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PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan NamePROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN
Plan identification number 503

PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

PROFESSIONAL BUILDING SYSTEMS, INC. has sponsored the creation of one or more 401k plans.

Company Name:PROFESSIONAL BUILDING SYSTEMS, INC.
Employer identification number (EIN):233038127
NAIC Classification:236110

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032021-01-01
5032020-01-01
5032019-01-01
5032018-01-01
5032017-01-01DAVID KONJURA DAVID KONJURA2018-10-15
5032016-01-01DAVID KONJURA DAVID KONJURA2017-10-16
5032015-01-01DAVID KONJURA DAVID KONJURA2016-10-13
5032014-01-01DAVID KONJURA DAVID KONJURA2015-10-06
5032013-01-01DAVID KONJURA DAVID KONJURA2014-10-14
5032012-01-01DAVID KONJURA DAVID KONJURA2013-10-14
5032011-01-01DAVID KONJURA DAVID KONJURA2012-10-12
5032010-01-01DAVID KONJURA DAVID KONJURA2011-10-17
5032009-01-01DAVID KONJURA

Plan Statistics for PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN

Measure Date Value
2021: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01234
Total number of active participants reported on line 7a of the Form 55002021-01-01236
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01236
2020: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01229
Total number of active participants reported on line 7a of the Form 55002020-01-01234
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01234
2019: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01225
Total number of active participants reported on line 7a of the Form 55002019-01-01229
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01229
2018: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01207
Total number of active participants reported on line 7a of the Form 55002018-01-01225
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01225
2017: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-010
Total number of active participants reported on line 7a of the Form 55002017-01-01207
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01207
2016: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01278
Total number of active participants reported on line 7a of the Form 55002016-01-01231
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01231
2015: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01268
Total number of active participants reported on line 7a of the Form 55002015-01-01278
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01278
2014: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01242
Total number of active participants reported on line 7a of the Form 55002014-01-01268
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01268
2013: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01229
Total number of active participants reported on line 7a of the Form 55002013-01-01242
Total of all active and inactive participants2013-01-01242
2012: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01226
Total number of active participants reported on line 7a of the Form 55002012-01-01229
Total of all active and inactive participants2012-01-01229
Total participants2012-01-01229
2011: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01208
Total number of active participants reported on line 7a of the Form 55002011-01-01226
Total of all active and inactive participants2011-01-01226
Total participants2011-01-01226
2010: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01148
Total number of active participants reported on line 7a of the Form 55002010-01-01208
Total of all active and inactive participants2010-01-01208
Total participants2010-01-01208
2009: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01225
Total number of active participants reported on line 7a of the Form 55002009-01-01148
Total of all active and inactive participants2009-01-01148
Total participants2009-01-01148

Form 5500 Responses for PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN

2021: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: PROFESSIONAL BUILDING SYSTEMS, INC. EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

