ERIE HOMES FOR CHILDREN AND ADULTS, INC has sponsored the creation of one or more 401k plans.
Measure | Date | Value |
---|
2022: EHCA-SP 2022 401k membership |
---|
Total participants, beginning-of-year | 2022-02-01 | 280 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 285 |
Total of all active and inactive participants | 2022-02-01 | 285 |
Total participants | 2022-02-01 | 285 |
2021: EHCA-SP 2021 401k membership |
---|
Total participants, beginning-of-year | 2021-02-01 | 318 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 280 |
Total of all active and inactive participants | 2021-02-01 | 280 |
Total participants | 2021-02-01 | 280 |
2020: EHCA-SP 2020 401k membership |
---|
Total participants, beginning-of-year | 2020-02-01 | 323 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 318 |
Number of retired or separated participants receiving benefits | 2020-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-02-01 | 0 |
Total of all active and inactive participants | 2020-02-01 | 318 |
Total participants | 2020-02-01 | 318 |
2019: EHCA-SP 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-02-01 | 324 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 323 |
Number of retired or separated participants receiving benefits | 2019-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-02-01 | 0 |
Total of all active and inactive participants | 2019-02-01 | 323 |
Total participants | 2019-02-01 | 323 |
2018: EHCA-SP 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-02-01 | 290 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 324 |
Number of retired or separated participants receiving benefits | 2018-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-02-01 | 0 |
Total of all active and inactive participants | 2018-02-01 | 324 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-02-01 | 0 |
Total participants | 2018-02-01 | 324 |
Number of participants with account balances | 2018-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2018-02-01 | 0 |
2017: EHCA-SP 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-02-01 | 297 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 287 |
Total of all active and inactive participants | 2017-02-01 | 287 |
Total participants | 2017-02-01 | 287 |
2016: EHCA-SP 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-02-01 | 276 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 297 |
Number of retired or separated participants receiving benefits | 2016-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2016-02-01 | 0 |
Total of all active and inactive participants | 2016-02-01 | 297 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-02-01 | 0 |
Total participants | 2016-02-01 | 297 |
Number of participants with account balances | 2016-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2016-02-01 | 0 |
Number of employers contributing to the scheme | 2016-02-01 | 0 |
2015: EHCA-SP 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-02-01 | 255 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 276 |
Number of retired or separated participants receiving benefits | 2015-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2015-02-01 | 0 |
Total of all active and inactive participants | 2015-02-01 | 276 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-02-01 | 0 |
Total participants | 2015-02-01 | 276 |
Number of participants with account balances | 2015-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2015-02-01 | 0 |
Number of employers contributing to the scheme | 2015-02-01 | 0 |
2014: EHCA-SP 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-02-01 | 274 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 255 |
Number of retired or separated participants receiving benefits | 2014-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-02-01 | 0 |
Total of all active and inactive participants | 2014-02-01 | 255 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-02-01 | 0 |
Total participants | 2014-02-01 | 255 |
Number of participants with account balances | 2014-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2014-02-01 | 0 |
Number of employers contributing to the scheme | 2014-02-01 | 0 |
2013: EHCA-SP 2013 401k membership |
---|
Total participants, beginning-of-year | 2013-02-01 | 259 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 274 |
Number of retired or separated participants receiving benefits | 2013-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-02-01 | 0 |
Total of all active and inactive participants | 2013-02-01 | 274 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-02-01 | 0 |
Total participants | 2013-02-01 | 274 |
Number of participants with account balances | 2013-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2013-02-01 | 0 |
Number of employers contributing to the scheme | 2013-02-01 | 0 |
2012: EHCA-SP 2012 401k membership |
---|
Total participants, beginning-of-year | 2012-02-01 | 233 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 259 |
Number of retired or separated participants receiving benefits | 2012-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-02-01 | 0 |
Total of all active and inactive participants | 2012-02-01 | 259 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-02-01 | 0 |
Total participants | 2012-02-01 | 259 |
Number of participants with account balances | 2012-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2012-02-01 | 0 |
Number of employers contributing to the scheme | 2012-02-01 | 0 |
2011: EHCA-SP 2011 401k membership |
---|
Total participants, beginning-of-year | 2011-02-01 | 225 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 233 |
Number of retired or separated participants receiving benefits | 2011-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2011-02-01 | 0 |
Total of all active and inactive participants | 2011-02-01 | 233 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-02-01 | 0 |
Total participants | 2011-02-01 | 233 |
