401k Plan data: HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN plan

HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN 401k Plan overview

Plan Name	HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN
Plan identification number	501

HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

HOOPER HOLMES, INC. has sponsored the creation of one or more 401k plans.

Company Name: HOOPER HOLMES, INC.

Employer identification number (EIN): 481208378

NAIC Classification: 809900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2017-01-01

Plan Statistics for HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN

401k plan membership statisitcs for HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN

Measure Date Value
2017: HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 260
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 260
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 260

Measure	Date	Value
2017: HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	260
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	260
Number of retired or separated participants receiving benefits	2017-01-01	0
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	260

Form 5500 Responses for HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN

2017: HOOPER HOLMES, INC. GROUP LIFE, HEALTH AND DENTAL INSURANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	First time form 5500 has been submitted	Yes
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

Insurance Providers Used on plan

BLUE CROSS AND BLUE SHIELD OF KANSAS CITY (National Association of Insurance Commissioners NAIC id number: 47171 )

Policy contract number

36651000

Policy instance

Insurance contract or identification number	36651000
Number of Individuals Covered	181
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $43,897
Total amount of fees paid to insurance company	USD $12,517
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,254,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $40,265
Amount paid for insurance broker fees	12517
Additional information about fees paid to insurance broker	ADMINISTRATIVE SERVICES NON-MONETARY COMPENSATION
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

KM05923382

Policy instance

Insurance contract or identification number	KM05923382
Number of Individuals Covered	215
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $22,258
Total amount of fees paid to insurance company	USD $2,924
Dental Insurance Welfare Benefit	Yes
Life 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 $94,453
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $22,258
Amount paid for insurance broker fees	2924
Additional information about fees paid to insurance broker	SUPPLEMENTAL COMPENSATION NON-MONETARY COMPENSATION
Insurance broker organization code?	3
Insurance broker name	HOLMES, MURPHY AND ASSOCIATES, LLC

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

181828

Policy instance

Insurance contract or identification number	181828
Number of Individuals Covered	103
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $9,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

GTU 4379950

Policy instance

Insurance contract or identification number	GTU 4379950
Number of Individuals Covered	1232
Insurance policy start date	2016-06-01
Insurance policy end date	2017-05-31
Total amount of commissions paid to insurance broker	USD $143
Total amount of fees paid to insurance company	USD $143
Other welfare benefits provided	BUSINESS TRAVEL ACCIDENT
Welfare Benefit Premiums Paid to Carrier	USD $950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $143
Amount paid for insurance broker fees	0
Insurance broker organization code?	3
Additional information about fees paid to insurance broker	MARKETING AND ADMINISTRATIVE SERVICES
Insurance broker name	REUBEN WARNER ASSOCIATES, INC.

Potentially related plans

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Company Name:	HOOPER HOLMES, INC.
Employer identification number (EIN):	481208378
NAIC Classification:	809900