SHUSTER'S BUILDERS SUPPLIES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN
401k plan membership statisitcs for SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN
Measure | Date | Value |
---|
2022: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2022 401k membership |
---|
Total participants, beginning-of-year | 2022-02-01 | 105 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 95 |
Number of retired or separated participants receiving benefits | 2022-02-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2022-02-01 | 0 |
Total of all active and inactive participants | 2022-02-01 | 97 |
2021: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2021 401k membership |
---|
Total participants, beginning-of-year | 2021-02-01 | 115 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 104 |
Number of retired or separated participants receiving benefits | 2021-02-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2021-02-01 | 0 |
Total of all active and inactive participants | 2021-02-01 | 105 |
2020: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2020 401k membership |
---|
Total participants, beginning-of-year | 2020-02-01 | 108 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 113 |
Number of retired or separated participants receiving benefits | 2020-02-01 | 2 |
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 | 115 |
2019: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-02-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 107 |
Number of retired or separated participants receiving benefits | 2019-02-01 | 1 |
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 | 108 |
2018: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-02-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 113 |
Number of retired or separated participants receiving benefits | 2018-02-01 | 3 |
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 | 116 |
2017: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-02-01 | 114 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 116 |
Number of retired or separated participants receiving benefits | 2017-02-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-02-01 | 0 |
Total of all active and inactive participants | 2017-02-01 | 116 |
2016: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-02-01 | 130 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 112 |
Number of retired or separated participants receiving benefits | 2016-02-01 | 2 |
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 | 114 |
2015: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-02-01 | 128 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 126 |
Number of retired or separated participants receiving benefits | 2015-02-01 | 4 |
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 | 130 |
2014: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-02-01 | 178 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 117 |
Number of retired or separated participants receiving benefits | 2014-02-01 | 11 |
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 | 128 |
2013: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2013 401k membership |
---|
Total participants, beginning-of-year | 2013-02-01 | 170 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 174 |
Number of retired or separated participants receiving benefits | 2013-02-01 | 4 |
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 | 178 |
2012: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2012 401k membership |
---|
Total participants, beginning-of-year | 2012-02-01 | 168 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 167 |
Number of retired or separated participants receiving benefits | 2012-02-01 | 3 |
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 | 170 |
2011: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2011 401k membership |
---|
Total participants, beginning-of-year | 2011-02-01 | 196 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 166 |
Number of retired or separated participants receiving benefits | 2011-02-01 | 2 |
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 | 168 |
2009: SHUSTER'S BUILDERS SUPPLIES, INC. WELFARE BENEFIT PLAN 2009 401k membership |
---|
Total participants, beginning-of-year | 2009-02-01 | 305 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-02-01 | 258 |
Number of retired or separated participants receiving benefits | 2009-02-01 | 11 |
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 | 269 |
BEAZLEY INSURANCE COMPANY INC (National Association of Insurance Commissioners NAIC id number: 37540 ) |
Policy contract number | 0H50J6 |
Policy instance | 3 |
Insurance contract or identification number | 0H50J6 | Insurance policy start date | 2022-02-02 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Number of Individuals Covered | 11 | Welfare Benefit Premiums Paid to Carrier | USD $8,529 | Commission paid to Insurance Broker | USD $853 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 307649 |
Policy instance | 2 |
Insurance contract or identification number | 307649 | Number of Individuals Covered | 110 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $8,811 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $54,078 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,811 | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0907803 |
Policy instance | 1 |
Insurance contract or identification number | 0907803 | Number of Individuals Covered | 201 | Insurance policy start date | 2022-02-01 | Insurance policy end date | 2023-01-31 | Total amount of commissions paid to insurance broker | USD $14,753 | Total amount of fees paid to insurance company | USD $22,900 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $822,776 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,507 | Amount paid for insurance broker fees | 22900 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
|
BEAZLEY INSURANCE COMPANY INC (National Association of Insurance Commissioners NAIC id number: 37540 ) |
Policy contract number | 0H50J6 |
Policy instance | 3 |
Insurance contract or identification number | 0H50J6 | Number of Individuals Covered | 14 | Insurance policy start date | 2021-02-02 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $1,524 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $10,161 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,016 | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 307649 |
Policy instance | 2 |
Insurance contract or identification number | 307649 | Number of Individuals Covered | 102 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $9,761 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D CRITICAL ILLNESS ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $60,106 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $9,761 | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0907803 |
Policy instance | 1 |
Insurance contract or identification number | 0907803 | Number of Individuals Covered | 223 | Insurance policy start date | 2021-02-01 | Insurance policy end date | 2022-01-31 | Total amount of commissions paid to insurance broker | USD $18,811 | Total amount of fees paid to insurance company | USD $22,616 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $781,961 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,924 | Amount paid for insurance broker fees | 22616 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0907803 |
Policy instance | 1 |