Number of participants with account balances | 2011-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2011-02-01 | 0 |
Number of employers contributing to the scheme | 2011-02-01 | 0 |
2010: EHCA-SP 2010 401k membership |
---|
Total participants, beginning-of-year | 2010-02-01 | 201 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 225 |
Number of retired or separated participants receiving benefits | 2010-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2010-02-01 | 0 |
Total of all active and inactive participants | 2010-02-01 | 225 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-02-01 | 0 |
Total participants | 2010-02-01 | 225 |
Number of participants with account balances | 2010-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-02-01 | 0 |
Number of employers contributing to the scheme | 2010-02-01 | 0 |
2009: EHCA-SP 2009 401k membership |
---|
Total participants, beginning-of-year | 2009-02-01 | 182 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 201 |
Number of retired or separated participants receiving benefits | 2009-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-02-01 | 0 |
Total of all active and inactive participants | 2009-02-01 | 201 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-02-01 | 0 |
Total participants | 2009-02-01 | 201 |
Number of participants with account balances | 2009-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-02-01 | 0 |
Number of employers contributing to the scheme | 2009-02-01 | 0 |
2008: EHCA-SP 2008 401k membership |
---|
Total participants, beginning-of-year | 2008-02-01 | 171 |
Total number of active participants reported on line 7a of the Form 5500 | 2008-02-01 | 182 |
Number of retired or separated participants receiving benefits | 2008-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2008-02-01 | 0 |
Total of all active and inactive participants | 2008-02-01 | 182 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2008-02-01 | 0 |
Total participants | 2008-02-01 | 182 |
Number of participants with account balances | 2008-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2008-02-01 | 0 |
Number of employers contributing to the scheme | 2008-02-01 | 0 |
2007: EHCA-SP 2007 401k membership |
---|
Total participants, beginning-of-year | 2007-02-01 | 171 |
Total number of active participants reported on line 7a of the Form 5500 | 2007-02-01 | 171 |
Number of retired or separated participants receiving benefits | 2007-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2007-02-01 | 0 |
Total of all active and inactive participants | 2007-02-01 | 171 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2007-02-01 | 0 |
Total participants | 2007-02-01 | 171 |
Number of participants with account balances | 2007-02-01 | 0 |
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2007-02-01 | 0 |
Number of employers contributing to the scheme | 2007-02-01 | 0 |
2022: EHCA-SP 2022 form 5500 responses |
---|
2022-02-01 | Type of plan entity | Single employer plan |
2022-02-01 | Submission has been amended | No |
2022-02-01 | This submission is the final filing | No |
2022-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-02-01 | Plan is a collectively bargained plan | No |
2022-02-01 | Plan funding arrangement – Insurance | Yes |
2022-02-01 | Plan benefit arrangement – Insurance | Yes |
2021: EHCA-SP 2021 form 5500 responses |
---|
2021-02-01 | Type of plan entity | Single employer plan |
2021-02-01 | Submission has been amended | No |
2021-02-01 | This submission is the final filing | No |
2021-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-02-01 | Plan is a collectively bargained plan | No |
2021-02-01 | Plan funding arrangement – Insurance | Yes |
2021-02-01 | Plan benefit arrangement – Insurance | Yes |
2020: EHCA-SP 2020 form 5500 responses |
---|
2020-02-01 | Type of plan entity | Single employer plan |
2020-02-01 | Submission has been amended | No |
2020-02-01 | This submission is the final filing | No |
2020-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-02-01 | Plan is a collectively bargained plan | No |
2020-02-01 | Plan funding arrangement – Insurance | Yes |
2020-02-01 | Plan benefit arrangement – Insurance | Yes |
2019: EHCA-SP 2019 form 5500 responses |
---|
2019-02-01 | Type of plan entity | Single employer plan |
2019-02-01 | Submission has been amended | No |
2019-02-01 | This submission is the final filing | No |
2019-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-02-01 | Plan is a collectively bargained plan | No |
2019-02-01 | Plan funding arrangement – Insurance | Yes |
2019-02-01 | Plan benefit arrangement – Insurance | Yes |
2018: EHCA-SP 2018 form 5500 responses |
---|
2018-02-01 | Type of plan entity | Single employer plan |
2018-02-01 | Submission has been amended | No |
2018-02-01 | This submission is the final filing | No |
2018-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-02-01 | Plan is a collectively bargained plan | No |
2018-02-01 | Plan funding arrangement – Insurance | Yes |
2018-02-01 | Plan benefit arrangement – Insurance | Yes |
2017: EHCA-SP 2017 form 5500 responses |
---|
2017-02-01 | Type of plan entity | Single employer plan |
2017-02-01 | Submission has been amended | No |
2017-02-01 | This submission is the final filing | No |
2017-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-02-01 | Plan is a collectively bargained plan | No |
2017-02-01 | Plan funding arrangement – Insurance | Yes |
2017-02-01 | Plan benefit arrangement – Insurance | Yes |
2016: EHCA-SP 2016 form 5500 responses |
---|
2016-02-01 | Type of plan entity | Single employer plan |
2016-02-01 | Submission has been amended | No |
2016-02-01 | This submission is the final filing | No |
2016-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-02-01 | Plan is a collectively bargained plan | No |
2016-02-01 | Plan funding arrangement – Insurance | Yes |
2016-02-01 | Plan benefit arrangement – Insurance | Yes |