NVA VISION (National Association of Insurance Commissioners NAIC id number: 11686 )
Policy contract number4184
Policy instance 4
Insurance contract or identification number4184
Number of Individuals Covered453
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,740
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,740
Insurance broker organization code?3
GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )
Policy contract number10117915
Policy instance 3
Insurance contract or identification number10117915
Number of Individuals Covered439
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $40,900
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,768,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,900
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number805550G
Policy instance 5
Insurance contract or identification number805550G
Number of Individuals Covered334
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $30,671
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $205,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,671
Insurance broker organization code?3
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16275
Policy instance 1
Insurance contract or identification number16275
Number of Individuals Covered458
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,742
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 numberR0465880
Policy instance 2
Insurance contract or identification numberR0465880
Number of Individuals Covered35
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $352
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $352
Insurance broker organization code?3
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16275
Policy instance 1
Insurance contract or identification number16275
Number of Individuals Covered458
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )
Policy contract number10117915
Policy instance 4
Insurance contract or identification number10117915
Number of Individuals Covered439
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $34,566
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,728,317
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,566
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0009641524
Policy instance 3
Insurance contract or identification number0009641524
Number of Individuals Covered11
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $63
Life Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $2,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $63
Insurance broker organization code?3
NVA VISION (National Association of Insurance Commissioners NAIC id number: 11686 )
Policy contract number4184
Policy instance 5
Insurance contract or identification number4184
Number of Individuals Covered453
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,740
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,740
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number805550G
Policy instance 6
Insurance contract or identification number805550G
Number of Individuals Covered334
Insurance policy start date2020-06-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $17,257
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D & SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $114,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,257
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0465880
Policy instance 2
Insurance contract or identification numberR0465880
Number of Individuals Covered35
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $301
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $11,959
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $301
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0465880
Policy instance 3
Insurance contract or identification numberR0465880
Number of Individuals Covered39
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $323
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $12,797
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $323
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0009641524
Policy instance 4
Insurance contract or identification number0009641524
Number of Individuals Covered14
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $76
Life Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $76
Insurance broker organization code?3
GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )
Policy contract number10117915
Policy instance 5
Insurance contract or identification number10117915
Number of Individuals Covered377
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $7,295
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $364,763
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,295
Insurance broker organization code?3
NVA VISION (National Association of Insurance Commissioners NAIC id number: 11686 )
Policy contract number4184
Policy instance 6
Insurance contract or identification number4184
Number of Individuals Covered461
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $3,772
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,772
Insurance broker organization code?3
GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )
Policy contract number10117915
Policy instance 7
Insurance contract or identification number10117915
Number of Individuals Covered427
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $34,198
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,709,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $34,198
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0284722
Policy instance 1
Insurance contract or identification number0284722
Number of Individuals Covered335
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $22,185
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $148,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,185
Insurance broker organization code?3
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16275
Policy instance 2
Insurance contract or identification number16275
Number of Individuals Covered474
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )
Policy contract number117915
Policy instance 5
Insurance contract or identification number117915
Number of Individuals Covered6
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $624
Total amount of fees paid to insurance companyUSD $19
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $624
Amount paid for insurance broker fees19
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0465880
Policy instance 3
Insurance contract or identification numberR0465880
Number of Individuals Covered40
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $372
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $14,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $372
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0284722
Policy instance 1
Insurance contract or identification number0284722
Number of Individuals Covered318
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $18,740
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $139,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,740
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0009641524
Policy instance 4
Insurance contract or identification number0009641524
Number of Individuals Covered14
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $89
Life Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89
Insurance broker organization code?3
NVA VISION (National Association of Insurance Commissioners NAIC id number: 11686 )
Policy contract number4184
Policy instance 6
Insurance contract or identification number4184
Number of Individuals Covered446
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $3,553
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $35,529
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,553
Insurance broker organization code?3
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16275
Policy instance 2
Insurance contract or identification number16275
Number of Individuals Covered471
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 )
Policy contract number117915
Policy instance 7
Insurance contract or identification number117915
Number of Individuals Covered431
