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ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN
Plan identification number 501

ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

ST. BARNABAS HEALTH SYSTEM, INC. has sponsored the creation of one or more 401k plans.

Company Name:ST. BARNABAS HEALTH SYSTEM, INC.
Employer identification number (EIN):251552913
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-07-01
5012021-07-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01JAMES D. TURCO JAMES D. TURCO2018-12-19
5012016-07-01JAMES D. TURCO JAMES D. TURCO2017-12-11
5012015-07-01JAMES D. TURCO JAMES D. TURCO2017-01-30
5012014-07-01JAMES D. TURCO JAMES D. TURCO2016-01-20
5012013-07-01JAMES D. TURCO JAMES D. TURCO2015-01-09
5012012-07-01JAMES D. TURCO JAMES D. TURCO2014-01-27
5012011-07-01JAMES D. TURCO JAMES D. TURCO2013-04-11
5012009-07-01JAMES D. TURCO JAMES D. TURCO2011-03-03
5012009-07-01MARGARET E. HORTON JAMES D. TURCO2011-03-01

Plan Statistics for ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN

401k plan membership statisitcs for ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN

Measure Date Value
2022: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-07-01299
Total number of active participants reported on line 7a of the Form 55002022-07-01305
Number of retired or separated participants receiving benefits2022-07-010
Number of other retired or separated participants entitled to future benefits2022-07-010
Total of all active and inactive participants2022-07-01305
2021: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01318
Total number of active participants reported on line 7a of the Form 55002021-07-01299
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01299
2020: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01327
Total number of active participants reported on line 7a of the Form 55002020-07-01318
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01318
2019: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01345
Total number of active participants reported on line 7a of the Form 55002019-07-01327
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-01327
2018: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01340
Total number of active participants reported on line 7a of the Form 55002018-07-01345
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01345
2017: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01334
Total number of active participants reported on line 7a of the Form 55002017-07-01340
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01340
2016: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01339
Total number of active participants reported on line 7a of the Form 55002016-07-01334
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01334
2015: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01299
Total number of active participants reported on line 7a of the Form 55002015-07-01339
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01339
2014: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01300
Total number of active participants reported on line 7a of the Form 55002014-07-01299
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01299
2013: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01291
Total number of active participants reported on line 7a of the Form 55002013-07-01300
Total of all active and inactive participants2013-07-01300
2012: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01215
Total number of active participants reported on line 7a of the Form 55002012-07-01291
Total of all active and inactive participants2012-07-01291
2011: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01199
Total number of active participants reported on line 7a of the Form 55002011-07-01215
Total of all active and inactive participants2011-07-01215
2009: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01230
Total number of active participants reported on line 7a of the Form 55002009-07-01217
Total of all active and inactive participants2009-07-01217

