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $48,718 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $48,718 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $48,718 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $18,801,442 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $12,341,428 |
| Contract administrator fees | 2015-12-31 | $1,091,313 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | Yes |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Qualified |
| Accountancy firm name | 2015-12-31 | WITHUMSMITHBROWN, P.C. |
| Accountancy firm EIN | 2015-12-31 | 222027092 |
| 2014 : SUMMIT MEDICAL GROUP, PA EMPLOYEES' BENEFIT TRUST 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-12-31 | $15,474,583 |
| Total of all expenses incurred | 2014-12-31 | $15,489,444 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $14,511,257 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $15,474,583 |
| Value of total assets at end of year | 2014-12-31 | $48,718 |
| Value of total assets at beginning of year | 2014-12-31 | $63,579 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $978,187 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $6,040,336 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-14,861 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $48,718 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $63,579 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $48,718 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $63,579 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $63,579 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $14,511,257 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $9,434,247 |
| Contract administrator fees | 2014-12-31 | $978,187 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Qualified |
| Accountancy firm name | 2014-12-31 | WITHUMSMITHBROWN, P.C. |
| Accountancy firm EIN | 2014-12-31 | 222027092 |
| 2013 : SUMMIT MEDICAL GROUP, PA EMPLOYEES' BENEFIT TRUST 2013 401k financial data |
|---|
| Total income from all sources (including contributions) | 2013-12-31 | $11,133,856 |
| Total of all expenses incurred | 2013-12-31 | $11,558,470 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $10,378,498 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $11,133,856 |
| Value of total assets at end of year | 2013-12-31 | $63,579 |
| Value of total assets at beginning of year | 2013-12-31 | $488,193 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $1,179,972 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Administrative expenses professional fees incurred | 2013-12-31 | $1,179,972 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $4,345,980 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $-424,614 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $63,579 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $488,193 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $63,579 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $488,193 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $488,193 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $10,378,498 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $6,787,876 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Qualified |
| Accountancy firm name | 2013-12-31 | WITHUMSMITHBROWN, P.C. |
| Accountancy firm EIN | 2013-12-31 | 222027092 |
| 2012 : SUMMIT MEDICAL GROUP, PA EMPLOYEES' BENEFIT TRUST 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-12-31 | $10,199,663 |
| Total of all expenses incurred | 2012-12-31 | $10,480,316 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $9,381,659 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $10,199,663 |
| Value of total assets at end of year | 2012-12-31 | $488,193 |
| Value of total assets at beginning of year | 2012-12-31 | $768,846 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $1,098,657 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $1,098,657 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $3,017,273 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-280,653 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $488,193 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $768,846 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $488,193 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $768,846 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $768,846 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $9,381,659 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $7,182,390 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Qualified |
| Accountancy firm name | 2012-12-31 | WITHUMSMITHBROWN, P.C. |
| Accountancy firm EIN | 2012-12-31 | 222027092 |
| 2011 : SUMMIT MEDICAL GROUP, PA EMPLOYEES' BENEFIT TRUST 2011 401k financial data |
|---|
| Total income from all sources (including contributions) | 2011-12-31 | $9,454,323 |
| Total of all expenses incurred | 2011-12-31 | $9,229,809 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $8,230,375 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $9,454,323 |
| Value of total assets at end of year | 2011-12-31 | $768,846 |
| Value of total assets at beginning of year | 2011-12-31 | $544,332 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $999,434 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $999,434 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $2,273,502 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $224,514 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $768,846 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $544,332 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $768,846 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $544,332 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $544,332 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $8,230,375 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $7,180,821 |
| Did the plan have assets held for investment | 2011-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Qualified |
| Accountancy firm name | 2011-12-31 | WITHUMSMITHBROWN, P.C. |
| Accountancy firm EIN | 2011-12-31 | 222027092 |
| 2010 : SUMMIT MEDICAL GROUP, PA EMPLOYEES' BENEFIT TRUST 2010 401k financial data |
|---|
| Total income from all sources (including contributions) | 2010-12-31 | $8,364,006 |
| Total of all expenses incurred | 2010-12-31 | $8,419,731 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $7,371,829 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $8,364,006 |
| Value of total assets at end of year | 2010-12-31 | $544,332 |
| Value of total assets at beginning of year | 2010-12-31 | $600,057 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $1,047,902 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Administrative expenses professional fees incurred | 2010-12-31 | $1,047,902 |