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $48,708
Total amount of fees paid to insurance companyUSD $1,461
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,623,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,708
Amount paid for insurance broker fees1461
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0284722
Policy instance 1
Insurance contract or identification number0284722
Number of Individuals Covered301
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $17,063
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D, SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $112,655
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,063
Insurance broker organization code?3
Insurance broker namePEGGY A REINARD
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16275
Policy instance 3
Insurance contract or identification number16275
Number of Individuals Covered372
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $79,003
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 number0009641524
Policy instance 5
Insurance contract or identification number0009641524
Number of Individuals Covered20
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $83
Life Insurance Welfare BenefitYes
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $3,252
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $83
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
NVA VISION (National Association of Insurance Commissioners NAIC id number: 11686 )
Policy contract number4184
Policy instance 7
Insurance contract or identification number4184
Number of Individuals Covered399
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,453
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,526
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,453
Insurance broker organization code?3
Insurance broker namePEGGY A REINARD
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract numberR0465880
Policy instance 4
Insurance contract or identification numberR0465880
Number of Individuals Covered45
Insurance policy start date2017-01-01
Insurance policy end date2018-01-01
Total amount of commissions paid to insurance brokerUSD $335
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $13,288
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $335
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES
GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 )
Policy contract number117915
Policy instance 6
Insurance contract or identification number117915
Number of Individuals Covered417
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $48,367
Total amount of fees paid to insurance companyUSD $1,451
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,612,236
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $48,367
Amount paid for insurance broker fees1451
Insurance broker organization code?3
Insurance broker namePURDY INSURANCE AGENCY
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000006227
Policy instance 2
Insurance contract or identification number0000006227
Number of Individuals Covered63
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $624
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $575
Insurance broker organization code?3
Insurance broker nameCUSTOM BENEFIT PROGRAMS
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000006227
Policy instance 2
Insurance contract or identification number0000006227
Number of Individuals Covered62
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,091
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $248
Insurance broker organization code?3
Insurance broker nameKIRK MYERS
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00525587
Policy instance 5
Insurance contract or identification number00525587
Number of Individuals Covered201
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $33,200
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,209,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,200
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number211609
Policy instance 4
Insurance contract or identification number211609
Number of Individuals Covered134
Insurance policy start date2014-11-01
Insurance policy end date2015-11-01
Total amount of commissions paid to insurance brokerUSD $5,201
Total amount of fees paid to insurance companyUSD $41
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $34,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,201
Amount paid for insurance broker fees41
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16275
Policy instance 3
Insurance contract or identification number16275
Number of Individuals Covered426
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,099
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 number211608
Policy instance 1
Insurance contract or identification number211608
Number of Individuals Covered278
Insurance policy start date2014-11-01
Insurance policy end date2015-11-01
Total amount of commissions paid to insurance brokerUSD $7,464
Total amount of fees paid to insurance companyUSD $100
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $79,737
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,464
Amount paid for insurance broker fees100
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number211608
Policy instance 1
Insurance contract or identification number211608
Number of Individuals Covered268
Insurance policy start date2013-11-01
Insurance policy end date2014-11-01
Total amount of commissions paid to insurance brokerUSD $7,290
Total amount of fees paid to insurance companyUSD $579
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $77,180
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,290
Amount paid for insurance broker fees579
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC.
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16275
Policy instance 5
Insurance contract or identification number16275
Number of Individuals Covered359
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number1804480000
Policy instance 2
Insurance contract or identification number1804480000
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $81
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $81
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number1804480000
Policy instance 3
Insurance contract or identification number1804480000
Number of Individuals Covered387
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $27,763
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,110,502
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,763
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number077827
Policy instance 6
Insurance contract or identification number077827
Number of Individuals Covered342
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $263
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $22,732
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $263
Insurance broker organization code?3
Insurance broker nameEMERSON REID & CO.
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number211609
Policy instance 7
Insurance contract or identification number211609
Number of Individuals Covered144
Insurance policy start date2013-11-01
Insurance policy end date2014-11-01
Total amount of commissions paid to insurance brokerUSD $4,811
Total amount of fees paid to insurance companyUSD $240
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $32,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,811
Amount paid for insurance broker fees240
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000006227
Policy instance 4
Insurance contract or identification number0000006227
Number of Individuals Covered62
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,445
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,817
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $479
Insurance broker organization code?3
Insurance broker nameKIRK MYERS
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number211609
Policy instance 7
Insurance contract or identification number211609
Number of Individuals Covered150
Insurance policy start date2012-11-01
Insurance policy end date2013-11-01
