BORO DEVELOPERS INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BORO CONSTRUCTION HEALTH AND WELFARE PLAN
Measure | Date | Value |
---|
2022: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2022 401k membership |
---|
Total participants, beginning-of-year | 2022-04-01 | 202 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 139 |
Number of retired or separated participants receiving benefits | 2022-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
Total of all active and inactive participants | 2022-04-01 | 139 |
Number of employers contributing to the scheme | 2022-04-01 | 0 |
2021: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2021 401k membership |
---|
Total participants, beginning-of-year | 2021-04-01 | 177 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 202 |
Number of retired or separated participants receiving benefits | 2021-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 0 |
Total of all active and inactive participants | 2021-04-01 | 202 |
Number of employers contributing to the scheme | 2021-04-01 | 0 |
2020: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2020 401k membership |
---|
Total participants, beginning-of-year | 2020-04-01 | 166 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 177 |
Number of retired or separated participants receiving benefits | 2020-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
Total of all active and inactive participants | 2020-04-01 | 177 |
Number of employers contributing to the scheme | 2020-04-01 | 0 |
2019: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-04-01 | 170 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 166 |
Number of retired or separated participants receiving benefits | 2019-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
Total of all active and inactive participants | 2019-04-01 | 166 |
Number of employers contributing to the scheme | 2019-04-01 | 0 |
2018: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-04-01 | 160 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 170 |
Number of retired or separated participants receiving benefits | 2018-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 0 |
Total of all active and inactive participants | 2018-04-01 | 170 |
Number of employers contributing to the scheme | 2018-04-01 | 0 |
2017: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-04-01 | 151 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 160 |
Number of retired or separated participants receiving benefits | 2017-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
Total of all active and inactive participants | 2017-04-01 | 160 |
Number of employers contributing to the scheme | 2017-04-01 | 0 |
2016: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-04-01 | 160 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 145 |
Number of retired or separated participants receiving benefits | 2016-04-01 | 6 |
Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 0 |
Total of all active and inactive participants | 2016-04-01 | 151 |
2015: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-04-01 | 152 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 160 |
Number of retired or separated participants receiving benefits | 2015-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 0 |
Total of all active and inactive participants | 2015-04-01 | 160 |
2014: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-04-01 | 131 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 152 |
Number of retired or separated participants receiving benefits | 2014-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-04-01 | 0 |
Total of all active and inactive participants | 2014-04-01 | 152 |
2013: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2013 401k membership |
---|
Total participants, beginning-of-year | 2013-04-01 | 102 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 131 |
Number of retired or separated participants receiving benefits | 2013-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-04-01 | 0 |
Total of all active and inactive participants | 2013-04-01 | 131 |
2012: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2012 401k membership |
---|
Total participants, beginning-of-year | 2012-04-01 | 114 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 102 |
Number of retired or separated participants receiving benefits | 2012-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-04-01 | 0 |
Total of all active and inactive participants | 2012-04-01 | 102 |
2011: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2011 401k membership |
---|
Total participants, beginning-of-year | 2011-04-01 | 174 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 114 |
Number of retired or separated participants receiving benefits | 2011-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-04-01 | 0 |
Total of all active and inactive participants | 2011-04-01 | 114 |
2010: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2010 401k membership |
---|
Total participants, beginning-of-year | 2010-04-01 | 129 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-04-01 | 97 |
Number of retired or separated participants receiving benefits | 2010-04-01 | 8 |
Number of other retired or separated participants entitled to future benefits | 2010-04-01 | 0 |
Total of all active and inactive participants | 2010-04-01 | 105 |
2009: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2009 401k membership |
---|
Total participants, beginning-of-year | 2009-04-01 | 195 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-04-01 | 205 |
Number of retired or separated participants receiving benefits | 2009-04-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-04-01 | 0 |
Total of all active and inactive participants | 2009-04-01 | 205 |
Total participants | 2009-04-01 | 0 |
2022: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2022 form 5500 responses |
---|
2022-04-01 | Type of plan entity | Single employer plan |
2022-04-01 | Plan funding arrangement – Insurance | Yes |
2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-04-01 | Plan benefit arrangement – Insurance | Yes |
2022-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2021 form 5500 responses |
---|
2021-04-01 | Type of plan entity | Single employer plan |
2021-04-01 | Plan funding arrangement – Insurance | Yes |
2021-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-04-01 | Plan benefit arrangement – Insurance | Yes |
2021-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2020 form 5500 responses |
---|
2020-04-01 | Type of plan entity | Single employer plan |
2020-04-01 | Plan funding arrangement – Insurance | Yes |
2020-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-04-01 | Plan benefit arrangement – Insurance | Yes |