| Was this plan covered by a fidelity bond | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $1,621,010 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-55,725 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $544,332 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $600,057 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $544,332 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $600,057 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $600,057 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $7,371,829 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $6,742,996 |
| Did the plan have assets held for investment | 2010-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Qualified |
| Accountancy firm name | 2010-12-31 | WITHUMSMITHBROWN, P.C. |
| Accountancy firm EIN | 2010-12-31 | 222027092 |
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | 411111T |
| Policy instance | 2 |
| Insurance contract or identification number | 411111T | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $678 | | Other welfare benefits provided | WD-STAT | | Welfare Benefit Premiums Paid to Carrier | USD $94,651 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $678 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | NPF CORPORATE SERVICES |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 159052 |
| Policy instance | 4 |
| Insurance contract or identification number | 159052 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $12,804 | | Total amount of fees paid to insurance company | USD $3,458 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $73,099 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,804 | | Amount paid for insurance broker fees | 1868 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | M FINANCIAL HOLDINGS INC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 158892 |
| Policy instance | 3 |
| Insurance contract or identification number | 158892 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $2,137 | | Total amount of fees paid to insurance company | USD $682 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,021 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,137 | | Amount paid for insurance broker fees | 322 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | M FINANCIAL HOLDINGS INC |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0837243-0837243 |
| Policy instance | 1 |
| Insurance contract or identification number | 0837243-0837243 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,975 | | 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 | 0837243-0837247 |
| Policy instance | 5 |
| Insurance contract or identification number | 0837243-0837247 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,528 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 752111 |
| Policy instance | 7 |
| Insurance contract or identification number | 752111 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $58,695 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | STATE DISABILITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,695 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | NFP CORPORATE SERVICES |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9859828 |
| Policy instance | 6 |
| Insurance contract or identification number | 9859828 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $120,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 752186 |
| Policy instance | 8 |
| Insurance contract or identification number | 752186 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $19,846 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | STATE DISABILITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,846 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | NFP CORPORATE SERVICES |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0837243-SL |
| Policy instance | 9 |
| Insurance contract or identification number | 0837243-SL | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,111,409 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9898313 |
| Policy instance | 10 |
| Insurance contract or identification number | 9898313 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,719 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | 767531GLT |
| Policy instance | 11 |
| Insurance contract or identification number | 767531GLT | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $8,917 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,917 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | NFP CORPORATE SERVICES |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | 411111T |
| Policy instance | 3 |
| Insurance contract or identification number | 411111T | | Number of Individuals Covered | 1878 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-09-30 | | Other welfare benefits provided | WD-STAT | | Welfare Benefit Premiums Paid to Carrier | USD $255,662 | | 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 | 0837243-0837243 |
| Policy instance | 1 |
| Insurance contract or identification number | 0837243-0837243 | | Number of Individuals Covered | 325 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,009 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767531G |
| Policy instance | 2 |
| Insurance contract or identification number | 767531G | | Number of Individuals Covered | 853 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $459 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $976,528 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $459 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG COMPANIES INC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 159052 |
| Policy instance | 5 |
| Insurance contract or identification number | 159052 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $14,821 | | Total amount of fees paid to insurance company | USD $5,692 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,411 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,821 | | Amount paid for insurance broker fees | 3058 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | M FINANCIAL HOLDINGS INC |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0837243-0837247 |
| Policy instance | 6 |
| Insurance contract or identification number | 0837243-0837247 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 ) |
| Policy contract number | 9859828 |
| Policy instance | 7 |
| Insurance contract or identification number | 9859828 | | Number of Individuals Covered | 1701 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $92,400 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 752111 |
| Policy instance | 8 |