2015: EHCA-SP 2015 form 5500 responses |
---|
2015-02-01 | Type of plan entity | Single employer plan |
2015-02-01 | Submission has been amended | No |
2015-02-01 | This submission is the final filing | No |
2015-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-02-01 | Plan is a collectively bargained plan | No |
2015-02-01 | Plan funding arrangement – Insurance | Yes |
2015-02-01 | Plan benefit arrangement – Insurance | Yes |
2014: EHCA-SP 2014 form 5500 responses |
---|
2014-02-01 | Type of plan entity | Single employer plan |
2014-02-01 | Submission has been amended | No |
2014-02-01 | This submission is the final filing | No |
2014-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-02-01 | Plan is a collectively bargained plan | No |
2014-02-01 | Plan funding arrangement – Insurance | Yes |
2014-02-01 | Plan benefit arrangement – Insurance | Yes |
2013: EHCA-SP 2013 form 5500 responses |
---|
2013-02-01 | Type of plan entity | Single employer plan |
2013-02-01 | Submission has been amended | No |
2013-02-01 | This submission is the final filing | No |
2013-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-02-01 | Plan is a collectively bargained plan | No |
2013-02-01 | Plan funding arrangement – Insurance | Yes |
2013-02-01 | Plan benefit arrangement – Insurance | Yes |
2012: EHCA-SP 2012 form 5500 responses |
---|
2012-02-01 | Type of plan entity | Single employer plan |
2012-02-01 | Submission has been amended | No |
2012-02-01 | This submission is the final filing | No |
2012-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-02-01 | Plan is a collectively bargained plan | No |
2012-02-01 | Plan funding arrangement – Insurance | Yes |
2012-02-01 | Plan benefit arrangement – Insurance | Yes |
2011: EHCA-SP 2011 form 5500 responses |
---|
2011-02-01 | Type of plan entity | Single employer plan |
2011-02-01 | Submission has been amended | No |
2011-02-01 | This submission is the final filing | No |
2011-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-02-01 | Plan is a collectively bargained plan | No |
2011-02-01 | Plan funding arrangement – Insurance | Yes |
2011-02-01 | Plan benefit arrangement – Insurance | Yes |
2010: EHCA-SP 2010 form 5500 responses |
---|
2010-02-01 | Type of plan entity | Single employer plan |
2010-02-01 | Submission has been amended | No |
2010-02-01 | This submission is the final filing | No |
2010-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-02-01 | Plan is a collectively bargained plan | No |
2010-02-01 | Plan funding arrangement – Insurance | Yes |
2010-02-01 | Plan benefit arrangement – Insurance | Yes |
2009: EHCA-SP 2009 form 5500 responses |
---|
2009-02-01 | Type of plan entity | Single employer plan |
2009-02-01 | Submission has been amended | No |
2009-02-01 | This submission is the final filing | No |
2009-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-02-01 | Plan is a collectively bargained plan | No |
2009-02-01 | Plan funding arrangement – Insurance | Yes |
2009-02-01 | Plan benefit arrangement – Insurance | Yes |
2008: EHCA-SP 2008 form 5500 responses |
---|
2008-02-01 | Type of plan entity | Single employer plan |
2008-02-01 | Submission has been amended | No |
2008-02-01 | This submission is the final filing | No |
2008-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2008-02-01 | Plan is a collectively bargained plan | No |
2008-02-01 | Plan funding arrangement – Insurance | Yes |
2008-02-01 | Plan benefit arrangement – Insurance | Yes |
2007: EHCA-SP 2007 form 5500 responses |
---|
2007-02-01 | Type of plan entity | Single employer plan |
2007-02-01 | Submission has been amended | No |
2007-02-01 | This submission is the final filing | No |
2007-02-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2007-02-01 | Plan is a collectively bargained plan | No |
2007-02-01 | Plan funding arrangement – Insurance | Yes |
2007-02-01 | Plan benefit arrangement – Insurance | Yes |
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788903 |
Policy instance | 4 |
Insurance contract or identification number | 021788903 | Number of Individuals Covered | 0 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $-38 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $-5,060 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $-38 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788902 |
Policy instance | 3 |
Insurance contract or identification number | 021788902 | Number of Individuals Covered | 0 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $-44 | Total amount of fees paid to insurance company | USD $0 | 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 $-2,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $-44 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788302 |
Policy instance | 2 |
Insurance contract or identification number | 021788302 | Number of Individuals Covered | 3 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $759 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $27,829 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $863 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788800 |
Policy instance | 1 |
Insurance contract or identification number | 021788800 | Number of Individuals Covered | 282 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $46,020 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $1,770,413 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $46,020 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788800 |
Policy instance | 1 |
Insurance contract or identification number | 021788800 | Number of Individuals Covered | 275 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $46,320 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $1,499,697 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $46,320 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788302 |
Policy instance | 2 |