Form 5500 Responses for ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN

2022: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-07-01Type of plan entitySingle employer plan
2022-07-01Plan funding arrangement – InsuranceYes
2022-07-01Plan benefit arrangement – InsuranceYes
2021: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2009: ST. BARNABAS HEALTH SYSTEM, INC. HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedYes
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number0100144351, ETC
Policy instance 5
Insurance contract or identification number0100144351, ETC
Number of Individuals Covered26
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $11,128
Total amount of fees paid to insurance companyUSD $1,228
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,081
Amount paid for insurance broker fees5
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberG169641
Policy instance 4
Insurance contract or identification numberG169641
Number of Individuals Covered305
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $13,480
Total amount of fees paid to insurance companyUSD $511
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,975
Insurance broker organization code?3
Amount paid for insurance broker fees511
Additional information about fees paid to insurance brokerOTHER COMPENSATION
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number1728
Policy instance 3
Insurance contract or identification number1728
Number of Individuals Covered214
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $779
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $779
Insurance broker organization code?3
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number136-421784
Policy instance 2
Insurance contract or identification number136-421784
Number of Individuals Covered462
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberT09
Policy instance 1
Insurance contract or identification numberT09
Number of Individuals Covered244
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Welfare Benefit Premiums Paid to CarrierUSD $296,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberT09
Policy instance 1
Insurance contract or identification numberT09
Number of Individuals Covered244
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Welfare Benefit Premiums Paid to CarrierUSD $350,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number912738
Policy instance 2
Insurance contract or identification number912738
Number of Individuals Covered197
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $97,521
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 number1728
Policy instance 3
Insurance contract or identification number1728
Number of Individuals Covered215
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $781
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $781
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B57F
Policy instance 4
Insurance contract or identification numberG000B57F
Number of Individuals Covered299
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $10,198
Total amount of fees paid to insurance companyUSD $8,237
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,198
Insurance broker organization code?3
Amount paid for insurance broker fees4942
Additional information about fees paid to insurance brokerOTHER COMPENSATION
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number0100144351, ETC
Policy instance 5
Insurance contract or identification number0100144351, ETC
Number of Individuals Covered17
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $6,888
Total amount of fees paid to insurance companyUSD $2,636
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,207
Amount paid for insurance broker fees198
Insurance broker organization code?3
BERKLEY LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64890 )
Policy contract numberT09
Policy instance 1
Insurance contract or identification numberT09
Number of Individuals Covered254
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Welfare Benefit Premiums Paid to CarrierUSD $322,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number912738
Policy instance 2
Insurance contract or identification number912738
Number of Individuals Covered203
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,261
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 number1728
Policy instance 3
Insurance contract or identification number1728
Number of Individuals Covered216
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $834
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $834
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B57F
Policy instance 4
Insurance contract or identification numberG000B57F
Number of Individuals Covered318
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $10,543
Total amount of fees paid to insurance companyUSD $10,813
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,415
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,543
Insurance broker organization code?3
Amount paid for insurance broker fees7208
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
Policy contract number016101800
Policy instance 1
Insurance contract or identification number016101800
Number of Individuals Covered468
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Welfare Benefit Premiums Paid to CarrierUSD $170,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number912738
Policy instance 2
Insurance contract or identification number912738
Number of Individuals Covered225
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,085
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 number1728
Policy instance 3
Insurance contract or identification number1728
Number of Individuals Covered241
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $888
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $888
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B57F
Policy instance 4
Insurance contract or identification numberG000B57F
Number of Individuals Covered327
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $11,084
Total amount of fees paid to insurance companyUSD $9,519
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,084
Insurance broker organization code?3
Amount paid for insurance broker fees6346
Additional information about fees paid to insurance brokerOTHER COMPENSATION
UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
Policy contract number016101800
Policy instance 1
Insurance contract or identification number016101800
Number of Individuals Covered523
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $11,915
Welfare Benefit Premiums Paid to CarrierUSD $164,111
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,915
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number912738
Policy instance 2
Insurance contract or identification number912738
Number of Individuals Covered197
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,379
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 number1728
Policy instance 3
Insurance contract or identification number1728
Number of Individuals Covered218
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $867
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $867
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B57F
Policy instance 4
Insurance contract or identification numberG000B57F
Number of Individuals Covered345
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $9,927
Total amount of fees paid to insurance companyUSD $6,438
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,927
Insurance broker organization code?3
Amount paid for insurance broker fees6438
Additional information about fees paid to insurance brokerOTHER COMPENSATION
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000B57F
Policy instance 4
Insurance contract or identification numberG000B57F
Number of Individuals Covered334
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $9,984
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,376
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,238
Insurance broker organization code?3
Insurance broker nameCOURY HEALTH SERVICES LLC
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number1728
Policy instance 3
Insurance contract or identification number1728
Number of Individuals Covered204
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $781
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $396
Insurance broker organization code?3
Insurance broker nameSIMPSON & MCCARDY BENEFITS
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number9163
Policy instance 2
Insurance contract or identification number9163
Number of Individuals Covered350