Insurance contract or identification number | 0907803 | Number of Individuals Covered | 238 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $14,621 | Total amount of fees paid to insurance company | USD $17,100 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $600,409 | 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 | Amount paid for insurance broker fees | 17100 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 307649 |
Policy instance | 2 |
Insurance contract or identification number | 307649 | Number of Individuals Covered | 137 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $7,613 | Total amount of fees paid to insurance company | USD $0 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D CRITICAL ILLNESS ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $60,194 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,613 | Insurance broker organization code? | 3 |
|
BEAZLEY INSURANCE COMPANY INC (National Association of Insurance Commissioners NAIC id number: 37540 ) |
Policy contract number | 0H50J6 |
Policy instance | 3 |
Insurance contract or identification number | 0H50J6 | Number of Individuals Covered | 11 | Insurance policy start date | 2020-02-02 | Insurance policy end date | 2021-01-31 | Total amount of commissions paid to insurance broker | USD $1,367 | Total amount of fees paid to insurance company | USD $0 | Welfare Benefit Premiums Paid to Carrier | USD $9,110 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $911 | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04555 |
Policy instance | 1 |
Insurance contract or identification number | 04555 | Number of Individuals Covered | 161 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $1,365 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $45,513 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,365 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 210573 |
Policy instance | 2 |
Insurance contract or identification number | 210573 | Number of Individuals Covered | 107 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $5,493 | Total amount of fees paid to insurance company | USD $414 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $45,845 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,493 | Amount paid for insurance broker fees | 414 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 4052566 |
Policy instance | 3 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 33 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $1,251 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $8,761 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,251 | Insurance broker organization code? | 3 |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 4052566 |
Policy instance | 4 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 15 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $1,298 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | SUPPLEMENTAL HEALTH INSURANCE | Welfare Benefit Premiums Paid to Carrier | USD $8,653 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,298 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 506424 |
Policy instance | 5 |
Insurance contract or identification number | 506424 | Number of Individuals Covered | 21 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $2,139 | Total amount of fees paid to insurance company | USD $107 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,810 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,139 | Amount paid for insurance broker fees | 107 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 907803 |
Policy instance | 6 |
Insurance contract or identification number | 907803 | Number of Individuals Covered | 157 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-01-31 | Total amount of commissions paid to insurance broker | USD $2,297 | Total amount of fees paid to insurance company | USD $16,790 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $647,802 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,297 | Amount paid for insurance broker fees | 16661 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04555 |
Policy instance | 1 |
Insurance contract or identification number | 04555 | Number of Individuals Covered | 163 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $1,313 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $43,769 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $744 | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 907803 |
Policy instance | 6 |
Insurance contract or identification number | 907803 | Number of Individuals Covered | 155 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $633 | Total amount of fees paid to insurance company | USD $17,670 | Health Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $575,647 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $431 | Amount paid for insurance broker fees | 10436 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 506424 |
Policy instance | 5 |
Insurance contract or identification number | 506424 | Number of Individuals Covered | 23 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $1,917 | Total amount of fees paid to insurance company | USD $155 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $13,797 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,917 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 155 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 4052566 |
Policy instance | 4 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 13 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $1,226 | Total amount of fees paid to insurance company | USD $1,185 | Other welfare benefits provided | SUPPLEMENTAL HEALTH INSURANCE | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,226 | Amount paid for insurance broker fees | 1185 | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES | Insurance broker organization code? | 3 |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 4052566 |
Policy instance | 3 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 36 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-01-31 | Total amount of commissions paid to insurance broker | USD $1,593 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | Welfare Benefit Premiums Paid to Carrier | USD $8,449 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,593 | Insurance broker organization code? | 3 |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 210573 |
Policy instance | 2 |
Insurance contract or identification number | 210573 | Number of Individuals Covered | 116 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $5,427 | Total amount of fees paid to insurance company | USD $671 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $60,351 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,427 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 671 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 907803 |
Policy instance | 6 |
Insurance contract or identification number | 907803 | Number of Individuals Covered | 149 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $672 | Total amount of fees paid to insurance company | USD $18,200 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $570,251 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $672 | Amount paid for insurance broker fees | 17959 | Additional information about fees paid to insurance broker | SERVICE FEE AGREEMENT | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 506424 |
Policy instance | 5 |
