MANUFACTURER & BUSINESS ASSOCIATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST
| Measure | Date | Value |
|---|
| 2015 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $858,373 |
| Total income from all sources (including contributions) | 2015-05-31 | $5,859,032 |
| Total of all expenses incurred | 2015-05-31 | $5,933,140 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-05-31 | $5,548,804 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-05-31 | $5,858,028 |
| Value of total assets at end of year | 2015-05-31 | $0 |
| Value of total assets at beginning of year | 2015-05-31 | $932,481 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-05-31 | $384,336 |
| Total interest from all sources | 2015-05-31 | $1,004 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-05-31 | Yes |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2015-05-31 | $0 |
| Administrative expenses professional fees incurred | 2015-05-31 | $28,942 |
| Was this plan covered by a fidelity bond | 2015-05-31 | Yes |
| Value of fidelity bond cover | 2015-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-05-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-05-31 | $14,049 |
| Administrative expenses (other) incurred | 2015-05-31 | $266,128 |
| Liabilities. Value of operating payables at end of year | 2015-05-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2015-05-31 | $111,319 |
| Total non interest bearing cash at end of year | 2015-05-31 | $0 |
| Total non interest bearing cash at beginning of year | 2015-05-31 | $102,648 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Value of net income/loss | 2015-05-31 | $-74,108 |
| Value of net assets at end of year (total assets less liabilities) | 2015-05-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-05-31 | $74,108 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-05-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-05-31 | $815,784 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-05-31 | $815,784 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-05-31 | $1,004 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-05-31 | $5,548,804 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-05-31 | No |
| Contributions received in cash from employer | 2015-05-31 | $5,858,028 |
| Contract administrator fees | 2015-05-31 | $89,266 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2015-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-05-31 | $747,054 |
| Did the plan have assets held for investment | 2015-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-05-31 | Yes |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-05-31 | Unqualified |
| Accountancy firm name | 2015-05-31 | SISTERSON & CO., LLP |
| Accountancy firm EIN | 2015-05-31 | 251467156 |
| 2014 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $858,373 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $1,038,374 |
| Total income from all sources (including contributions) | 2014-05-31 | $11,343,307 |
| Total of all expenses incurred | 2014-05-31 | $11,472,458 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-05-31 | $10,884,532 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-05-31 | $11,337,277 |
| Value of total assets at end of year | 2014-05-31 | $932,481 |
| Value of total assets at beginning of year | 2014-05-31 | $1,241,633 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-05-31 | $587,926 |
| Total interest from all sources | 2014-05-31 | $2,674 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-05-31 | No |
| Administrative expenses professional fees incurred | 2014-05-31 | $7,650 |
| Was this plan covered by a fidelity bond | 2014-05-31 | Yes |
| Value of fidelity bond cover | 2014-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-05-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-05-31 | $14,049 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-05-31 | $3,113 |
| Other income not declared elsewhere | 2014-05-31 | $3,356 |
| Administrative expenses (other) incurred | 2014-05-31 | $380,139 |
| Liabilities. Value of operating payables at end of year | 2014-05-31 | $111,319 |
| Liabilities. Value of operating payables at beginning of year | 2014-05-31 | $29,880 |
| Total non interest bearing cash at end of year | 2014-05-31 | $102,648 |
| Total non interest bearing cash at beginning of year | 2014-05-31 | $119,688 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Value of net income/loss | 2014-05-31 | $-129,151 |
| Value of net assets at end of year (total assets less liabilities) | 2014-05-31 | $74,108 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-05-31 | $203,259 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-05-31 | $815,784 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-05-31 | $1,118,832 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-05-31 | $1,118,832 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-05-31 | $2,674 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-05-31 | $10,884,532 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-05-31 | No |
| Contributions received in cash from employer | 2014-05-31 | $11,337,277 |
| Contract administrator fees | 2014-05-31 | $200,137 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2014-05-31 | $747,054 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-05-31 | $1,008,494 |
| Did the plan have assets held for investment | 2014-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-05-31 | Unqualified |
| Accountancy firm name | 2014-05-31 | SISTERSON & CO., LLP |
| Accountancy firm EIN | 2014-05-31 | 251467156 |
| 2013 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $1,038,374 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $1,168,868 |
| Total income from all sources (including contributions) | 2013-05-31 | $13,442,421 |
| Total of all expenses incurred | 2013-05-31 | $13,349,804 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-05-31 | $12,668,374 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-05-31 | $13,439,268 |