| Insurance contract or identification number | 752111 | | Number of Individuals Covered | 1707 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2014-12-31 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | STATE DISABILITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 752186 |
| Policy instance | 9 |
| Insurance contract or identification number | 752186 | | Number of Individuals Covered | 379 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2014-12-31 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | STATE DISABILITY | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 158892 |
| Policy instance | 4 |
| Insurance contract or identification number | 158892 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $2,452 | | Total amount of fees paid to insurance company | USD $1,527 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,452 | | Amount paid for insurance broker fees | 1105 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | M FINANCIAL HOLDINGS INC |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0837243-SL |
| Policy instance | 10 |
| Insurance contract or identification number | 0837243-SL | | Number of Individuals Covered | 1523 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $748,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 158892 |
| Policy instance | 8 |
| Insurance contract or identification number | 158892 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $1,322 | | Total amount of fees paid to insurance company | USD $1,930 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,434 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,322 | | Amount paid for insurance broker fees | 1754 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | M FINANCIAL HOLDINGS INC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 159052 |
| Policy instance | 7 |
| Insurance contract or identification number | 159052 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $9,194 | | Total amount of fees paid to insurance company | USD $16,327 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,896 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,194 | | Amount paid for insurance broker fees | 15101 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | M FINANCIAL HOLDINGS INC |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | 411111T |
| Policy instance | 6 |
| Insurance contract or identification number | 411111T | | Number of Individuals Covered | 1533 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,805 | | Total amount of fees paid to insurance company | USD $852 | | Other welfare benefits provided | WD-STAT | | Welfare Benefit Premiums Paid to Carrier | USD $283,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,805 | | Amount paid for insurance broker fees | 852 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767531G |
| Policy instance | 5 |
| Insurance contract or identification number | 767531G | | Number of Individuals Covered | 1282 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $29,918 | | Total amount of fees paid to insurance company | USD $8,356 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $1,134,958 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,918 | | Amount paid for insurance broker fees | 8356 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 620915 |
| Policy instance | 3 |
| Insurance contract or identification number | 620915 | | Number of Individuals Covered | 1134 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $46,015 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $567,514 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,015 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
| Policy contract number | 3949 |
| Policy instance | 2 |
| Insurance contract or identification number | 3949 | | Number of Individuals Covered | 1044 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,052 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,016,662 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,052 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| FLAGSHIP HEALTH SYSTEMS (National Association of Insurance Commissioners NAIC id number: 11179 ) |
| Policy contract number | 3949 |
| Policy instance | 1 |
| Insurance contract or identification number | 3949 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $605 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $605 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| AMERICAN ALTERNATIVE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 19720 ) |
| Policy contract number | 33A2ES000006500 |
| Policy instance | 4 |
| Insurance contract or identification number | 33A2ES000006500 | | Number of Individuals Covered | 1100 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,854 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $42,376 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,854 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767531G |
| Policy instance | 8 |
| Insurance contract or identification number | 767531G | | Number of Individuals Covered | 1032 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $46,231 | | Total amount of fees paid to insurance company | USD $10,056 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $1,117,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,231 | | Amount paid for insurance broker fees | 10056 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 901022 |
| Policy instance | 2 |
| Insurance contract or identification number | 901022 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-08-01 | | Total amount of commissions paid to insurance broker | USD $1,135 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,135 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 509012 |
| Policy instance | 3 |
| Insurance contract or identification number | 509012 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-08-01 | | Total amount of commissions paid to insurance broker | USD $7,251 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $87,819 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,251 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
| Policy contract number | 3949 |
| Policy instance | 4 |
| Insurance contract or identification number | 3949 | | Number of Individuals Covered | 903 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $33,275 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $968,292 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,275 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 901245 |
| Policy instance | 5 |
| Insurance contract or identification number | 901245 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-08-01 | | Total amount of commissions paid to insurance broker | USD $873 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $8,123 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $873 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 620915 |
