C.A. CURTZE COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan C.A. CURTZE COMPANY/NORTHERN HASEROT WELFARE PLAN
401k plan membership statisitcs for C.A. CURTZE COMPANY/NORTHERN HASEROT WELFARE PLAN
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873904 |
Policy instance | 3 |
Insurance contract or identification number | 903873904 | Number of Individuals Covered | 3 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $472 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,160 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $472 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873905 |
Policy instance | 15 |
Insurance contract or identification number | 903873905 | Number of Individuals Covered | 1 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $128 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,770 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $128 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873306 |
Policy instance | 1 |
Insurance contract or identification number | 903873306 | Number of Individuals Covered | 306 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $26,661 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,626,366 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $26,661 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873307 |
Policy instance | 2 |
Insurance contract or identification number | 903873307 | Number of Individuals Covered | 34 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $3,034 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $184,597 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,034 | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 913735 |
Policy instance | 4 |
Insurance contract or identification number | 913735 | Number of Individuals Covered | 364 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $13,312 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $199,626 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $13,312 | Insurance broker organization code? | 3 |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4546 |
Policy instance | 5 |
Insurance contract or identification number | 4546 | Number of Individuals Covered | 234 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GLUG0BDJH |
Policy instance | 6 |
Insurance contract or identification number | GLUG0BDJH | Number of Individuals Covered | 402 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $3,024 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $30,238 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,024 | Insurance broker organization code? | 3 |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | GVTL0BDJH |
Policy instance | 7 |
Insurance contract or identification number | GVTL0BDJH | Number of Individuals Covered | 122 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $5,227 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $34,850 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,227 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873310 |
Policy instance | 8 |
Insurance contract or identification number | 903873310 | Number of Individuals Covered | 254 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $22,581 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,367,294 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,581 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873315 |
Policy instance | 14 |
Insurance contract or identification number | 903873315 | Number of Individuals Covered | 1 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $71 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $4,832 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $71 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873906 |
Policy instance | 13 |
Insurance contract or identification number | 903873906 | Number of Individuals Covered | 0 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $142 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,624 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $142 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873314 |
Policy instance | 12 |
Insurance contract or identification number | 903873314 | Number of Individuals Covered | 98 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $7,687 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $475,387 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,687 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873312 |
Policy instance | 11 |
Insurance contract or identification number | 903873312 | Number of Individuals Covered | 9 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $954 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,699 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $954 | Insurance broker organization code? | 3 |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4545 |
Policy instance | 10 |
Insurance contract or identification number | 4545 | Number of Individuals Covered | 127 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873311 |
Policy instance | 9 |
Insurance contract or identification number | 903873311 | Number of Individuals Covered | 5 | Insurance policy start date | 2022-01-01 | Insurance policy end date | 2022-12-31 | Total amount of commissions paid to insurance broker | USD $358 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,469 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $358 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873306 |
Policy instance | 1 |
Insurance contract or identification number | 903873306 | Number of Individuals Covered | 306 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $28,522 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,428,493 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,522 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873307 |
Policy instance | 2 |
Insurance contract or identification number | 903873307 | Number of Individuals Covered | 41 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $3,145 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $174,707 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,145 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873904 |
Policy instance | 3 |
Insurance contract or identification number | 903873904 | Number of Individuals Covered | 3 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | 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 $22,171 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4545 |
Policy instance | 10 |
Insurance contract or identification number | 4545 | Number of Individuals Covered | 130 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4546 |
Policy instance | 5 |
Insurance contract or identification number | 4546 | Number of Individuals Covered | 227 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BDJH |
Policy instance | 6 |
Insurance contract or identification number | G000BDJH | Number of Individuals Covered | 381 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $2,763 | Total amount of fees paid to insurance company | USD $1,087 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $27,626 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,763 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1087 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BDJH |