| Value of total assets at end of year | 2013-05-31 | $1,241,633 |
| Value of total assets at beginning of year | 2013-05-31 | $1,279,510 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-05-31 | $681,430 |
| Total interest from all sources | 2013-05-31 | $3,153 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-05-31 | No |
| Administrative expenses professional fees incurred | 2013-05-31 | $11,831 |
| Was this plan covered by a fidelity bond | 2013-05-31 | Yes |
| Value of fidelity bond cover | 2013-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-05-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-05-31 | $3,113 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-05-31 | $340 |
| Administrative expenses (other) incurred | 2013-05-31 | $606,716 |
| Liabilities. Value of operating payables at end of year | 2013-05-31 | $29,880 |
| Liabilities. Value of operating payables at beginning of year | 2013-05-31 | $25,522 |
| Total non interest bearing cash at end of year | 2013-05-31 | $119,688 |
| Total non interest bearing cash at beginning of year | 2013-05-31 | $143,959 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
| Value of net income/loss | 2013-05-31 | $92,617 |
| Value of net assets at end of year (total assets less liabilities) | 2013-05-31 | $203,259 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-05-31 | $110,642 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-05-31 | $1,118,832 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-05-31 | $1,135,211 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-05-31 | $1,135,211 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-05-31 | $3,153 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-05-31 | $12,668,374 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-05-31 | No |
| Contributions received in cash from employer | 2013-05-31 | $13,439,268 |
| Contract administrator fees | 2013-05-31 | $62,883 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-05-31 | $1,008,494 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-05-31 | $1,143,346 |
| Did the plan have assets held for investment | 2013-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-05-31 | Unqualified |
| Accountancy firm name | 2013-05-31 | SISTERSON & CO., LLP |
| Accountancy firm EIN | 2013-05-31 | 251467156 |
| 2012 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $1,168,868 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $1,437,640 |
| Total income from all sources (including contributions) | 2012-05-31 | $16,120,125 |
| Total of all expenses incurred | 2012-05-31 | $16,052,810 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-05-31 | $15,344,372 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-05-31 | $16,115,930 |
| Value of total assets at end of year | 2012-05-31 | $1,279,510 |
| Value of total assets at beginning of year | 2012-05-31 | $1,480,967 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-05-31 | $708,438 |
| Total interest from all sources | 2012-05-31 | $4,195 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-05-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-05-31 | No |
| Administrative expenses professional fees incurred | 2012-05-31 | $11,829 |
| Was this plan covered by a fidelity bond | 2012-05-31 | Yes |
| Value of fidelity bond cover | 2012-05-31 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-05-31 | No |
| Assets. Other investments not covered elsewhere at end of year | 2012-05-31 | $340 |
| Assets. Other investments not covered elsewhere at beginning of year | 2012-05-31 | $1,265 |
| Administrative expenses (other) incurred | 2012-05-31 | $631,582 |
| Liabilities. Value of operating payables at end of year | 2012-05-31 | $25,522 |
| Total non interest bearing cash at end of year | 2012-05-31 | $143,959 |
| Total non interest bearing cash at beginning of year | 2012-05-31 | $117,919 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
| Value of net income/loss | 2012-05-31 | $67,315 |
| Value of net assets at end of year (total assets less liabilities) | 2012-05-31 | $110,642 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-05-31 | $43,327 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-05-31 | $1,135,211 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-05-31 | $1,361,783 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-05-31 | $1,361,783 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-05-31 | $4,195 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-05-31 | $15,344,372 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-05-31 | No |
| Contributions received in cash from employer | 2012-05-31 | $16,115,930 |
| Income. Dividends from common stock | 2012-05-31 | $0 |
| Contract administrator fees | 2012-05-31 | $65,027 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-05-31 | $1,143,346 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-05-31 | $1,437,640 |
| Did the plan have assets held for investment | 2012-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-05-31 | Unqualified |
| Accountancy firm name | 2012-05-31 | SISTERSON & CO LLP |
| Accountancy firm EIN | 2012-05-31 | 251467156 |
| 2011 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-05-31 | $1,437,640 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-05-31 | $1,753,077 |
| Total income from all sources (including contributions) | 2011-05-31 | $19,447,143 |
| Total of all expenses incurred | 2011-05-31 | $19,678,860 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-05-31 | $18,670,476 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-05-31 | $19,440,358 |
| Value of total assets at end of year | 2011-05-31 | $1,480,967 |
| Value of total assets at beginning of year | 2011-05-31 | $2,028,121 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-05-31 | $1,008,384 |