Insurance contract or identification number | 506424 | Number of Individuals Covered | 23 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $1,930 | Total amount of fees paid to insurance company | USD $161 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,869 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,930 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 161 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker name | THREE RIVERS FIN. SERVICES, INC. |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 4052566 |
Policy instance | 4 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 8 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $1,207 | Total amount of fees paid to insurance company | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,207 | Insurance broker organization code? | 3 | Insurance broker name | KEY INSURANCE & BENEFITS SERV. INC. |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 4052566 |
Policy instance | 3 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 33 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $574 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $7,709 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $574 | Insurance broker organization code? | 3 | Insurance broker name | KEY INSURANCE & BENEFITS SERV. INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 210573 |
Policy instance | 2 |
Insurance contract or identification number | 210573 | Number of Individuals Covered | 116 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $5,384 | Total amount of fees paid to insurance company | USD $689 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $59,824 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,384 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 689 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION PAID | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04555 |
Policy instance | 1 |
Insurance contract or identification number | 04555 | Number of Individuals Covered | 171 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-01-31 | Total amount of commissions paid to insurance broker | USD $1,372 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $45,747 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,372 | Insurance broker organization code? | 3 | Insurance broker name | KEY INSURANCE & BENEFITS SERV. INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 506424 |
Policy instance | 5 |
Insurance contract or identification number | 506424 | Number of Individuals Covered | 24 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $1,963 | Total amount of fees paid to insurance company | USD $170 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,831 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,963 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 170 | Additional information about fees paid to insurance broker | CONTRACT FEES/BROKER BONUS | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04555 |
Policy instance | 1 |
Insurance contract or identification number | 04555 | Number of Individuals Covered | 178 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $1,408 | Total amount of fees paid to insurance company | USD $0 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,932 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,408 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 210573 |
Policy instance | 2 |
Insurance contract or identification number | 210573 | Number of Individuals Covered | 126 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $4,864 | Total amount of fees paid to insurance company | USD $662 | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $51,847 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,864 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 662 | Additional information about fees paid to insurance broker | CONTRACT FEES/BROKER BONUS | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 4052566 |
Policy instance | 3 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 22 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $1,028 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $7,191 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,028 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 4052566 |
Policy instance | 4 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 12 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $1,400 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | GAP/HOSPITAL CONFINEMENT INDEMNITY | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,400 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 01736954 |
Policy instance | 6 |
Insurance contract or identification number | 01736954 | Number of Individuals Covered | 167 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-01-31 | Total amount of commissions paid to insurance broker | USD $16,651 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $562,192 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $16,651 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 506424 |
Policy instance | 5 |
Insurance contract or identification number | 506424 | Number of Individuals Covered | 25 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $2,587 | Total amount of fees paid to insurance company | USD $301 | 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 | Welfare Benefit Premiums Paid to Carrier | USD $17,249 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,587 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 301 | Additional information about fees paid to insurance broker | ADDITIONAL BROKER COMPENSATION | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 210573 |
Policy instance | 2 |
Insurance contract or identification number | 210573 | Number of Individuals Covered | 117 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $4,579 | Total amount of fees paid to insurance company | USD $901 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $51,488 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,579 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 901 | Additional information about fees paid to insurance broker | ADDITIONAL BROKER COMPENSATION | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 01736954 |
Policy instance | 6 |
Insurance contract or identification number | 01736954 | Number of Individuals Covered | 97 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $15,050 | 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 $501,392 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $15,050 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 4052566 |
Policy instance | 3 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 22 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $1,607 | 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 | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $8,560 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,607 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04555 |
Policy instance | 1 |
Insurance contract or identification number | 04555 | Number of Individuals Covered | 93 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $1,483 | 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 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $49,443 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,483 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 4052566 |
Policy instance | 4 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 11 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-01-31 | Total amount of commissions paid to insurance broker | USD $1,333 | 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 | Other welfare benefits provided | GAP/HOSPITAL CONFINEMENT INDEMNITY | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,333 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 4052566 |