| Policy instance | 6 |
| Insurance contract or identification number | 620915 | | Number of Individuals Covered | 2039 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $41,458 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $511,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,458 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| AMERICAN ALTERNATIVE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 19720 ) |
| Policy contract number | 33A2ES000006500 |
| Policy instance | 7 |
| Insurance contract or identification number | 33A2ES000006500 | | Number of Individuals Covered | 933 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,028 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $40,370 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,028 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | 411111T |
| Policy instance | 9 |
| Insurance contract or identification number | 411111T | | Number of Individuals Covered | 1290 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,488 | | Total amount of fees paid to insurance company | USD $2,444 | | Other welfare benefits provided | WD-STAT | | Welfare Benefit Premiums Paid to Carrier | USD $264,985 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,488 | | Amount paid for insurance broker fees | 2444 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| FLAGSHIP HEALTH SYSTEMS (National Association of Insurance Commissioners NAIC id number: 11179 ) |
| Policy contract number | 3949 |
| Policy instance | 1 |
| Insurance contract or identification number | 3949 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $975 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $975 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | INSURANCE AGENT/BROKER | | Insurance broker organization code? | 3 | | Insurance broker name | CONNER STRONG & BUCKELEW CO., INC. |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 901022 |
| Policy instance | 2 |
| Insurance contract or identification number | 901022 | | Number of Individuals Covered | 1176 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $5,643 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $175,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 509012 |
| Policy instance | 3 |
| Insurance contract or identification number | 509012 | | Number of Individuals Covered | 966 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-08-01 | | Total amount of commissions paid to insurance broker | USD $9,864 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $604,361 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
| Policy contract number | 3949 |
| Policy instance | 4 |
| Insurance contract or identification number | 3949 | | Number of Individuals Covered | 893 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $895,508 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 901245 |
| Policy instance | 5 |
| Insurance contract or identification number | 901245 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-08-01 | | Total amount of commissions paid to insurance broker | USD $5,210 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $48,466 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 767531G |
| Policy instance | 8 |
| Insurance contract or identification number | 767531G | | Number of Individuals Covered | 1079 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $17,989 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $320,412 | | 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 | 620915 |
| Policy instance | 6 |
| Insurance contract or identification number | 620915 | | Number of Individuals Covered | 2152 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $32,912 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $441,652 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN ALTERNATIVE INSURANCE CORPORATION (National Association of Insurance Commissioners NAIC id number: 19720 ) |
| Policy contract number | 33A2ES000006500 |
| Policy instance | 7 |
| Insurance contract or identification number | 33A2ES000006500 | | Number of Individuals Covered | 882 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,826 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $37,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FLAGSHIP HEALTH SYSTEMS (National Association of Insurance Commissioners NAIC id number: 11179 ) |
| Policy contract number | 3949 |
| Policy instance | 1 |
| Insurance contract or identification number | 3949 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $670 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 141624 |
| Policy instance | 7 |
| Insurance contract or identification number | 141624 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $28 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,122 | | 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 | 620915 |
| Policy instance | 6 |
| Insurance contract or identification number | 620915 | | Number of Individuals Covered | 1844 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $40,986 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $477,214 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 901245 |
| Policy instance | 5 |
| Insurance contract or identification number | 901245 | | Number of Individuals Covered | 210 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $3,780 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $37,800 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
| Policy contract number | 3949 |
| Policy instance | 4 |
| Insurance contract or identification number | 3949 | | Number of Individuals Covered | 788 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $12,332 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $774,650 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 901022 |
| Policy instance | 2 |
| Insurance contract or identification number | 901022 | | Number of Individuals Covered | 1088 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,431 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $196,224 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FLAGSHIP HEALTH SYSTEMS (National Association of Insurance Commissioners NAIC id number: 11179 ) |
| Policy contract number | 3949 |
| Policy instance | 1 |
| Insurance contract or identification number | 3949 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $754 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 509012 |
| Policy instance | 3 |
| Insurance contract or identification number | 509012 | | Number of Individuals Covered | 924 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $13,938 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $754,092 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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