| Total interest from all sources | 2011-05-31 | $6,783 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-05-31 | $2 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-05-31 | No |
| Administrative expenses professional fees incurred | 2011-05-31 | $7,959 |
| Was this plan covered by a fidelity bond | 2011-05-31 | Yes |
| Value of fidelity bond cover | 2011-05-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-05-31 | No |
| Assets. Other investments not covered elsewhere at end of year | 2011-05-31 | $1,265 |
| Assets. Other investments not covered elsewhere at beginning of year | 2011-05-31 | $1,702 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-05-31 | $10,000 |
| Administrative expenses (other) incurred | 2011-05-31 | $879,010 |
| Total non interest bearing cash at end of year | 2011-05-31 | $117,919 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
| Value of net income/loss | 2011-05-31 | $-231,717 |
| Value of net assets at end of year (total assets less liabilities) | 2011-05-31 | $43,327 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-05-31 | $275,044 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-05-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-05-31 | $1,361,783 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-05-31 | $2,016,419 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-05-31 | $2,016,419 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-05-31 | $6,783 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-05-31 | $18,670,476 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-05-31 | No |
| Contributions received in cash from employer | 2011-05-31 | $19,440,358 |
| Income. Dividends from common stock | 2011-05-31 | $2 |
| Contract administrator fees | 2011-05-31 | $121,415 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-05-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-05-31 | $1,437,640 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-05-31 | $1,753,077 |
| Did the plan have assets held for investment | 2011-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-05-31 | Unqualified |
| Accountancy firm name | 2011-05-31 | SISTERSON & CO LLP |
| Accountancy firm EIN | 2011-05-31 | 251467156 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 259168 + SUBS |
| Policy instance | 3 |
| Insurance contract or identification number | 259168 + SUBS | | Number of Individuals Covered | 709 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 510 |
| Policy instance | 4 |
| Insurance contract or identification number | 510 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $416 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $416 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | 0176244 |
| Policy instance | 1 |
| Insurance contract or identification number | 0176244 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $3,241 | | 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 $39,992 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,241 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 ) |
| Policy contract number | 1068456 |
| Policy instance | 5 |
| Insurance contract or identification number | 1068456 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FHM908799 |
| Policy instance | 6 |
| Insurance contract or identification number | FHM908799 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $387 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $38,112 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $387 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 260087,88,89 |
| Policy instance | 9 |
| Insurance contract or identification number | 260087,88,89 | | Number of Individuals Covered | 1739 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $44,424 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $44,424 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00414661 |
| Policy instance | 7 |
| Insurance contract or identification number | 00414661 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $2,094 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,686 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,053 | | Insurance broker organization code? | 3 | | Insurance broker name | LIFETIME FINANCIAL GROWTH, LLC |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 05831000 |
| Policy instance | 8 |
| Insurance contract or identification number | 05831000 | | Number of Individuals Covered | 9619 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $578,388 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,974,915 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $131,851 | | Insurance broker organization code? | 3 | | Insurance broker name | HANZEL & HILL, INC. |
|
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00506002 |
| Policy instance | 2 |
| Insurance contract or identification number | 00506002 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | SMB-001 TO 005 |
| Policy instance | 10 |
| Insurance contract or identification number | SMB-001 TO 005 | | Number of Individuals Covered | 590 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,054 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 01332315 |
| Policy instance | 11 |
| Insurance contract or identification number | 01332315 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $473 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $30,541 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $192 | | Insurance broker organization code? | 3 | | Insurance broker name | HANZEL & HILL, INC. |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 01228604 |
| Policy instance | 12 |
| Insurance contract or identification number | 01228604 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $1,886 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,691 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,279 | | Insurance broker organization code? | 3 | | Insurance broker name | ARMS INSURANCE GROUP, INC. |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | SMB-001 TO 005 |