Policy instance | 7 |
Insurance contract or identification number | G000BDJH | Number of Individuals Covered | 120 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $5,095 | Total amount of fees paid to insurance company | USD $1,237 | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $33,965 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,095 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1237 | Additional information about fees paid to insurance broker | OTHER COMPENSATION |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873310 |
Policy instance | 8 |
Insurance contract or identification number | 903873310 | Number of Individuals Covered | 277 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $22,249 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,110,167 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,249 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873311 |
Policy instance | 9 |
Insurance contract or identification number | 903873311 | Number of Individuals Covered | 4 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $397 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,282 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $397 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873312 |
Policy instance | 11 |
Insurance contract or identification number | 903873312 | Number of Individuals Covered | 10 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $838 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $44,262 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $838 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873314 |
Policy instance | 12 |
Insurance contract or identification number | 903873314 | Number of Individuals Covered | 95 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $6,462 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $349,683 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,462 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873906 |
Policy instance | 13 |
Insurance contract or identification number | 903873906 | Number of Individuals Covered | 0 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $49 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,448 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $49 | Insurance broker organization code? | 3 |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 913735 |
Policy instance | 4 |
Insurance contract or identification number | 913735 | Number of Individuals Covered | 342 | Insurance policy start date | 2021-01-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $21,073 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $196,971 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,073 | Insurance broker organization code? | 3 |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4546 |
Policy instance | 5 |
Insurance contract or identification number | 4546 | Number of Individuals Covered | 292 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 913735 |
Policy instance | 4 |
Insurance contract or identification number | 913735 | Number of Individuals Covered | 646 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $20,537 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $213,491 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $20,537 | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873904 |
Policy instance | 3 |
Insurance contract or identification number | 903873904 | Number of Individuals Covered | 10 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | 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 $38,178 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873307 |
Policy instance | 2 |
Insurance contract or identification number | 903873307 | Number of Individuals Covered | 30 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,845 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $136,595 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,845 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873306 |
Policy instance | 1 |
Insurance contract or identification number | 903873306 | Number of Individuals Covered | 307 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $32,147 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,595,421 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,147 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BDJH |
Policy instance | 6 |
Insurance contract or identification number | G000BDJH | Number of Individuals Covered | 350 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $2,932 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $31,067 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,932 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BDJH |
Policy instance | 7 |
Insurance contract or identification number | G000BDJH | Number of Individuals Covered | 109 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $5,306 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $35,372 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,306 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873310 |
Policy instance | 8 |
Insurance contract or identification number | 903873310 | Number of Individuals Covered | 280 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $28,975 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,428,753 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,975 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873311 |
Policy instance | 9 |
Insurance contract or identification number | 903873311 | Number of Individuals Covered | 4 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $500 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $21,823 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $500 | Insurance broker organization code? | 3 |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4545 |
Policy instance | 10 |
Insurance contract or identification number | 4545 | Number of Individuals Covered | 121 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873312 |
Policy instance | 11 |
Insurance contract or identification number | 903873312 | Number of Individuals Covered | 6 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $641 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $37,787 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $641 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873314 |
Policy instance | 12 |
Insurance contract or identification number | 903873314 | Number of Individuals Covered | 82 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $7,337 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $358,801 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,337 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873910 |
Policy instance | 13 |
Insurance contract or identification number | 903873910 | Number of Individuals Covered | 0 | Insurance policy start date | 2020-01-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $10 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $490 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BDJH |
Policy instance | 7 |
