AMERICAN FEDERATION OF TEACHERS, AFL-CIO has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN
401k plan membership statisitcs for AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2023: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 330 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 340 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 0 |
| Total of all active and inactive participants | 2023-01-01 | 340 |
| Number of employers contributing to the scheme | 2023-01-01 | 0 |
| 2022: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 434 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 330 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 102 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 432 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 429 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 298 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 136 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 44 |
| Total of all active and inactive participants | 2021-01-01 | 478 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 446 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 321 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 108 |
| 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 | 429 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 427 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 446 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 113 |
| 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 | 559 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 442 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 322 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 105 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 427 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 484 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 349 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 108 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 457 |
| 2016: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 466 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 347 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 118 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 19 |
| Total of all active and inactive participants | 2016-01-01 | 484 |
| 2015: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 460 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 354 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 98 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 14 |
| Total of all active and inactive participants | 2015-01-01 | 466 |
| 2014: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 377 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 376 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 69 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 15 |
| Total of all active and inactive participants | 2014-01-01 | 460 |
| 2013: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 349 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 377 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 377 |
| 2012: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 349 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 349 |
| Number of retired or separated participants receiving benefits | 2012-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 0 |
| Total of all active and inactive participants | 2012-10-01 | 349 |
| 2011: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-10-01 | 410 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-10-01 | 349 |
| Number of retired or separated participants receiving benefits | 2011-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-10-01 | 0 |
| Total of all active and inactive participants | 2011-10-01 | 349 |
| 2009: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-10-01 | 401 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-10-01 | 358 |
| Number of retired or separated participants receiving benefits | 2009-10-01 | 20 |
| Number of other retired or separated participants entitled to future benefits | 2009-10-01 | 20 |
| Total of all active and inactive participants | 2009-10-01 | 398 |
| 2008: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-10-01 | 380 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-10-01 | 351 |
| Number of retired or separated participants receiving benefits | 2008-10-01 | 25 |
| Number of other retired or separated participants entitled to future benefits | 2008-10-01 | 25 |
| Total of all active and inactive participants | 2008-10-01 | 401 |
| 2007: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-10-01 | 369 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-10-01 | 338 |
| Number of retired or separated participants receiving benefits | 2007-10-01 | 21 |
| Number of other retired or separated participants entitled to future benefits | 2007-10-01 | 21 |
| Total of all active and inactive participants | 2007-10-01 | 380 |
| 2006: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-10-01 | 372 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-10-01 | 329 |
| Number of retired or separated participants receiving benefits | 2006-10-01 | 20 |
| Number of other retired or separated participants entitled to future benefits | 2006-10-01 | 20 |
| Total of all active and inactive participants | 2006-10-01 | 369 |
| 2005: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-10-01 | 388 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-10-01 | 326 |
| Number of retired or separated participants receiving benefits | 2005-10-01 | 23 |
| Number of other retired or separated participants entitled to future benefits | 2005-10-01 | 23 |
| Total of all active and inactive participants | 2005-10-01 | 372 |
| 2004: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-10-01 | 363 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-10-01 | 322 |
| Number of retired or separated participants receiving benefits | 2004-10-01 | 33 |
| Number of other retired or separated participants entitled to future benefits | 2004-10-01 | 33 |
| Total of all active and inactive participants | 2004-10-01 | 388 |
| 2003: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-10-01 | 357 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-10-01 | 317 |
| Number of retired or separated participants receiving benefits | 2003-10-01 | 23 |
| Number of other retired or separated participants entitled to future benefits | 2003-10-01 | 23 |
| Total of all active and inactive participants | 2003-10-01 | 363 |
| 2002: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-10-01 | 337 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-10-01 | 307 |
| Number of retired or separated participants receiving benefits | 2002-10-01 | 25 |
| Number of other retired or separated participants entitled to future benefits | 2002-10-01 | 25 |
| Total of all active and inactive participants | 2002-10-01 | 357 |
| 2001: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2001 401k membership |
|---|
| Total participants, beginning-of-year | 2001-10-01 | 293 |
| Total number of active participants reported on line 7a of the Form 5500 | 2001-10-01 | 297 |
| Number of retired or separated participants receiving benefits | 2001-10-01 | 20 |
| Number of other retired or separated participants entitled to future benefits | 2001-10-01 | 20 |