| Policy instance | 10 |
| Insurance contract or identification number | SMB-001 TO 005 | | Number of Individuals Covered | 997 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 260087,88,89 |
| Policy instance | 9 |
| Insurance contract or identification number | 260087,88,89 | | Number of Individuals Covered | 1835 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $40,298 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,298 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 1068456 |
| Policy instance | 8 |
| Insurance contract or identification number | 1068456 | | Number of Individuals Covered | 13587 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $798,328 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,015,464 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $207,775 | | Insurance broker organization code? | 3 | | Insurance broker name | BROOKVILLE INSURANCE AGENCY, INC. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00414661 |
| Policy instance | 7 |
| Insurance contract or identification number | 00414661 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $2,421 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,374 | | Insurance broker organization code? | 3 | | Insurance broker name | LIFETIME FINANCIAL GROWTH, LLC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FHM908799 |
| Policy instance | 6 |
| Insurance contract or identification number | FHM908799 | | Number of Individuals Covered | 446 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $56,970 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 510 |
| Policy instance | 4 |
| Insurance contract or identification number | 510 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $433 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $433 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 259168 + SUBS |
| Policy instance | 3 |
| Insurance contract or identification number | 259168 + SUBS | | Number of Individuals Covered | 778 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00506002 |
| Policy instance | 2 |
| Insurance contract or identification number | 00506002 | | Number of Individuals Covered | 163 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | 0176244 |
| Policy instance | 1 |
| Insurance contract or identification number | 0176244 | | Number of Individuals Covered | 211 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $3,126 | | 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 $40,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,126 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 ) |
| Policy contract number | 1068456 |
| Policy instance | 5 |
| Insurance contract or identification number | 1068456 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $257,656 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FHM908799 |
| Policy instance | 8 |
| Insurance contract or identification number | FHM908799 | | Number of Individuals Covered | 481 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $58,235 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | 0176244 |
| Policy instance | 1 |
| Insurance contract or identification number | 0176244 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $3,064 | | 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 $40,184 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,064 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00506002 |
| Policy instance | 2 |
| Insurance contract or identification number | 00506002 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 510 |
| Policy instance | 4 |
| Insurance contract or identification number | 510 | | Number of Individuals Covered | 86 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $423 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $423 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 259168 + SUBS |
| Policy instance | 3 |
| Insurance contract or identification number | 259168 + SUBS | | Number of Individuals Covered | 788 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 ) |
| Policy contract number | 1068456 |
| Policy instance | 5 |
| Insurance contract or identification number | 1068456 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $472,676 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 1068456 |
| Policy instance | 6 |
| Insurance contract or identification number | 1068456 | | Number of Individuals Covered | 1345 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $911,582 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,978,471 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $235,330 | | Insurance broker organization code? | 3 | | Insurance broker name | FRINGE BENEFIT SERVICES, INC. |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00414661 |
| Policy instance | 7 |
| Insurance contract or identification number | 00414661 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $2,253 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,726 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,209 | | Insurance broker organization code? | 3 | | Insurance broker name | LIFETIME FINANCIAL GROWTH, LLC |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 260087,88,89 |
| Policy instance | 9 |
| Insurance contract or identification number | 260087,88,89 | | Number of Individuals Covered | 2009 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $46,218 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,218 | | Insurance broker organization code? | 3 | | Insurance broker name | SMC INSURANCE AGENCY, INC. |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | SMB-001 TO 005 |
| Policy instance | 10 |
| Insurance contract or identification number | SMB-001 TO 005 | | Number of Individuals Covered | 1094 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,990 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $44,221 | | 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 | 1990 | | Additional information about fees paid to insurance broker | ADDITIONAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HM LIFE INSURANCE COMPANY |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01068456 |