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $93,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
Policy contract number016101800
Policy instance 1
Insurance contract or identification number016101800
Number of Individuals Covered518
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $11,693
Welfare Benefit Premiums Paid to CarrierUSD $163,085
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,693
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10170456-8
Policy instance 4
Insurance contract or identification number10170456-8
Number of Individuals Covered339
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $8,236
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $94,806
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,236
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS USA INC.
UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
Policy contract number016101800
Policy instance 1
Insurance contract or identification number016101800
Number of Individuals Covered502
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $7,485
Welfare Benefit Premiums Paid to CarrierUSD $110,962
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,485
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number9163
Policy instance 2
Insurance contract or identification number9163
Number of Individuals Covered328
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,194
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 number1728
Policy instance 3
Insurance contract or identification number1728
Number of Individuals Covered182
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $685
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $685
Insurance broker organization code?3
Insurance broker nameFOUR M CONSULTING INC.
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number9163
Policy instance 2
Insurance contract or identification number9163
Number of Individuals Covered285
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,247
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 number1728
Policy instance 3
Insurance contract or identification number1728
Number of Individuals Covered139
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $553
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $553
Insurance broker organization code?3
Insurance broker nameFOUR M CONSULTING INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10170456-8
Policy instance 4
Insurance contract or identification number10170456-8
Number of Individuals Covered299
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $6,919
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,795
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,919
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS USA INC.
UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
Policy contract number016101800
Policy instance 1
Insurance contract or identification number016101800
Number of Individuals Covered416
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $6,659
Welfare Benefit Premiums Paid to CarrierUSD $89,080
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,659
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number1728
Policy instance 3
Insurance contract or identification number1728
Number of Individuals Covered139
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $593
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $593
Insurance broker organization code?3
Insurance broker nameFOUR M CONSULTING INC.
UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
Policy contract number016101800
Policy instance 1
Insurance contract or identification number016101800
Number of Individuals Covered448
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Welfare Benefit Premiums Paid to CarrierUSD $93,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS PA
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number9163
Policy instance 2
Insurance contract or identification number9163
Number of Individuals Covered205
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $62,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10170456-8
Policy instance 4
Insurance contract or identification number10170456-8
Number of Individuals Covered300
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $7,923
Total amount of fees paid to insurance companyUSD $4,690
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $87,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,923
Amount paid for insurance broker fees4690
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS USA INC.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10170456-8
Policy instance 5
Insurance contract or identification number10170456-8
Number of Individuals Covered291
Insurance policy start date2013-01-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $4,218
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $34,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,218
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SVCS USA INC.
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number1728
Policy instance 4
Insurance contract or identification number1728
Number of Individuals Covered135
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $580
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $580
Insurance broker organization code?3
Insurance broker nameFOUR M CONSULTING INC.
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number161606,148240,1
Policy instance 3
Insurance contract or identification number161606,148240,1
Number of Individuals Covered292
Insurance policy start date2012-07-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $3,140
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,140
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS SERVICES
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number9163
Policy instance 2
Insurance contract or identification number9163
Number of Individuals Covered144
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $44,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
Policy contract number016101800
Policy instance 1
Insurance contract or identification number016101800
Number of Individuals Covered410
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Welfare Benefit Premiums Paid to CarrierUSD $98,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INS PA
UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
Policy contract number016101800
Policy instance 1
Insurance contract or identification number016101800
Number of Individuals Covered230
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Welfare Benefit Premiums Paid to CarrierUSD $85,566
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 number9163
Policy instance 2
Insurance contract or identification number9163
Number of Individuals Covered131
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $41,723
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number1616061482401
Policy instance 3
Insurance contract or identification number1616061482401
Number of Individuals Covered269
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $7,455
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $81,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number16101300-902
Policy instance 1
Insurance contract or identification number16101300-902
Number of Individuals Covered199
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $4,059
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $102,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number16101300-902
Policy instance 2
Insurance contract or identification number16101300-902
Number of Individuals Covered199
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $4,368
Welfare Benefit Premiums Paid to CarrierUSD $82,602
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 number9163
Policy instance 3
Insurance contract or identification number9163
Number of Individuals Covered149
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $37,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number10112502
Policy instance 4
Insurance contract or identification number10112502
Number of Individuals Covered267
Insurance policy start date2010-07-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,028
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,093
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract number1616061482401
Policy instance 5
Insurance contract or identification number1616061482401
Number of Individuals Covered260
Insurance policy start date2011-01-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $3,597
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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