2020-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2019 form 5500 responses |
---|
2019-04-01 | Type of plan entity | Single employer plan |
2019-04-01 | Plan funding arrangement – Insurance | Yes |
2019-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-04-01 | Plan benefit arrangement – Insurance | Yes |
2019-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2018 form 5500 responses |
---|
2018-04-01 | Type of plan entity | Single employer plan |
2018-04-01 | Plan funding arrangement – Insurance | Yes |
2018-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-04-01 | Plan benefit arrangement – Insurance | Yes |
2018-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2017 form 5500 responses |
---|
2017-04-01 | Type of plan entity | Single employer plan |
2017-04-01 | Plan funding arrangement – Insurance | Yes |
2017-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-04-01 | Plan benefit arrangement – Insurance | Yes |
2017-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2016 form 5500 responses |
---|
2016-04-01 | Type of plan entity | Single employer plan |
2016-04-01 | Submission has been amended | No |
2016-04-01 | This submission is the final filing | No |
2016-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-04-01 | Plan is a collectively bargained plan | No |
2016-04-01 | Plan funding arrangement – Insurance | Yes |
2016-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-04-01 | Plan benefit arrangement – Insurance | Yes |
2016-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2015 form 5500 responses |
---|
2015-04-01 | Type of plan entity | Single employer plan |
2015-04-01 | Submission has been amended | No |
2015-04-01 | This submission is the final filing | No |
2015-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-04-01 | Plan is a collectively bargained plan | No |
2015-04-01 | Plan funding arrangement – Insurance | Yes |
2015-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-04-01 | Plan benefit arrangement – Insurance | Yes |
2015-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2014 form 5500 responses |
---|
2014-04-01 | Type of plan entity | Single employer plan |
2014-04-01 | Submission has been amended | No |
2014-04-01 | This submission is the final filing | No |
2014-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-04-01 | Plan is a collectively bargained plan | No |
2014-04-01 | Plan funding arrangement – Insurance | Yes |
2014-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2014-04-01 | Plan benefit arrangement – Insurance | Yes |
2014-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2013: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2013 form 5500 responses |
---|
2013-04-01 | Type of plan entity | Single employer plan |
2013-04-01 | Submission has been amended | No |
2013-04-01 | This submission is the final filing | No |
2013-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-04-01 | Plan is a collectively bargained plan | No |
2013-04-01 | Plan funding arrangement – Insurance | Yes |
2013-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2013-04-01 | Plan benefit arrangement – Insurance | Yes |
2013-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2012: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2012 form 5500 responses |
---|
2012-04-01 | Type of plan entity | Single employer plan |
2012-04-01 | Submission has been amended | No |
2012-04-01 | This submission is the final filing | No |
2012-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-04-01 | Plan is a collectively bargained plan | No |
2012-04-01 | Plan funding arrangement – Insurance | Yes |
2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2012-04-01 | Plan benefit arrangement – Insurance | Yes |
2012-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2011: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2011 form 5500 responses |
---|
2011-04-01 | Type of plan entity | Single employer plan |
2011-04-01 | Submission has been amended | No |
2011-04-01 | This submission is the final filing | No |
2011-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-04-01 | Plan is a collectively bargained plan | No |
2011-04-01 | Plan funding arrangement – Insurance | Yes |
2011-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2011-04-01 | Plan benefit arrangement – Insurance | Yes |
2011-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2010: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2010 form 5500 responses |
---|
2010-04-01 | Type of plan entity | Single employer plan |
2010-04-01 | Submission has been amended | No |
2010-04-01 | This submission is the final filing | No |
2010-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-04-01 | Plan is a collectively bargained plan | No |
2010-04-01 | Plan funding arrangement – Insurance | Yes |
2010-04-01 | Plan benefit arrangement – Insurance | Yes |
2009: BORO CONSTRUCTION HEALTH AND WELFARE PLAN 2009 form 5500 responses |
---|
2009-04-01 | Type of plan entity | Single employer plan |
2009-04-01 | Submission has been amended | No |
2009-04-01 | This submission is the final filing | No |
2009-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-04-01 | Plan is a collectively bargained plan | No |
2009-04-01 | Plan funding arrangement – Insurance | Yes |
2009-04-01 | Plan benefit arrangement – Insurance | Yes |
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 887685G |
Policy instance | 1 |
Insurance contract or identification number | 887685G | Number of Individuals Covered | 139 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $12,865 | Total amount of fees paid to insurance company | USD $1,359 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $71,471 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,865 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | BONUS |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 101271 |
Policy instance | 2 |
Insurance contract or identification number | 101271 | Number of Individuals Covered | 138 | Insurance policy start date | 2022-04-01 | Insurance policy end date | 2023-03-31 | Total amount of commissions paid to insurance broker | USD $795 | Total amount of fees paid to insurance company | USD $40,016 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $768,364 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $795 | Amount paid for insurance broker fees | 40016 | Additional information about fees paid to insurance broker | 2022 PINNACLE VISION RETENTION INCENTIVE RISK, DIRECT COMPENSATION | Insurance broker organization code? | 3 |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 101271 |
Policy instance | 2 |