Policy instance | 4 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 25 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $1,378 | 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 | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $8,596 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,378 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 5924763000 |
Policy instance | 3 |
Insurance contract or identification number | 5924763000 | Number of Individuals Covered | 174 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $11,590 | 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 $462,166 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,590 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04555 |
Policy instance | 1 |
Insurance contract or identification number | 04555 | Number of Individuals Covered | 100 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $1,461 | 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 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $48,697 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,461 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
Policy contract number | 4052566 |
Policy instance | 6 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 10 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $1,227 | 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 | Other welfare benefits provided | GAP/HOSPITAL CONFINEMENT INDEMNITY | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,227 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
Policy contract number | 5924760000 |
Policy instance | 5 |
Insurance contract or identification number | 5924760000 | Number of Individuals Covered | 4 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-01-31 | Total amount of commissions paid to insurance broker | USD $341 | 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 $15,043 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $341 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 210573 |
Policy instance | 2 |
Insurance contract or identification number | 210573 | Number of Individuals Covered | 135 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $4,589 | Total amount of fees paid to insurance company | USD $602 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $52,089 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,589 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 602 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
Policy contract number | 4052566 |
Policy instance | 4 |
Insurance contract or identification number | 4052566 | Number of Individuals Covered | 23 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $2,129 | 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 | Other welfare benefits provided | CRITICAL ILLNESS, ACCIDENT | Welfare Benefit Premiums Paid to Carrier | USD $8,644 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,129 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
HEALTHAMERICA OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 95060 ) |
Policy contract number | 5924760000 |
Policy instance | 3 |
Insurance contract or identification number | 5924760000 | Number of Individuals Covered | 166 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $12,368 | 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 $494,732 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $12,368 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 04555 |
Policy instance | 1 |
Insurance contract or identification number | 04555 | Number of Individuals Covered | 89 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $1,392 | 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 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,413 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,024 | Insurance broker organization code? | 3 | Insurance broker name | THREE RIVERS FINANCIAL SERVICES,INC |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 210573 |
Policy instance | 2 |
Insurance contract or identification number | 210573 | Number of Individuals Covered | 124 | Insurance policy start date | 2012-01-01 | Insurance policy end date | 2012-12-31 | Total amount of commissions paid to insurance broker | USD $4,161 | Total amount of fees paid to insurance company | USD $572 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $45,731 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,161 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 572 | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
Policy contract number | 5924760000 |
Policy instance | 5 |
Insurance contract or identification number | 5924760000 | Number of Individuals Covered | 4 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $343 | 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 $13,405 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $343 | Insurance broker organization code? | 3 | Insurance broker name | FIRST NIAGRA RISK MANAGEMENT, INC. |
|
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
Policy contract number | 5924760000 |
Policy instance | 3 |
Insurance contract or identification number | 5924760000 | Number of Individuals Covered | 168 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $17,539 | 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 $584,841 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | PA4555 |
Policy instance | 1 |
Insurance contract or identification number | PA4555 | Number of Individuals Covered | 85 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of commissions paid to insurance broker | USD $1,395 | 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 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $46,513 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 210573 |
Policy instance | 2 |
Insurance contract or identification number | 210573 | Number of Individuals Covered | 112 | Insurance policy start date | 2011-01-01 | Insurance policy end date | 2011-12-31 | Total amount of commissions paid to insurance broker | USD $4,256 | Total amount of fees paid to insurance company | USD $172 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $46,040 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 475289 |
Policy instance | 3 |
Insurance contract or identification number | 475289 | Number of Individuals Covered | 196 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $8,768 | 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 $735,630 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
Policy contract number | 210573 |
Policy instance | 2 |
Insurance contract or identification number | 210573 | Number of Individuals Covered | 129 | Insurance policy start date | 2010-01-01 | Insurance policy end date | 2010-12-31 | Total amount of commissions paid to insurance broker | USD $4,772 | Total amount of fees paid to insurance company | USD $332 | 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 | Temporary Disability Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $53,030 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | PA4555 |
Policy instance | 1 |
Insurance contract or identification number | PA4555 | Number of Individuals Covered | 103 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $1,595 | 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 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $53,167 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|