Insurance contract or identification number | 021788302 | Number of Individuals Covered | 4 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $863 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $27,731 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $863 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788903 |
Policy instance | 3 |
Insurance contract or identification number | 021788903 | Number of Individuals Covered | 1 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $399 | Total amount of fees paid to insurance company | USD $0 | 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 $15,966 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $399 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788902 |
Policy instance | 4 |
Insurance contract or identification number | 021788902 | Number of Individuals Covered | 0 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $158 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $6,454 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $158 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788800 |
Policy instance | 1 |
Insurance contract or identification number | 021788800 | Number of Individuals Covered | 314 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $45,491 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $178,711,844 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $45,491 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788302 |
Policy instance | 2 |
Insurance contract or identification number | 021788302 | Number of Individuals Covered | 4 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $792 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $28,368 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $792 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788903 |
Policy instance | 3 |
Insurance contract or identification number | 021788903 | Number of Individuals Covered | 0 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $93 | Total amount of fees paid to insurance company | USD $0 | 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 $3,991 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $93 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788902 |
Policy instance | 4 |
Insurance contract or identification number | 021788902 | Number of Individuals Covered | 0 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | 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? | 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? | Yes | 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 | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | DRTBIVR GRR | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788902 |
Policy instance | 4 |
Insurance contract or identification number | 021788902 | Number of Individuals Covered | 0 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | 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? | 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 $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788900 |
Policy instance | 3 |
Insurance contract or identification number | 021788900 | Number of Individuals Covered | 0 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $291 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $6,367 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $291 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788302 |
Policy instance | 2 |
Insurance contract or identification number | 021788302 | Number of Individuals Covered | 5 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $700 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $23,420 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $700 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788300 |
Policy instance | 1 |
Insurance contract or identification number | 021788300 | Number of Individuals Covered | 318 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $45,675 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $1,471,050 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $45,675 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788902 |
Policy instance | 6 |
Insurance contract or identification number | 021788902 | Number of Individuals Covered | 0 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | 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? | 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? | Yes | 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 | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788300 |
Policy instance | 1 |
Insurance contract or identification number | 021788300 | Number of Individuals Covered | 286 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $30,250 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $1,195,288 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $30,250 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788301 |
Policy instance | 2 |
Insurance contract or identification number | 021788301 | Number of Individuals Covered | 29 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $3,203 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $126,430 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $3,203 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788302 |
Policy instance | 3 |
Insurance contract or identification number | 021788302 | Number of Individuals Covered | 3 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $546 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $20,858 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $546 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788900 |
Policy instance | 4 |
Insurance contract or identification number | 021788900 | Number of Individuals Covered | 2 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $457 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $18,564 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $457 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
Policy contract number | 021788901 |
Policy instance | 5 |