Insurance contract or identification number | 101271 | Number of Individuals Covered | 177 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $799 | Total amount of fees paid to insurance company | USD $40,034 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $727,551 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $799 | Amount paid for insurance broker fees | 40034 | Additional information about fees paid to insurance broker | 2021 PINNACLE MEDICAL RETENTION INCENTIVE RISK, DIRECT COMPENSATION | Insurance broker organization code? | 3 |
|
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 887685G |
Policy instance | 1 |
Insurance contract or identification number | 887685G | Number of Individuals Covered | 202 | Insurance policy start date | 2021-04-01 | Insurance policy end date | 2022-03-31 | Total amount of commissions paid to insurance broker | USD $13,836 | Total amount of fees paid to insurance company | USD $2,078 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $76,864 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,836 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | BONUS |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 101271 |
Policy instance | 2 |
Insurance contract or identification number | 101271 | Number of Individuals Covered | 237 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $781 | Total amount of fees paid to insurance company | USD $38,771 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $697,315 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $781 | Amount paid for insurance broker fees | 38771 | Additional information about fees paid to insurance broker | 2020 PINNACLE MEDICAL RETENTION INCENTIVE RISK DIRECT COMPENSATION | Insurance broker organization code? | 3 |
|
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 887685G |
Policy instance | 1 |
Insurance contract or identification number | 887685G | Number of Individuals Covered | 177 | Insurance policy start date | 2020-04-01 | Insurance policy end date | 2021-03-31 | Total amount of commissions paid to insurance broker | USD $14,005 | Total amount of fees paid to insurance company | USD $550 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $77,805 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $14,005 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
Policy contract number | 887685G |
Policy instance | 1 |
Insurance contract or identification number | 887685G | Number of Individuals Covered | 166 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $13,118 | Total amount of fees paid to insurance company | USD $4,607 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $72,880 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,118 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | BONUS |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 101271 |
Policy instance | 2 |
Insurance contract or identification number | 101271 | Number of Individuals Covered | 277 | Insurance policy start date | 2019-04-01 | Insurance policy end date | 2020-03-31 | Total amount of commissions paid to insurance broker | USD $695 | Total amount of fees paid to insurance company | USD $37,333 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $717,461 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $695 | Amount paid for insurance broker fees | 37333 | Additional information about fees paid to insurance broker | DIRECT COMPENSATION INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0101271 |
Policy instance | 1 |
Insurance contract or identification number | 0101271 | Number of Individuals Covered | 132 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $661 | Total amount of fees paid to insurance company | USD $35,375 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $687,759 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $661 | Amount paid for insurance broker fees | 35375 | Additional information about fees paid to insurance broker | DIRECT COMPENSATION INDIRECT COMPENSATION | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147563 |
Policy instance | 2 |
Insurance contract or identification number | 147563 | Number of Individuals Covered | 170 | Insurance policy start date | 2018-04-01 | Insurance policy end date | 2019-03-31 | Total amount of commissions paid to insurance broker | USD $7,832 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $54,246 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,832 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147563 |
Policy instance | 2 |
Insurance contract or identification number | 147563 | Number of Individuals Covered | 160 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $8,283 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $58,386 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,283 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 0101271 |
Policy instance | 1 |
Insurance contract or identification number | 0101271 | Number of Individuals Covered | 115 | Insurance policy start date | 2017-04-01 | Insurance policy end date | 2018-03-31 | Total amount of commissions paid to insurance broker | USD $558 | Total amount of fees paid to insurance company | USD $32,765 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $678,226 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $558 | Amount paid for insurance broker fees | 32765 | Additional information about fees paid to insurance broker | DIRECT AND INDIRECT COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LOCKTON COMPANIES, LLC |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 947587 |
Policy instance | 2 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 94 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $22,172 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,172 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 ) |
Policy contract number | 947587 |
Policy instance | 1 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 2 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $153 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $2,134 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $153 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA |
|
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 97587 |
Policy instance | 3 |
Insurance contract or identification number | 97587 | Number of Individuals Covered | 46 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $12,374 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,374 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNSYLVANIA |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147563/147564 |
Policy instance | 4 |
Insurance contract or identification number | 147563/147564 | Number of Individuals Covered | 160 | Insurance policy start date | 2015-04-01 | Insurance policy end date | 2016-03-31 | Total amount of commissions paid to insurance broker | USD $7,433 | Total amount of fees paid to insurance company | USD $660 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $52,804 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,433 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 660 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | TOMPKINS INSURANCE AGENCIES, INC. |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 947587 |