| Total of all active and inactive participants | 2001-10-01 | 337 |
| 2000: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2000 401k membership |
|---|
| Total participants, beginning-of-year | 2000-10-01 | 283 |
| Total number of active participants reported on line 7a of the Form 5500 | 2000-10-01 | 287 |
| Number of retired or separated participants receiving benefits | 2000-10-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2000-10-01 | 3 |
| Total of all active and inactive participants | 2000-10-01 | 293 |
| 1998: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1998 401k membership |
|---|
| Total participants, beginning-of-year | 1998-10-01 | 258 |
| Total number of active participants reported on line 7a of the Form 5500 | 1998-10-01 | 267 |
| Number of retired or separated participants receiving benefits | 1998-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1998-10-01 | 0 |
| Total of all active and inactive participants | 1998-10-01 | 267 |
| 1997: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1997 401k membership |
|---|
| Total participants, beginning-of-year | 1997-10-01 | 256 |
| Total number of active participants reported on line 7a of the Form 5500 | 1997-10-01 | 258 |
| Number of retired or separated participants receiving benefits | 1997-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1997-10-01 | 0 |
| Total of all active and inactive participants | 1997-10-01 | 258 |
| 1996: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1996 401k membership |
|---|
| Total participants, beginning-of-year | 1996-10-01 | 250 |
| Total number of active participants reported on line 7a of the Form 5500 | 1996-10-01 | 256 |
| Number of retired or separated participants receiving benefits | 1996-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1996-10-01 | 0 |
| Total of all active and inactive participants | 1996-10-01 | 256 |
| 1995: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1995 401k membership |
|---|
| Total participants, beginning-of-year | 1995-10-01 | 244 |
| Total number of active participants reported on line 7a of the Form 5500 | 1995-10-01 | 250 |
| Number of retired or separated participants receiving benefits | 1995-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1995-10-01 | 0 |
| Total of all active and inactive participants | 1995-10-01 | 250 |
| 1994: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1994 401k membership |
|---|
| Total participants, beginning-of-year | 1994-10-01 | 238 |
| Total number of active participants reported on line 7a of the Form 5500 | 1994-10-01 | 244 |
| Number of retired or separated participants receiving benefits | 1994-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1994-10-01 | 0 |
| Total of all active and inactive participants | 1994-10-01 | 244 |
| 1993: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1993 401k membership |
|---|
| Total participants, beginning-of-year | 1993-10-01 | 232 |
| Total number of active participants reported on line 7a of the Form 5500 | 1993-10-01 | 238 |
| Number of retired or separated participants receiving benefits | 1993-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1993-10-01 | 0 |
| Total of all active and inactive participants | 1993-10-01 | 238 |
| 1992: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1992 401k membership |
|---|
| Total participants, beginning-of-year | 1992-10-01 | 226 |
| Total number of active participants reported on line 7a of the Form 5500 | 1992-10-01 | 232 |
| Number of retired or separated participants receiving benefits | 1992-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1992-10-01 | 0 |
| Total of all active and inactive participants | 1992-10-01 | 232 |
| 1991: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1991 401k membership |
|---|
| Total participants, beginning-of-year | 1991-10-01 | 220 |
| Total number of active participants reported on line 7a of the Form 5500 | 1991-10-01 | 226 |
| Number of retired or separated participants receiving benefits | 1991-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1991-10-01 | 0 |
| Total of all active and inactive participants | 1991-10-01 | 226 |
| 1990: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1990 401k membership |
|---|
| Total participants, beginning-of-year | 1990-10-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 1990-10-01 | 220 |
| Number of retired or separated participants receiving benefits | 1990-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1990-10-01 | 0 |
| Total of all active and inactive participants | 1990-10-01 | 220 |
| 1989: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1989 401k membership |
|---|
| Total participants, beginning-of-year | 1989-10-01 | 208 |
| Total number of active participants reported on line 7a of the Form 5500 | 1989-10-01 | 214 |
| Number of retired or separated participants receiving benefits | 1989-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1989-10-01 | 0 |
| Total of all active and inactive participants | 1989-10-01 | 214 |
| 1988: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1988 401k membership |
|---|
| Total participants, beginning-of-year | 1988-10-01 | 203 |
| Total number of active participants reported on line 7a of the Form 5500 | 1988-10-01 | 208 |
| Number of retired or separated participants receiving benefits | 1988-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 1988-10-01 | 0 |
| Total of all active and inactive participants | 1988-10-01 | 208 |
| 2023: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 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: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 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: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 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: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 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 funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Submission has been amended | No |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2011 form 5500 responses |
|---|
| 2011-10-01 | Type of plan entity | Single employer plan |
| 2011-10-01 | Submission has been amended | No |
| 2011-10-01 | This submission is the final filing | No |
| 2011-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-10-01 | Plan is a collectively bargained plan | No |
| 2011-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2009 form 5500 responses |
|---|
| 2009-10-01 | Type of plan entity | Single employer plan |
| 2009-10-01 | Submission has been amended | No |
| 2009-10-01 | This submission is the final filing | No |
| 2009-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-10-01 | Plan is a collectively bargained plan | No |
| 2009-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2008 form 5500 responses |
|---|
| 2008-10-01 | Type of plan entity | Single employer plan |
| 2008-10-01 | Submission has been amended | No |
| 2008-10-01 | This submission is the final filing | No |
| 2008-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-10-01 | Plan is a collectively bargained plan | No |
| 2008-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2008-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2007: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2007 form 5500 responses |
|---|
| 2007-10-01 | Type of plan entity | Single employer plan |
