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WINN CONSTRUCTION SERVICES INSURANCE PROGAM 401k Plan overview

Plan NameWINN CONSTRUCTION SERVICES INSURANCE PROGAM
Plan identification number 501

WINN CONSTRUCTION SERVICES INSURANCE PROGAM Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Other welfare benefit cover

401k Sponsoring company profile

WINN CONSTRUCTION SERVICES INSURANC has sponsored the creation of one or more 401k plans.

Company Name:WINN CONSTRUCTION SERVICES INSURANC
Employer identification number (EIN):462428144
NAIC Classification:237310
NAIC Description:Highway, Street, and Bridge Construction

Additional information about WINN CONSTRUCTION SERVICES INSURANC

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 2013-03-28
Company Identification Number: 4380547
Legal Registered Office Address: 74 Hudson River Rd
Saratoga
Waterford
United States of America (USA)
12188

More information about WINN CONSTRUCTION SERVICES INSURANC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WINN CONSTRUCTION SERVICES INSURANCE PROGAM

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01DUSTIN WINN2023-07-17 DUSTIN WINN2023-07-17
5012021-01-01DUSTIN WINN2022-10-16 DUSTIN WINN2022-10-16
5012020-01-01DUSTIN WINN2021-10-12 DUSTIN WINN2021-10-12
5012019-01-01DUSTIN WINN2020-07-12 DUSTIN WINN2020-07-12
5012018-01-01
5012017-01-01
5012016-08-01DUSTIN WINN

Plan Statistics for WINN CONSTRUCTION SERVICES INSURANCE PROGAM

401k plan membership statisitcs for WINN CONSTRUCTION SERVICES INSURANCE PROGAM

Measure Date Value
2022: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2022 401k membership
Total participants, beginning-of-year2022-01-0112
Total number of active participants reported on line 7a of the Form 55002022-01-0112
Total of all active and inactive participants2022-01-0112
2021: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2021 401k membership
Total participants, beginning-of-year2021-01-0113
Total number of active participants reported on line 7a of the Form 55002021-01-0112
Total of all active and inactive participants2021-01-0112
2020: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2020 401k membership
Total participants, beginning-of-year2020-01-0113
Total number of active participants reported on line 7a of the Form 55002020-01-0113
Total of all active and inactive participants2020-01-0113
2019: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2019 401k membership
Total participants, beginning-of-year2019-01-0111
Total number of active participants reported on line 7a of the Form 55002019-01-0113
Total of all active and inactive participants2019-01-0113
2018: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2018 401k membership
Total participants, beginning-of-year2018-01-018
Total number of active participants reported on line 7a of the Form 55002018-01-0111
Total of all active and inactive participants2018-01-0111
2017: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2017 401k membership
Total participants, beginning-of-year2017-01-018
Total number of active participants reported on line 7a of the Form 55002017-01-018
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-018
2016: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2016 401k membership
Total participants, beginning-of-year2016-08-010
Total number of active participants reported on line 7a of the Form 55002016-08-018
Number of retired or separated participants receiving benefits2016-08-010
Number of other retired or separated participants entitled to future benefits2016-08-010
Total of all active and inactive participants2016-08-018