Insurance contract or identification number | G000BDJH | Number of Individuals Covered | 432 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $3,013 | Total amount of fees paid to insurance company | USD $340 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $30,128 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,013 | Amount paid for insurance broker fees | 340 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BDJH |
Policy instance | 8 |
Insurance contract or identification number | G000BDJH | Number of Individuals Covered | 129 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $5,322 | Total amount of fees paid to insurance company | USD $356 | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $35,483 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,322 | Amount paid for insurance broker fees | 356 | Additional information about fees paid to insurance broker | OTHER COMPENSATION | Insurance broker organization code? | 3 |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873310 |
Policy instance | 9 |
Insurance contract or identification number | 903873310 | Number of Individuals Covered | 350 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $29,055 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,482,067 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $29,055 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873311 |
Policy instance | 10 |
Insurance contract or identification number | 903873311 | Number of Individuals Covered | 15 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $1,188 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $60,591 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,188 | Insurance broker organization code? | 3 |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4545 |
Policy instance | 11 |
Insurance contract or identification number | 4545 | Number of Individuals Covered | 154 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873312 |
Policy instance | 12 |
Insurance contract or identification number | 903873312 | Number of Individuals Covered | 5 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $267 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,326 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $267 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873314 |
Policy instance | 13 |
Insurance contract or identification number | 903873314 | Number of Individuals Covered | 121 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $5,596 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $321,180 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,596 | Insurance broker organization code? | 3 |
|
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4546 |
Policy instance | 6 |
Insurance contract or identification number | 4546 | Number of Individuals Covered | 243 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 913735 |
Policy instance | 5 |
Insurance contract or identification number | 913735 | Number of Individuals Covered | 828 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $22,936 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $222,690 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,936 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873905 |
Policy instance | 4 |
Insurance contract or identification number | 903873905 | Number of Individuals Covered | 1 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | 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 $6,440 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873904 |
Policy instance | 3 |
Insurance contract or identification number | 903873904 | Number of Individuals Covered | 2 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | 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 $14,090 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873307 |
Policy instance | 2 |
Insurance contract or identification number | 903873307 | Number of Individuals Covered | 43 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $4,636 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $228,335 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,636 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873306 |
Policy instance | 1 |
Insurance contract or identification number | 903873306 | Number of Individuals Covered | 348 | Insurance policy start date | 2019-01-01 | Insurance policy end date | 2019-12-31 | Total amount of commissions paid to insurance broker | USD $32,637 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,606,667 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $32,637 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873306 |
Policy instance | 1 |
Insurance contract or identification number | 903873306 | Number of Individuals Covered | 340 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $17,163 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,162,893 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,163 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873307 |
Policy instance | 2 |
Insurance contract or identification number | 903873307 | Number of Individuals Covered | 52 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $3,913 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $244,890 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,913 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873904 |
Policy instance | 3 |
Insurance contract or identification number | 903873904 | Number of Individuals Covered | 5 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | 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 $9,280 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873905 |
Policy instance | 4 |
Insurance contract or identification number | 903873905 | Number of Individuals Covered | 0 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | 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 $2,946 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | 913735 |
Policy instance | 5 |
Insurance contract or identification number | 913735 | Number of Individuals Covered | 324 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $6,623 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $65,891 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,623 | Insurance broker organization code? | 3 |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4546 |
Policy instance | 6 |
Insurance contract or identification number | 4546 | Number of Individuals Covered | 182 | Insurance policy start date | 2018-09-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BDJH |
Policy instance | 7 |
Insurance contract or identification number | G000BDJH | Number of Individuals Covered | 348 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $908 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $9,081 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $908 | Insurance broker organization code? | 3 |
|
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
Policy contract number | G000BDJH |
Policy instance | 8 |
Insurance contract or identification number | G000BDJH | Number of Individuals Covered | 105 | Insurance policy start date | 2018-01-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $1,478 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | VOLUNTARY LIFE | Welfare Benefit Premiums Paid to Carrier | USD $9,856 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,478 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873310 |