| 2007-10-01 | Submission has been amended | No |
| 2007-10-01 | This submission is the final filing | No |
| 2007-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-10-01 | Plan is a collectively bargained plan | No |
| 2007-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2007-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2006: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2006 form 5500 responses |
|---|
| 2006-10-01 | Type of plan entity | Single employer plan |
| 2006-10-01 | Submission has been amended | No |
| 2006-10-01 | This submission is the final filing | No |
| 2006-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-10-01 | Plan is a collectively bargained plan | No |
| 2006-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2006-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2005: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2005 form 5500 responses |
|---|
| 2005-10-01 | Type of plan entity | Single employer plan |
| 2005-10-01 | Submission has been amended | No |
| 2005-10-01 | This submission is the final filing | No |
| 2005-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-10-01 | Plan is a collectively bargained plan | No |
| 2005-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2005-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2004: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2004 form 5500 responses |
|---|
| 2004-10-01 | Type of plan entity | Single employer plan |
| 2004-10-01 | Submission has been amended | No |
| 2004-10-01 | This submission is the final filing | No |
| 2004-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-10-01 | Plan is a collectively bargained plan | No |
| 2004-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2004-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2003: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2003 form 5500 responses |
|---|
| 2003-10-01 | Type of plan entity | Single employer plan |
| 2003-10-01 | Submission has been amended | No |
| 2003-10-01 | This submission is the final filing | No |
| 2003-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-10-01 | Plan is a collectively bargained plan | No |
| 2003-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2003-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2002: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2002 form 5500 responses |
|---|
| 2002-10-01 | Type of plan entity | Single employer plan |
| 2002-10-01 | Submission has been amended | No |
| 2002-10-01 | This submission is the final filing | No |
| 2002-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-10-01 | Plan is a collectively bargained plan | No |
| 2002-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2002-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2001: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2001 form 5500 responses |
|---|
| 2001-10-01 | Type of plan entity | Single employer plan |
| 2001-10-01 | Submission has been amended | No |
| 2001-10-01 | This submission is the final filing | No |
| 2001-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2001-10-01 | Plan is a collectively bargained plan | No |
| 2001-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2001-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2000: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 2000 form 5500 responses |
|---|
| 2000-10-01 | Type of plan entity | Single employer plan |
| 2000-10-01 | Submission has been amended | No |
| 2000-10-01 | This submission is the final filing | No |
| 2000-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2000-10-01 | Plan is a collectively bargained plan | No |
| 2000-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2000-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1998: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1998 form 5500 responses |
|---|
| 1998-10-01 | Type of plan entity | Single employer plan |
| 1998-10-01 | Submission has been amended | No |
| 1998-10-01 | This submission is the final filing | No |
| 1998-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1998-10-01 | Plan is a collectively bargained plan | No |
| 1998-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1998-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1997: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1997 form 5500 responses |
|---|
| 1997-10-01 | Type of plan entity | Single employer plan |
| 1997-10-01 | Submission has been amended | No |
| 1997-10-01 | This submission is the final filing | No |
| 1997-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1997-10-01 | Plan is a collectively bargained plan | No |
| 1997-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1997-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1996: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1996 form 5500 responses |
|---|
| 1996-10-01 | Type of plan entity | Single employer plan |
| 1996-10-01 | Submission has been amended | No |
| 1996-10-01 | This submission is the final filing | No |
| 1996-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1996-10-01 | Plan is a collectively bargained plan | No |
| 1996-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1996-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1995: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1995 form 5500 responses |
|---|
| 1995-10-01 | Type of plan entity | Single employer plan |
| 1995-10-01 | Submission has been amended | No |
| 1995-10-01 | This submission is the final filing | No |
| 1995-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1995-10-01 | Plan is a collectively bargained plan | No |
| 1995-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1995-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1994: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1994 form 5500 responses |
|---|
| 1994-10-01 | Type of plan entity | Single employer plan |
| 1994-10-01 | Submission has been amended | No |
| 1994-10-01 | This submission is the final filing | No |
| 1994-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1994-10-01 | Plan is a collectively bargained plan | No |
| 1994-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1994-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1993: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1993 form 5500 responses |
|---|
| 1993-10-01 | Type of plan entity | Single employer plan |
| 1993-10-01 | Submission has been amended | No |
| 1993-10-01 | This submission is the final filing | No |
| 1993-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1993-10-01 | Plan is a collectively bargained plan | No |
| 1993-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1993-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1992: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1992 form 5500 responses |
|---|
| 1992-10-01 | Type of plan entity | Single employer plan |
| 1992-10-01 | Submission has been amended | No |
| 1992-10-01 | This submission is the final filing | No |
| 1992-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1992-10-01 | Plan is a collectively bargained plan | No |
| 1992-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1992-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1991: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1991 form 5500 responses |
|---|
