CORLE BUILDING SYSTEMS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC.
401k plan membership statisitcs for EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC.
| Measure | Date | Value |
|---|
| 2022: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-03-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-03-01 | 111 |
| Number of retired or separated participants receiving benefits | 2022-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-03-01 | 0 |
| Total of all active and inactive participants | 2022-03-01 | 111 |
| Number of employers contributing to the scheme | 2022-03-01 | 0 |
| 2021: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-03-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-03-01 | 105 |
| Number of retired or separated participants receiving benefits | 2021-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-03-01 | 0 |
| Total of all active and inactive participants | 2021-03-01 | 105 |
| Number of employers contributing to the scheme | 2021-03-01 | 0 |
| Total participants, beginning-of-year | 2021-01-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 119 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 119 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 111 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 111 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 152 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 152 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 152 |
| Total of all active and inactive participants | 2018-01-01 | 152 |
| 2017: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 156 |
| Total of all active and inactive participants | 2017-01-01 | 156 |
| 2016: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 150 |
| Total of all active and inactive participants | 2016-01-01 | 150 |
| 2015: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 152 |
| Total of all active and inactive participants | 2015-01-01 | 152 |
| 2014: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 134 |
| Total of all active and inactive participants | 2014-01-01 | 134 |
| 2013: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 114 |
| Total of all active and inactive participants | 2013-01-01 | 114 |
| 2022: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2022 form 5500 responses |
|---|
| 2022-03-01 | Type of plan entity | Single employer plan |
| 2022-03-01 | Plan funding arrangement – Insurance | Yes |
| 2022-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2021 form 5500 responses |
|---|
| 2021-03-01 | Type of plan entity | Single employer plan |
| 2021-03-01 | Plan funding arrangement – Insurance | Yes |
| 2021-03-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-03-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-03-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: EMPLOYEE HEALTH PLAN OF CORLE BUILDING SYSTEMS, INC. 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | First time form 5500 has been submitted | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 167340 |
| Policy instance | 3 |
| Insurance contract or identification number | 167340 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $19,764 | | Total amount of fees paid to insurance company | USD $2,314 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT,CRITICAL ILLNESS, HOSPITAL | | Welfare Benefit Premiums Paid to Carrier | USD $45,972 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,764 | | Amount paid for insurance broker fees | 661 | | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 ) |
| Policy contract number | 17766 ET AL |
| Policy instance | 2 |
| Insurance contract or identification number | 17766 ET AL | | Number of Individuals Covered | 204 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,650 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 17766 ET AL |
| Policy instance | 1 |
| Insurance contract or identification number | 17766 ET AL | | Number of Individuals Covered | 201 | | Insurance policy start date | 2022-03-01 | | Insurance policy end date | 2023-02-28 | | Total amount of commissions paid to insurance broker | USD $2,117 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,121,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,117 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 167340 |
| Policy instance | 3 |
| Insurance contract or identification number | 167340 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $20,150 | | Total amount of fees paid to insurance company | USD $1,496 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $49,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,150 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION |
|
| UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 ) |
| Policy contract number | 17766 ET AL |
| Policy instance | 2 |
| Insurance contract or identification number | 17766 ET AL | | Number of Individuals Covered | 200 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,274 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 17766 ET AL |
| Policy instance | 1 |
| Insurance contract or identification number | 17766 ET AL | | Number of Individuals Covered | 198 | | Insurance policy start date | 2021-03-01 | | Insurance policy end date | 2022-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $972,212 | | 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 | 4796 |
| Policy instance | 2 |
| Insurance contract or identification number | 4796 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 167340 |
| Policy instance | 1 |
| Insurance contract or identification number | 167340 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2021-02-28 | | Total amount of commissions paid to insurance broker | USD $22,915 | | Total amount of fees paid to insurance company | USD $10,473 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $58,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,915 | | Amount paid for insurance broker fees | 10473 | | Additional information about fees paid to insurance broker | CONTINGENT COMPENSATION | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4796 |
| Policy instance | 1 |
| Insurance contract or identification number | 4796 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2020-03-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 | 000GP770 |
| Policy instance | 3 |
| Insurance contract or identification number | 000GP770 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-02-28 | | Total amount of commissions paid to insurance broker | USD $224 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,829 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 017766300 |
| Policy instance | 1 |
| Insurance contract or identification number | 017766300 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-02-28 | | Total amount of commissions paid to insurance broker | USD $5,146 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $111,774 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 017766900 |
| Policy instance | 2 |
| Insurance contract or identification number | 017766900 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-02-28 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | 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 | 00418796 |
| Policy instance | 3 |
| Insurance contract or identification number | 00418796 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,731 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,658 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 017766900 |
| Policy instance | 2 |
| Insurance contract or identification number | 017766900 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $22 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 017766300 |
| Policy instance | 1 |
| Insurance contract or identification number | 017766300 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $16,982 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $567,196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,982 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 017766900 |
| Policy instance | 2 |
| Insurance contract or identification number | 017766900 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-12-31 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $54 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $54 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 017766300 |
| Policy instance | 1 |
| Insurance contract or identification number | 017766300 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $15,593 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $529,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,593 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 017766900 |
| Policy instance | 2 |
| Insurance contract or identification number | 017766900 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $42 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,046 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 017766300 |
| Policy instance | 1 |
| Insurance contract or identification number | 017766300 | | Number of Individuals Covered | 113 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $13,515 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $416,463 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,515 | | Insurance broker organization code? | 3 |
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