Policy instance | 9 |
Insurance contract or identification number | 903873310 | Number of Individuals Covered | 300 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $7,150 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $527,121 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,150 | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873311 |
Policy instance | 10 |
Insurance contract or identification number | 903873311 | Number of Individuals Covered | 11 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $188 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,170 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $188 | Insurance broker organization code? | 3 |
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VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
Policy contract number | 4545 |
Policy instance | 11 |
Insurance contract or identification number | 4545 | Number of Individuals Covered | 136 | Insurance policy start date | 2018-08-01 | Insurance policy end date | 2018-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Vision Insurance Welfare Benefit | Yes | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
Policy contract number | 952658 |
Policy instance | 1 |
Insurance contract or identification number | 952658 | Number of Individuals Covered | 178 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $2,039 | Total amount of fees paid to insurance company | USD $13,611 | Are there contracts with allocated funds for individual policies? | 0 | 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 | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | BASIC AD&D/LIFE | 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 $13,611 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,039 | Insurance broker name | THE DJB GROUP, INC. |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873306 |
Policy instance | 2 |
Insurance contract or identification number | 903873306 | Number of Individuals Covered | 259 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $16,050 | Total amount of fees paid to insurance company | USD $1,011,407 | Are there contracts with allocated funds for individual policies? | 0 | 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 $1,011,407 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,050 | Amount paid for insurance broker fees | 95 | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | Insurance broker organization code? | 3 | Insurance broker name | LILLIS MCKIBBEN AND COMPANY |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873307 |
Policy instance | 3 |
Insurance contract or identification number | 903873307 | Number of Individuals Covered | 47 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $3,475 | Total amount of fees paid to insurance company | USD $205,164 | Are there contracts with allocated funds for individual policies? | 0 | 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 $205,164 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,475 | Insurance broker name | LILLIS MCKIBBEN AND COMPANY |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873904 |
Policy instance | 4 |
Insurance contract or identification number | 903873904 | Number of Individuals Covered | 1 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $1,794 | Are there contracts with allocated funds for individual policies? | 0 | 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 $1,794 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873905 |
Policy instance | 5 |
Insurance contract or identification number | 903873905 | Number of Individuals Covered | 2 | Insurance policy start date | 2017-01-01 | Insurance policy end date | 2017-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $982 | Are there contracts with allocated funds for individual policies? | 0 | 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 $982 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873905 |
Policy instance | 7 |
Insurance contract or identification number | 903873905 | Number of Individuals Covered | 0 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873306 |
Policy instance | 2 |
Insurance contract or identification number | 903873306 | Number of Individuals Covered | 260 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $1,026,307 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873307 |
Policy instance | 3 |
Insurance contract or identification number | 903873307 | Number of Individuals Covered | 60 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $237,003 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873308 |
Policy instance | 4 |
Insurance contract or identification number | 903873308 | Number of Individuals Covered | 4 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $26,524 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873309 |
Policy instance | 5 |
Insurance contract or identification number | 903873309 | Number of Individuals Covered | 2 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $13,262 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873904 |
Policy instance | 6 |
Insurance contract or identification number | 903873904 | Number of Individuals Covered | 4 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $7,736 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
Policy contract number | BP0059 |
Policy instance | 1 |
Insurance contract or identification number | BP0059 | Number of Individuals Covered | 165 | Insurance policy start date | 2015-01-01 | Insurance policy end date | 2015-12-31 | Total amount of commissions paid to insurance broker | USD $1,863 | 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 | 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 | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | BASIC ADD/LIFE | 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 $13,387 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,863 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 | Insurance broker name | THE DJB GROUP INC. |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873901 |
Policy instance | 5 |
Insurance contract or identification number | 903873901 | Number of Individuals Covered | 0 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $803 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873902 |
Policy instance | 2 |
Insurance contract or identification number | 903873902 | Number of Individuals Covered | 1 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $6,940 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873303 |
Policy instance | 3 |
Insurance contract or identification number | 903873303 | Number of Individuals Covered | 32 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $106,276 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
Policy contract number | 186C56 |
Policy instance | 1 |