| 1991-10-01 | Type of plan entity | Single employer plan |
| 1991-10-01 | Submission has been amended | No |
| 1991-10-01 | This submission is the final filing | No |
| 1991-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1991-10-01 | Plan is a collectively bargained plan | No |
| 1991-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1991-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1990: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1990 form 5500 responses |
|---|
| 1990-10-01 | Type of plan entity | Single employer plan |
| 1990-10-01 | Submission has been amended | No |
| 1990-10-01 | This submission is the final filing | No |
| 1990-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1990-10-01 | Plan is a collectively bargained plan | No |
| 1990-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1990-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1989: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1989 form 5500 responses |
|---|
| 1989-10-01 | Type of plan entity | Single employer plan |
| 1989-10-01 | Submission has been amended | No |
| 1989-10-01 | This submission is the final filing | No |
| 1989-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1989-10-01 | Plan is a collectively bargained plan | No |
| 1989-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1989-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 1988: AMERICAN FEDERATION OF TEACHERS, AFL-CIO HEALTH AND WELFARE PLAN 1988 form 5500 responses |
|---|
| 1988-10-01 | Type of plan entity | Single employer plan |
| 1988-10-01 | First time form 5500 has been submitted | Yes |
| 1988-10-01 | Submission has been amended | No |
| 1988-10-01 | This submission is the final filing | No |
| 1988-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 1988-10-01 | Plan is a collectively bargained plan | No |
| 1988-10-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 1988-10-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99088109 |
| Policy instance | 8 |
| Insurance contract or identification number | 99088109 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $169,868 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT,ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,132,454 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 |
| Policy instance | 1 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $11,023 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $549,881 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | N/A |
| Policy instance | 2 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 330 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $13,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 61708 |
| Policy instance | 3 |
| Insurance contract or identification number | 61708 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $26,648 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $199,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BENISTAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 01569 |
| Policy instance | 4 |
| Insurance contract or identification number | 01569 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $291,654 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 1033405 |
| Policy instance | 5 |
| Insurance contract or identification number | 1033405 | | Number of Individuals Covered | 268 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $4,064 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 234618 |
| Policy instance | 6 |
| Insurance contract or identification number | 234618 | | Number of Individuals Covered | 12108 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $3,355 | | Total amount of fees paid to insurance company | USD $1,831 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,200 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | GTP0009160083 |
| Policy instance | 7 |
| Insurance contract or identification number | GTP0009160083 | | Number of Individuals Covered | 340 | | Insurance policy start date | 2022-06-30 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $7,543 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $50,285 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 |
| Policy instance | 1 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $10,715 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $582,584 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,715 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| KGA, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | N/A |
| Policy instance | 2 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 330 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $12,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 61708 |
| Policy instance | 3 |
| Insurance contract or identification number | 61708 | | Number of Individuals Covered | 329 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $16,436 | | Total amount of fees paid to insurance company | USD $4,805 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $164,364 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,436 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS |
|
| BENISTAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 4 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $277,468 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99088109 |
| Policy instance | 5 |
| Insurance contract or identification number | 99088109 | | Number of Individuals Covered | 330 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $168,053 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT,ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,120,353 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $168,053 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99062087 |
| Policy instance | 1 |
| Insurance contract or identification number | 99062087 | | Number of Individuals Covered | 298 | | Insurance policy start date | 2020-06-30 | | Insurance policy end date | 2021-06-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 |
| Policy instance | 2 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $17,043 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $803,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,043 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| KGA, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | N/A |
| Policy instance | 3 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 330 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $12,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 61708 |
| Policy instance | 4 |
| Insurance contract or identification number | 61708 | | Number of Individuals Covered | 319 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $16,348 | | Total amount of fees paid to insurance company | USD $3,292 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $163,482 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,348 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| BENISTAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 5 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $247,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99062087 |
| Policy instance | 1 |
| Insurance contract or identification number | 99062087 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2019-06-30 | | Insurance policy end date | 2020-06-29 | | Total amount of commissions paid to insurance broker | USD $298 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $18,058 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $298 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 |