Policy instance | 1 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 40 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 02919 |
Policy instance | 7 |
Insurance contract or identification number | 02919 | Number of Individuals Covered | 82 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $1,970 | 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 $1,970 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | TOMPKINS INSURANCE |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147563 |
Policy instance | 6 |
Insurance contract or identification number | 147563 | Number of Individuals Covered | 152 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $1,335 | Total amount of fees paid to insurance company | USD $62 | 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 $19,016 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 62 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | VIST INSURANCE LLC |
|
AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
Policy contract number | 947587 |
Policy instance | 5 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 2 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 947587 |
Policy instance | 4 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 27 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 ) |
Policy contract number | 947587 |
Policy instance | 3 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 1 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA, INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147564 |
Policy instance | 2 |
Insurance contract or identification number | 147564 | Number of Individuals Covered | 39 | Insurance policy start date | 2014-04-01 | Insurance policy end date | 2015-03-31 | Total amount of commissions paid to insurance broker | USD $5,827 | Total amount of fees paid to insurance company | USD $98 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE ADD | Welfare Benefit Premiums Paid to Carrier | USD $31,158 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,827 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker name | TOMPKINS INSURANCE AGENCIES, INC. |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 02919 |
Policy instance | 7 |
Insurance contract or identification number | 02919 | Number of Individuals Covered | 73 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $1,752 | 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 $1,752 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | TOMPKINS INSURANCE |
|
AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
Policy contract number | 947587 |
Policy instance | 5 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 2 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $2,349 | Total amount of fees paid to insurance company | USD $0 | Health 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 $2,349 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 947587 |
Policy instance | 1 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 23 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $7,069 | Total amount of fees paid to insurance company | USD $0 | Health 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 $7,069 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147564 |
Policy instance | 2 |
Insurance contract or identification number | 147564 | Number of Individuals Covered | 45 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $6,276 | Total amount of fees paid to insurance company | USD $215 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE ADD | Welfare Benefit Premiums Paid to Carrier | USD $33,559 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,276 | Amount paid for insurance broker fees | 215 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | VIST INSURANCE LLC |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 ) |
Policy contract number | 947587 |
Policy instance | 3 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 1 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $122 | Total amount of fees paid to insurance company | USD $0 | Health 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 $122 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA, INC. |
|
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 947587 |
Policy instance | 4 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 35 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $28,170 | Total amount of fees paid to insurance company | USD $0 | Health 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 $28,170 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147563 |
Policy instance | 6 |
Insurance contract or identification number | 147563 | Number of Individuals Covered | 152 | Insurance policy start date | 2013-04-01 | Insurance policy end date | 2014-03-31 | Total amount of commissions paid to insurance broker | USD $1,204 | Total amount of fees paid to insurance company | USD $105 | 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 $17,104 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,204 | Amount paid for insurance broker fees | 105 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 | Insurance broker name | TOMPKINS INSURANCE, LLC |
|
AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
Policy contract number | 947587 |
Policy instance | 5 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 2 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $3,507 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | 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 $3,507 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 ) |
Policy contract number | 947587 |
Policy instance | 3 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 1 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $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 $0 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA, INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147564 |
Policy instance | 2 |
Insurance contract or identification number | 147564 | Number of Individuals Covered | 41 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $5,397 | Total amount of fees paid to insurance company | USD $216 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE ADD | Welfare Benefit Premiums Paid to Carrier | USD $28,858 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,397 | Amount paid for insurance broker fees | 216 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | TOMKINS INSURANCE |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 947587 |