Insurance contract or identification number | 186C56 | Number of Individuals Covered | 281 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $2,369 | 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 | 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 | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | BASIC ADD/LIFE | 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 $19,317 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,369 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | THE DJB GROUP INC |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873302 |
Policy instance | 4 |
Insurance contract or identification number | 903873302 | Number of Individuals Covered | 269 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $1,014,077 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873900 |
Policy instance | 6 |
Insurance contract or identification number | 903873900 | Number of Individuals Covered | 1 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $8,512 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873301 |
Policy instance | 7 |
Insurance contract or identification number | 903873301 | Number of Individuals Covered | 63 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $204,322 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873300 |
Policy instance | 8 |
Insurance contract or identification number | 903873300 | Number of Individuals Covered | 229 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $906,238 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873304 |
Policy instance | 9 |
Insurance contract or identification number | 903873304 | Number of Individuals Covered | 5 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $33,261 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 903873305 |
Policy instance | 10 |
Insurance contract or identification number | 903873305 | Number of Individuals Covered | 2 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $0 | 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 $8,080 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
Policy contract number | 903873902 |
Policy instance | 2 |
Insurance contract or identification number | 903873902 | Number of Individuals Covered | 4 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $307 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,650 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $307 | Amount paid for insurance broker fees | 0 | Insurance broker name | CROTTY INSURANCE AGENCY, INC. |
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UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
Policy contract number | 903873901 |
Policy instance | 3 |
Insurance contract or identification number | 903873901 | Number of Individuals Covered | 1 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,539 | 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 name | CROTTY INSURANCE AGENCY, INC. |
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UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
Policy contract number | 903873900 |
Policy instance | 4 |
Insurance contract or identification number | 903873900 | Number of Individuals Covered | 5 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $54 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,952 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54 | Amount paid for insurance broker fees | 0 | Insurance broker name | CROTTY INSURANCE AGENCY, INC. |
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UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
Policy contract number | 903873303 |
Policy instance | 5 |
Insurance contract or identification number | 903873303 | Number of Individuals Covered | 23 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $1,925 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $83,068 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,925 | Amount paid for insurance broker fees | 0 | Insurance broker name | CROTTY INSURANCE AGENCY, INC. |
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UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
Policy contract number | 903873302 |
Policy instance | 6 |
Insurance contract or identification number | 903873302 | Number of Individuals Covered | 265 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $25,190 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,003,451 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $25,190 | Amount paid for insurance broker fees | 0 | Insurance broker name | CROTTY INSURANCE AGENCY, INC. |
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UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
Policy contract number | 903873300 |
Policy instance | 8 |
Insurance contract or identification number | 903873300 | Number of Individuals Covered | 238 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $22,002 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $858,536 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,002 | Amount paid for insurance broker fees | 0 | Insurance broker name | CROTTY INSURANCE AGENCY, INC. |
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NATIONWIDE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 66869 ) |
Policy contract number | 186C56 |
Policy instance | 1 |
Insurance contract or identification number | 186C56 | Number of Individuals Covered | 273 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $2,424 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | BSC ADD/LIFE | Welfare Benefit Premiums Paid to Carrier | USD $22,426 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Commission paid to Insurance Broker | USD $2,424 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | THE DJB GROUP, INC. |
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UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
Policy contract number | 903873301 |
Policy instance | 7 |
Insurance contract or identification number | 903873301 | Number of Individuals Covered | 55 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $5,381 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $202,791 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,381 | Amount paid for insurance broker fees | 0 | Insurance broker name | CROTTY INSURANCE AGENCY, INC. |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G 00610052 |
Policy instance | 1 |
Insurance contract or identification number | G 00610052 | Number of Individuals Covered | 267 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $1,944 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $23,403 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
Policy contract number | |
Policy instance | 2 |
Number of Individuals Covered | 109 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $171,307 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
Policy contract number | G 00610052 |
Policy instance | 1 |
Insurance contract or identification number | G 00610052 | Number of Individuals Covered | 240 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $1,725 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $18,991 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
Policy contract number | |
Policy instance | 2 |
Number of Individuals Covered | 107 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Welfare Benefit Premiums Paid to Carrier | USD $166,706 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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