| Policy instance | 2 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $11,914 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $566,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,914 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| KGA, INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | N/A |
| Policy instance | 3 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 330 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $12,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 61708 |
| Policy instance | 4 |
| Insurance contract or identification number | 61708 | | Number of Individuals Covered | 329 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $16,269 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $162,692 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,269 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BENISTAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 5 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2020-01-01 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $245,984 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BENISTAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 5 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $226,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 61708 |
| Policy instance | 4 |
| Insurance contract or identification number | 61708 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $24,446 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $161,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,446 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 3040 |
| Policy instance | 3 |
| Insurance contract or identification number | 3040 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $18,587 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 |
| Policy instance | 2 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $34,377 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $638,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,377 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99062087 |
| Policy instance | 1 |
| Insurance contract or identification number | 99062087 | | Number of Individuals Covered | 446 | | Insurance policy start date | 2018-06-30 | | Insurance policy end date | 2019-06-29 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
| Policy contract number | 61708 |
| Policy instance | 6 |
| Insurance contract or identification number | 61708 | | Number of Individuals Covered | 337 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $8,260 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $82,598 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,260 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99062087 |
| Policy instance | 1 |
| Insurance contract or identification number | 99062087 | | Number of Individuals Covered | 322 | | Insurance policy start date | 2017-06-30 | | Insurance policy end date | 2018-06-29 | | Total amount of commissions paid to insurance broker | USD $549 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $3,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $549 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 (MID-AT) |
| Policy instance | 2 |
| Insurance contract or identification number | 7909 (MID-AT) | | Number of Individuals Covered | 99 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $28,733 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $573,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,733 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| BENISTAR (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 8 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $86,163 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 5757187 |
| Policy instance | 7 |
| Insurance contract or identification number | 5757187 | | Number of Individuals Covered | 778 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $43,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TMO5757187 |
| Policy instance | 5 |
| Insurance contract or identification number | TMO5757187 | | Number of Individuals Covered | 782 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $1,485 | | Total amount of fees paid to insurance company | USD $1,316 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $448,430 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,485 | | Amount paid for insurance broker fees | 1316 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 3040 |
| Policy instance | 3 |
| Insurance contract or identification number | 3040 | | Number of Individuals Covered | 349 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $14,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 215949 |
| Policy instance | 4 |
| Insurance contract or identification number | 215949 | | Number of Individuals Covered | 341 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $11,711 | | Total amount of fees paid to insurance company | USD $5,091 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $98,958 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,711 | | Amount paid for insurance broker fees | 5091 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05757187 |
| Policy instance | 5 |
| Insurance contract or identification number | TM05757187 | | Number of Individuals Covered | 782 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $1,485 | | Total amount of fees paid to insurance company | USD $1,316 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $448,430 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,485 | | Amount paid for insurance broker fees | 1316 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99062087 |
| Policy instance | 1 |
| Insurance contract or identification number | 99062087 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2016-06-30 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $2,568 | | Total amount of fees paid to insurance company | USD $514 | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,119 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,568 | | Amount paid for insurance broker fees | 514 | | Additional information about fees paid to insurance broker | GUARANTEED SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 (MID-AT) |
| Policy instance | 2 |
| Insurance contract or identification number | 7909 (MID-AT) | | Number of Individuals Covered | 100 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $607,409 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 3040 |
| Policy instance | 3 |
| Insurance contract or identification number | 3040 | | Number of Individuals Covered | 349 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $15,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 215949 |
| Policy instance | 4 |
| Insurance contract or identification number | 215949 | | Number of Individuals Covered | 347 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $25,908 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $202,584 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,908 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL NEW ENGLAND LLC |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05757187 |
| Policy instance | 5 |