Financial Data on WINN CONSTRUCTION SERVICES INSURANCE PROGAM

Measure Date Value
2022 : WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2022 401k financial data
Total income from all sources2022-12-31$167,742
Expenses. Total of all expenses incurred2022-12-31$178,146
Benefits paid (including direct rollovers)2022-12-31$175,503
Total plan assets at end of year2022-12-31$63,933
Total plan assets at beginning of year2022-12-31$74,337
Net income (gross income less expenses)2022-12-31$-10,404
Net plan assets at end of year (total assets less liabilities)2022-12-31$63,933
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$74,337
Total contributions received or receivable from employer(s)2022-12-31$167,742
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$2,643
2021 : WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2021 401k financial data
Total income from all sources2021-12-31$186,329
Expenses. Total of all expenses incurred2021-12-31$169,375
Benefits paid (including direct rollovers)2021-12-31$166,214
Total plan assets at end of year2021-12-31$74,337
Total plan assets at beginning of year2021-12-31$57,383
Net income (gross income less expenses)2021-12-31$16,954
Net plan assets at end of year (total assets less liabilities)2021-12-31$74,337
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$57,383
Total contributions received or receivable from employer(s)2021-12-31$186,329
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$3,161
2020 : WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2020 401k financial data
Total income from all sources2020-12-31$161,041
Expenses. Total of all expenses incurred2020-12-31$189,887
Benefits paid (including direct rollovers)2020-12-31$177,065
Total plan assets at end of year2020-12-31$57,383
Total plan assets at beginning of year2020-12-31$86,229
Net income (gross income less expenses)2020-12-31$-28,846
Net plan assets at end of year (total assets less liabilities)2020-12-31$57,383
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$86,229
Total contributions received or receivable from employer(s)2020-12-31$161,041
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$12,822
2019 : WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2019 401k financial data
Total income from all sources2019-12-31$192,621
Expenses. Total of all expenses incurred2019-12-31$172,379
Benefits paid (including direct rollovers)2019-12-31$188,909
Total plan assets at end of year2019-12-31$86,229
Total plan assets at beginning of year2019-12-31$65,987
Net income (gross income less expenses)2019-12-31$20,242
Net plan assets at end of year (total assets less liabilities)2019-12-31$86,229
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$65,987
Total contributions received or receivable from employer(s)2019-12-31$192,621
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$-16,530
2018 : WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2018 401k financial data
Total income from all sources2018-12-31$181,573
Expenses. Total of all expenses incurred2018-12-31$148,158
Benefits paid (including direct rollovers)2018-12-31$135,990
Total plan assets at end of year2018-12-31$65,987
Total plan assets at beginning of year2018-12-31$32,572
Net income (gross income less expenses)2018-12-31$33,415
Net plan assets at end of year (total assets less liabilities)2018-12-31$65,987
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$32,572
Total contributions received or receivable from employer(s)2018-12-31$181,573
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$12,168
2017 : WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2017 401k financial data
Total income from all sources2017-12-31$96,326
Expenses. Total of all expenses incurred2017-12-31$88,655
Benefits paid (including direct rollovers)2017-12-31$90,675
Total plan assets at end of year2017-12-31$32,572
Total plan assets at beginning of year2017-12-31$24,901
Net income (gross income less expenses)2017-12-31$7,671
Net plan assets at end of year (total assets less liabilities)2017-12-31$32,572
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$24,901
Total contributions received or receivable from employer(s)2017-12-31$96,326
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$-2,020
2016 : WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2016 401k financial data
Total income from all sources2016-12-31$52,911
Expenses. Total of all expenses incurred2016-12-31$28,010
Benefits paid (including direct rollovers)2016-12-31$29,561
Total plan assets at end of year2016-12-31$24,901
Total plan assets at beginning of year2016-12-31$0
Net income (gross income less expenses)2016-12-31$24,901
Net plan assets at end of year (total assets less liabilities)2016-12-31$24,901
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$0
Total contributions received or receivable from employer(s)2016-12-31$52,911
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$-1,551

Form 5500 Responses for WINN CONSTRUCTION SERVICES INSURANCE PROGAM

2022: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: WINN CONSTRUCTION SERVICES INSURANCE PROGAM 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Submission has been amendedNo
2016-08-01This submission is the final filingNo
2016-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-08-01Plan is a collectively bargained planNo
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan funding arrangement – TrustYes
2016-08-01Plan benefit arrangement – InsuranceYes
2016-08-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

EYE MED VISION CARE (National Association of Insurance Commissioners NAIC id number: 98512 )
Policy contract number1031070-1001
Policy instance 2
Insurance contract or identification number1031070-1001
Number of Individuals Covered10
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $3,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
CDPHP (National Association of Insurance Commissioners NAIC id number: 95491 )
Policy contract number40021836
Policy instance 1
Insurance contract or identification number40021836
Number of Individuals Covered11
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $170,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
CDPHP (National Association of Insurance Commissioners NAIC id number: 95491 )
Policy contract number40021836
Policy instance 1
Insurance contract or identification number40021836
Number of Individuals Covered12
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $162,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
UCCI TRUST (National Association of Insurance Commissioners NAIC id number: 62294 )
Policy contract numberDVPNY303
Policy instance 2
Insurance contract or identification numberDVPNY303
Number of Individuals Covered12
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $4,565
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
CDPHP (National Association of Insurance Commissioners NAIC id number: 95491 )
Policy contract number40021836
Policy instance 1
Insurance contract or identification number40021836
Number of Individuals Covered13
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $164,199
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number426802
Policy instance 3
Insurance contract or identification number426802
Number of Individuals Covered13
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $74,912
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
UCCI TRUST (National Association of Insurance Commissioners NAIC id number: 62294 )
Policy contract numberDVPNY303
Policy instance 2
Insurance contract or identification numberDVPNY303
Number of Individuals Covered13
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $14,731
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
CDPHP (National Association of Insurance Commissioners NAIC id number: 95491 )
Policy contract number40021836
Policy instance 1
Insurance contract or identification number40021836
Number of Individuals Covered13
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $97,167
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number426802
Policy instance 2
Insurance contract or identification number426802
Number of Individuals Covered11
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $125,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
UCCI TRUST (National Association of Insurance Commissioners NAIC id number: 62294 )
Policy contract numberDVPNY303
Policy instance 1
Insurance contract or identification numberDVPNY303
Number of Individuals Covered11
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $10,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number426802
Policy instance 2
Insurance contract or identification number426802
Number of Individuals Covered8
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $82,482
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS CENTER
UCCI TRUST (National Association of Insurance Commissioners NAIC id number: 62294 )
Policy contract numberDVPNY303
Policy instance 1
Insurance contract or identification numberDVPNY303
Number of Individuals Covered8
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $8,193
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BNEEFITS CENTER, LLC

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