Total amount of commissions paid to insurance brokerUSD $5,160
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $31,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,160
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number077827
Policy instance 6
Insurance contract or identification number077827
Number of Individuals Covered341
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $204
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $128
Insurance broker organization code?3
Insurance broker nameMELISSA A. WEVODAU
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16275
Policy instance 5
Insurance contract or identification number16275
Number of Individuals Covered365
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $57,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 )
Policy contract number0000006227
Policy instance 4
Insurance contract or identification number0000006227
Number of Individuals Covered62
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $2,179
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,034
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $496
Insurance broker organization code?3
Insurance broker nameKIRK MYERS
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number1804480000
Policy instance 2
Insurance contract or identification number1804480000
Number of Individuals Covered1
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,841
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number211608
Policy instance 1
Insurance contract or identification number211608
Number of Individuals Covered242
Insurance policy start date2012-11-01
Insurance policy end date2013-11-01
Total amount of commissions paid to insurance brokerUSD $8,547
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $76,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,547
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC.
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number1804480000
Policy instance 3
Insurance contract or identification number1804480000
Number of Individuals Covered389
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $27,354
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,089,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,354
Insurance broker organization code?3
Insurance broker nameSAUVE CONSULTING GROUP INC
UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )
Policy contract number847176-001
Policy instance 6
Insurance contract or identification number847176-001
Number of Individuals Covered327
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Dental Insurance Welfare BenefitYes
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract numberV255155
Policy instance 5
Insurance contract or identification numberV255155
Number of Individuals Covered192
Insurance policy start date2012-01-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $6,723
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL. DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $33,617
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,723
Insurance broker organization code?3
Insurance broker nameTRUMAN R. PURDY
AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )
Policy contract numberG255159
Policy instance 4
Insurance contract or identification numberG255159
Number of Individuals Covered229
Insurance policy start date2012-01-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $4,074
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $34,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,074
Insurance broker organization code?3
Insurance broker nameTRUMAN R. PURDY
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number1804480000
Policy instance 3
Insurance contract or identification number1804480000
Number of Individuals Covered369
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,665
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,649
Insurance broker organization code?3
Insurance broker nameERC - SAUVE CONSULTING GROUP INC
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number1804480000
Policy instance 2
Insurance contract or identification number1804480000
Number of Individuals Covered408
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $22,287
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $926,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,638
Insurance broker organization code?3
Insurance broker nameERC - SAUVE CONSULTING GROUP INC
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number077827
Policy instance 1
Insurance contract or identification number077827
Number of Individuals Covered327
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $197
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,373
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35
Insurance broker organization code?3
Insurance broker nameWEVODAU, MELISSA A.
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number077827
Policy instance 1
Insurance contract or identification number077827
Number of Individuals Covered319
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $204
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )
Policy contract number847176-001
Policy instance 6
Insurance contract or identification number847176-001
Number of Individuals Covered302
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )
Policy contract numberV255155
Policy instance 5
Insurance contract or identification numberV255155
Number of Individuals Covered111
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $7,440
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL. DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $37,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )
Policy contract numberG255159
Policy instance 4
Insurance contract or identification numberG255159
Number of Individuals Covered226
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,444
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $41,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number1804480000
Policy instance 3
Insurance contract or identification number1804480000
Number of Individuals Covered1
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $133
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number1804480000
Policy instance 2
Insurance contract or identification number1804480000
Number of Individuals Covered386
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $19,530
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $781,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number077827
Policy instance 1
Insurance contract or identification number077827
Number of Individuals Covered321
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $182
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )
Policy contract number847176-001
Policy instance 6
Insurance contract or identification number847176-001
Number of Individuals Covered290
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )
Policy contract numberV255155
Policy instance 5
Insurance contract or identification numberV255155
Number of Individuals Covered101
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,795
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedVOL. DEPENDENT LIFE
Welfare Benefit Premiums Paid to CarrierUSD $33,975
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 )
Policy contract numberG255159
Policy instance 4
Insurance contract or identification numberG255159
Number of Individuals Covered208
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,074
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $35,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract number1804480000
Policy instance 3
Insurance contract or identification number1804480000
Number of Individuals Covered13
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $980
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number1804480000
Policy instance 2
Insurance contract or identification number1804480000
Number of Individuals Covered356
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $24,326
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $693,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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