| Policy instance | 5 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 1207 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,672 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 510 |
| Policy instance | 4 |
| Insurance contract or identification number | 510 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $372 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | SMB-001 TO 005 |
| Policy instance | 13 |
| Insurance contract or identification number | SMB-001 TO 005 | | Number of Individuals Covered | 1030 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,050 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,554 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 260087, 88,89 |
| Policy instance | 3 |
| Insurance contract or identification number | 260087, 88,89 | | Number of Individuals Covered | 2393 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $54,127 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | ACCT 0176244 |
| Policy instance | 1 |
| Insurance contract or identification number | ACCT 0176244 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $3,210 | | 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 $40,047 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01068456 |
| Policy instance | 6 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 1400 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,441,742 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 ) |
| Policy contract number | 01068456 |
| Policy instance | 7 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $678,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01068456 |
| Policy instance | 8 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | BLUE RX | | Welfare Benefit Premiums Paid to Carrier | USD $11,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01068456 |
| Policy instance | 9 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 1579 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | MEDICAL | | Welfare Benefit Premiums Paid to Carrier | USD $9,329,986 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | GP11/GP497 |
| Policy instance | 10 |
| Insurance contract or identification number | GP11/GP497 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $2,766 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FHM908799 |
| Policy instance | 11 |
| Insurance contract or identification number | FHM908799 | | Number of Individuals Covered | 1994 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | ADD DEPSP LIFSUP STD LIFE ADDSUP | | Welfare Benefit Premiums Paid to Carrier | USD $64,993 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 0058485 |
| Policy instance | 12 |
| Insurance contract or identification number | 0058485 | | Number of Individuals Covered | 845 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00506002 |
| Policy instance | 2 |
| Insurance contract or identification number | 00506002 | | Number of Individuals Covered | 601 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FHM908799 |
| Policy instance | 11 |
| Insurance contract or identification number | FHM908799 | | Number of Individuals Covered | 845 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $1,093 | | Total amount of fees paid to insurance company | USD $68 | | 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 | ADD DEPSP LIFSUP STD LIFE ADDSUP | | Welfare Benefit Premiums Paid to Carrier | USD $93,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | 251239-ALL SUBS |
| Policy instance | 1 |
| Insurance contract or identification number | 251239-ALL SUBS | | Number of Individuals Covered | 262 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $3,410 | | 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 $45,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00506002 |
| Policy instance | 2 |
| Insurance contract or identification number | 00506002 | | Number of Individuals Covered | 771 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 260087, 88,89 |
| Policy instance | 3 |
| Insurance contract or identification number | 260087, 88,89 | | Number of Individuals Covered | 2408 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $63,366 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 510 |
| Policy instance | 4 |
| Insurance contract or identification number | 510 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $338 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01068456 |
| Policy instance | 5 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 1315 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,682 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01068456 |
| Policy instance | 6 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 1618 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,814,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 ) |
| Policy contract number | 01068456 |
| Policy instance | 7 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $981,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01068456 |
| Policy instance | 8 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | BLUE RX | | Welfare Benefit Premiums Paid to Carrier | USD $22,508 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01068456 |
| Policy instance | 9 |
| Insurance contract or identification number | 01068456 | | Number of Individuals Covered | 1859 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | MEDICAL | | Welfare Benefit Premiums Paid to Carrier | USD $10,977,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | GP11/GP497 |
| Policy instance | 10 |
| Insurance contract or identification number | GP11/GP497 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $2,979 | | 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 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