Policy instance | 1 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 12 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $26,900 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | 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 $26,900 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 02919 |
Policy instance | 7 |
Insurance contract or identification number | 02919 | Number of Individuals Covered | 57 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $1,196 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | 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 $1,196 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | TOMPKINS INSURANCE |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147563 |
Policy instance | 6 |
Insurance contract or identification number | 147563 | Number of Individuals Covered | 102 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $1,029 | Total amount of fees paid to insurance company | USD $116 | 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 $15,495 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,029 | Amount paid for insurance broker fees | 116 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | TOMPKINS INSURANCE, LLC |
|
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 947587 |
Policy instance | 4 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 31 | Insurance policy start date | 2012-04-01 | Insurance policy end date | 2013-03-31 | Total amount of commissions paid to insurance broker | USD $46,010 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | 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 $46,010 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147563 |
Policy instance | 6 |
Insurance contract or identification number | 147563 | Number of Individuals Covered | 107 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $1,537 | 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 | ACCIDENTAL DEATH & DISMEMBERMENT | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
Policy contract number | 947587 |
Policy instance | 5 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 7 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $7,278 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 02919 |
Policy instance | 7 |
Insurance contract or identification number | 02919 | Number of Individuals Covered | 75 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $2,096 | 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 |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 947587 |
Policy instance | 1 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 12 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $8,716 | Total amount of fees paid to insurance company | USD $0 | Health 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 | 147564 |
Policy instance | 2 |
Insurance contract or identification number | 147564 | Number of Individuals Covered | 37 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $7,944 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | LIFESTYLE ADD | Welfare Benefit Premiums Paid to Carrier | USD $40,848 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 ) |
Policy contract number | 947587 |
Policy instance | 3 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 1 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 947587 |
Policy instance | 4 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 85 | Insurance policy start date | 2011-04-01 | Insurance policy end date | 2012-03-31 | Total amount of commissions paid to insurance broker | USD $66,758 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | PA 2919 |
Policy instance | 7 |
Insurance contract or identification number | PA 2919 | Number of Individuals Covered | 272 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $3,096 | 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 $3,096 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | VIST INSURANCE |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147563 |
Policy instance | 6 |
Insurance contract or identification number | 147563 | Number of Individuals Covered | 174 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $1,628 | Total amount of fees paid to insurance company | USD $212 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIEDENTAL DEATH, DISMEMBERMENT,LIFESTYLE ACCIDENTAL DEATH, DISMEMBERMENT | Welfare Benefit Premiums Paid to Carrier | USD $21,124 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,628 | Amount paid for insurance broker fees | 212 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | VIST INSURANCE, LLC |
|
AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 ) |
Policy contract number | 947587 |
Policy instance | 5 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 13 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $7,061 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $108,635 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,061 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
Policy contract number | 947587 |
Policy instance | 4 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 175 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $74,958 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,153,197 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $74,958 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 ) |
Policy contract number | 947587 |
Policy instance | 3 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 2 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,060 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA, INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 147564 |
Policy instance | 2 |
Insurance contract or identification number | 147564 | Number of Individuals Covered | 76 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $7,890 | Total amount of fees paid to insurance company | USD $427 | Other welfare benefits provided | LIFESTYLE ADD, LIFESTYLE LIFE | Welfare Benefit Premiums Paid to Carrier | USD $42,192 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,890 | Amount paid for insurance broker fees | 427 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | VIST INSURANCE LLC |
|
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
Policy contract number | 947587 |
Policy instance | 1 |
Insurance contract or identification number | 947587 | Number of Individuals Covered | 21 | Insurance policy start date | 2010-04-01 | Insurance policy end date | 2011-03-31 | Total amount of commissions paid to insurance broker | USD $11,041 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $169,860 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,041 | Insurance broker organization code? | 3 | Insurance broker name | BROWN AND BROWN OF PENNA INC. |
|