| Insurance contract or identification number | TM05757187 | | Number of Individuals Covered | 800 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $10,514 | | Total amount of fees paid to insurance company | USD $3,257 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Welfare Benefit Premiums Paid to Carrier | USD $451,167 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,029 | | Amount paid for insurance broker fees | 2129 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS SVCES INC |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 |
| Policy instance | 1 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $7,331 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $551,411 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,331 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05757187 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05757187 | | Number of Individuals Covered | 594 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $18,985 | | Total amount of fees paid to insurance company | USD $204 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $433,789 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,985 | | Amount paid for insurance broker fees | 204 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 215949 |
| Policy instance | 3 |
| Insurance contract or identification number | 215949 | | Number of Individuals Covered | 365 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $5,935 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | 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 | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $49,895 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,935 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 3040 |
| Policy instance | 4 |
| Insurance contract or identification number | 3040 | | Number of Individuals Covered | 353 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99062087 |
| Policy instance | 5 |
| Insurance contract or identification number | 99062087 | | Number of Individuals Covered | 466 | | Insurance policy start date | 2014-06-30 | | Insurance policy end date | 2015-06-29 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 |
| Policy instance | 1 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $9,439 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $517,268 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,439 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05757187 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05757187 | | Number of Individuals Covered | 869 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $18,952 | | Total amount of fees paid to insurance company | USD $2,173 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $475,375 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,952 | | Amount paid for insurance broker fees | 2173 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 215949 |
| Policy instance | 3 |
| Insurance contract or identification number | 215949 | | Number of Individuals Covered | 385 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $24,754 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | 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 | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $207,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,754 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
|
| MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 3040 |
| Policy instance | 4 |
| Insurance contract or identification number | 3040 | | Number of Individuals Covered | 353 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $8,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99073988 |
| Policy instance | 6 |
| Insurance contract or identification number | 99073988 | | Number of Individuals Covered | 460 | | Insurance policy start date | 2013-08-13 | | Insurance policy end date | 2014-08-12 | | Total amount of commissions paid to insurance broker | USD $5,892 | | Total amount of fees paid to insurance company | USD $1,277 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMNBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $39,281 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $5,892 | | Amount paid for insurance broker fees | 1277 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
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| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99062087 |
| Policy instance | 5 |
| Insurance contract or identification number | 99062087 | | Number of Individuals Covered | 460 | | Insurance policy start date | 2013-06-30 | | Insurance policy end date | 2014-06-29 | | Total amount of commissions paid to insurance broker | USD $2,369 | | Total amount of fees paid to insurance company | USD $513 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $15,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $2,369 | | Amount paid for insurance broker fees | 513 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
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| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 9115642B |
| Policy instance | 7 |
| Insurance contract or identification number | 9115642B | | Number of Individuals Covered | 460 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $182 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $182 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
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| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 99062087 |
| Policy instance | 5 |
| Insurance contract or identification number | 99062087 | | Number of Individuals Covered | 377 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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| MHN SERVICES (National Association of Insurance Commissioners NAIC id number: 52411 ) |
| Policy contract number | 3040 |
| Policy instance | 4 |
| Insurance contract or identification number | 3040 | | Number of Individuals Covered | 353 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $15,800 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 215949 |
| Policy instance | 3 |
| Insurance contract or identification number | 215949 | | Number of Individuals Covered | 377 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $22,095 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | 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 | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $182,932 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,095 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05757187 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05757187 | | Number of Individuals Covered | 831 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $18,278 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $459,477 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,278 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
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| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 7909 |
| Policy instance | 1 |
| Insurance contract or identification number | 7909 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $3,723 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $506,046 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,723 | | Insurance broker organization code? | 3 | | Insurance broker name | HUB INTERNATIONAL INS. SVCES., INC. |
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