Insurance contract or identification number | 021788901 | Number of Individuals Covered | 0 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | 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? | 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? | Yes | 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 | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 |
|
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 08883470 |
Policy instance | 1 |
Insurance contract or identification number | 08883470 | Number of Individuals Covered | 287 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $45,526 | Total amount of fees paid to insurance company | USD $0 | 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? | Yes | 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 $1,384,707 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $45,526 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 | Insurance broker name | LOESEL-SCHAFF INSURANCE AGENCY INC |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 7005820000 |
Policy instance | 1 |
Insurance contract or identification number | 7005820000 | Number of Individuals Covered | 276 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $28,449 | 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? | Yes | 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 $1,309,937 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $9,738 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 | Insurance broker name | BERT COMPANY DBA NORTHWEST INSSRVS |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 7005820000 |
Policy instance | 1 |
Insurance contract or identification number | 7005820000 | Number of Individuals Covered | 255 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $27,396 | 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? | Yes | 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 $1,095,859 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $27,396 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 | Insurance broker name | BERT COMPANY DBA NORTHWEST INS SRVS |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 7005820000 |
Policy instance | 1 |
Insurance contract or identification number | 7005820000 | Number of Individuals Covered | 274 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $27,612 | 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? | Yes | 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 $1,120,970 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $18,412 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 | Insurance broker name | BERT COMPANY |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 7005820000 |
Policy instance | 1 |
Insurance contract or identification number | 7005820000 | Number of Individuals Covered | 259 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $27,243 | 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? | Yes | 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 $908,098 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $27,243 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEE | Insurance broker organization code? | 3 | Insurance broker name | BERT COMPANY |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 7005820000 |
Policy instance | 1 |
Insurance contract or identification number | 7005820000 | Number of Individuals Covered | 233 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $25,007 | 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? | Yes | 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 $833,574 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 7005820000 |
Policy instance | 1 |
Insurance contract or identification number | 7005820000 | Number of Individuals Covered | 225 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $25,951 | 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? | Yes | 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 $865,041 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 7005820000 |
Policy instance | 1 |
Insurance contract or identification number | 7005820000 | Number of Individuals Covered | 201 | Insurance policy start date | 2009-02-01 | Insurance policy end date | 2010-01-31 | Total amount of commissions paid to insurance broker | USD $27,158 | 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? | Yes | 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 $905,265 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $27,158 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 | Insurance broker name | BERT COMPANY |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 7005820000 |
Policy instance | 1 |
Insurance contract or identification number | 7005820000 | Number of Individuals Covered | 182 | Insurance policy start date | 2008-02-01 | Insurance policy end date | 2009-01-31 | Total amount of commissions paid to insurance broker | USD $23,292 | 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? | Yes | 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 $776,404 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $23,292 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 | Insurance broker name | BERT COMPANY |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 7005820000 |
Policy instance | 1 |
Insurance contract or identification number | 7005820000 | Number of Individuals Covered | 171 | Insurance policy start date | 2007-02-01 | Insurance policy end date | 2008-01-31 | Total amount of commissions paid to insurance broker | USD $21,304 | 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? | Yes | 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 $710,143 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Other information about contract | GROUP INSURANCE | Commission paid to Insurance Broker | USD $21,304 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | SERVICE FEES | Insurance broker organization code? | 3 | Insurance broker name | BERT COMPANY |
|