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CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 401k Plan overview

Plan NameCHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN
Plan identification number 501

CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

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

Company Name:CHOPTANK COMMUNITY HEALTH SYSTEM, INC.
Employer identification number (EIN):521116591
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-08-01SARA RICH2023-11-06
5012021-08-01SARA RICH2022-11-10
5012020-08-01SARA RICH2021-12-10
5012019-08-01SARA RICH2020-12-17
5012018-08-01SARA RICH2020-01-06
5012017-08-01
5012016-08-01SARA RICH
5012015-08-01SARA RICH
5012014-08-01SARA RICH
5012013-08-01DAVID FISHER
5012012-08-01DAVID M FISHER
5012011-08-01TERRY WEAVER
5012009-08-01TERRY WEAVER
5012008-08-01TERRY WEAVER

Plan Statistics for CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN

401k plan membership statisitcs for CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN

Measure Date Value
2022: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-08-01198
Total number of active participants reported on line 7a of the Form 55002022-08-01250
Number of retired or separated participants receiving benefits2022-08-010
Number of other retired or separated participants entitled to future benefits2022-08-010
Total of all active and inactive participants2022-08-01250
Number of employers contributing to the scheme2022-08-010
2021: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-08-01179
Total number of active participants reported on line 7a of the Form 55002021-08-01198
Number of retired or separated participants receiving benefits2021-08-010
Number of other retired or separated participants entitled to future benefits2021-08-010
Total of all active and inactive participants2021-08-01198
Number of employers contributing to the scheme2021-08-010
2020: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-08-01136
Total number of active participants reported on line 7a of the Form 55002020-08-01179
Number of retired or separated participants receiving benefits2020-08-010
Number of other retired or separated participants entitled to future benefits2020-08-010
Total of all active and inactive participants2020-08-01179
Number of employers contributing to the scheme2020-08-010
2019: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-08-01130
Total number of active participants reported on line 7a of the Form 55002019-08-01136
Number of retired or separated participants receiving benefits2019-08-010
Number of other retired or separated participants entitled to future benefits2019-08-010
Total of all active and inactive participants2019-08-01136
Number of employers contributing to the scheme2019-08-010
2018: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-08-01159
Total number of active participants reported on line 7a of the Form 55002018-08-01189
Number of retired or separated participants receiving benefits2018-08-010
Number of other retired or separated participants entitled to future benefits2018-08-010
Total of all active and inactive participants2018-08-01189
Number of employers contributing to the scheme2018-08-010
2017: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-08-01112
Total number of active participants reported on line 7a of the Form 55002017-08-01173
Number of retired or separated participants receiving benefits2017-08-010
Number of other retired or separated participants entitled to future benefits2017-08-010
Total of all active and inactive participants2017-08-01173
Number of employers contributing to the scheme2017-08-010
2016: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-08-01125
Total number of active participants reported on line 7a of the Form 55002016-08-01112
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 participants2016-08-01112
2015: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-08-01135
Total number of active participants reported on line 7a of the Form 55002015-08-01125
Number of retired or separated participants receiving benefits2015-08-010
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-01125
2014: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-08-01112
Total number of active participants reported on line 7a of the Form 55002014-08-01135
Number of retired or separated participants receiving benefits2014-08-010
Number of other retired or separated participants entitled to future benefits2014-08-010
Total of all active and inactive participants2014-08-01135
2013: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-08-01113
Total number of active participants reported on line 7a of the Form 55002013-08-01112
Number of retired or separated participants receiving benefits2013-08-010
Number of other retired or separated participants entitled to future benefits2013-08-010
Total of all active and inactive participants2013-08-01112
2012: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-08-01151
Total number of active participants reported on line 7a of the Form 55002012-08-01113
Number of retired or separated participants receiving benefits2012-08-010
Number of other retired or separated participants entitled to future benefits2012-08-010
Total of all active and inactive participants2012-08-01113
2011: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-08-01147
Total number of active participants reported on line 7a of the Form 55002011-08-01151
Number of retired or separated participants receiving benefits2011-08-010
Number of other retired or separated participants entitled to future benefits2011-08-010
Total of all active and inactive participants2011-08-01151
2009: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-08-01115
Total number of active participants reported on line 7a of the Form 55002009-08-01109
Number of retired or separated participants receiving benefits2009-08-010
Number of other retired or separated participants entitled to future benefits2009-08-010
Total of all active and inactive participants2009-08-01109
2008: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-08-01107
Total number of active participants reported on line 7a of the Form 55002008-08-01104
Number of retired or separated participants receiving benefits2008-08-010
Number of other retired or separated participants entitled to future benefits2008-08-010
Total of all active and inactive participants2008-08-01104

Form 5500 Responses for CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN

2022: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-08-01Type of plan entitySingle employer plan
2022-08-01Plan funding arrangement – InsuranceYes
2022-08-01Plan funding arrangement – General assets of the sponsorYes
2022-08-01Plan benefit arrangement – InsuranceYes
2022-08-01Plan benefit arrangement – General assets of the sponsorYes
2021: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-08-01Type of plan entitySingle employer plan
2021-08-01Plan funding arrangement – InsuranceYes
2021-08-01Plan funding arrangement – General assets of the sponsorYes
2021-08-01Plan benefit arrangement – InsuranceYes
2021-08-01Plan benefit arrangement – General assets of the sponsorYes
2020: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-08-01Type of plan entitySingle employer plan
2020-08-01Plan funding arrangement – InsuranceYes
2020-08-01Plan funding arrangement – General assets of the sponsorYes
2020-08-01Plan benefit arrangement – InsuranceYes
2020-08-01Plan benefit arrangement – General assets of the sponsorYes
2019: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-08-01Type of plan entitySingle employer plan
2019-08-01Plan funding arrangement – InsuranceYes
2019-08-01Plan funding arrangement – General assets of the sponsorYes
2019-08-01Plan benefit arrangement – InsuranceYes
2019-08-01Plan benefit arrangement – General assets of the sponsorYes
2018: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-08-01Type of plan entitySingle employer plan
2018-08-01Plan funding arrangement – InsuranceYes
2018-08-01Plan funding arrangement – General assets of the sponsorYes
2018-08-01Plan benefit arrangement – InsuranceYes
2018-08-01Plan benefit arrangement – General assets of the sponsorYes
2017: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan funding arrangement – General assets of the sponsorYes
2017-08-01Plan benefit arrangement – InsuranceYes
2017-08-01Plan benefit arrangement – General assets of the sponsorYes
2016: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 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)No
2016-08-01Plan is a collectively bargained planNo
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – InsuranceYes
2015: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Submission has been amendedNo
2015-08-01This submission is the final filingNo
2015-08-01This return/report is a short plan year return/report (less than 12 months)No
2015-08-01Plan is a collectively bargained planNo
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – InsuranceYes
2014: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Submission has been amendedNo
2014-08-01This submission is the final filingNo
2014-08-01This return/report is a short plan year return/report (less than 12 months)No
2014-08-01Plan is a collectively bargained planNo
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes
2012: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Submission has been amendedNo
2012-08-01This submission is the final filingNo
2012-08-01This return/report is a short plan year return/report (less than 12 months)No
2012-08-01Plan is a collectively bargained planNo
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Submission has been amendedNo
2011-08-01This submission is the final filingNo
2011-08-01This return/report is a short plan year return/report (less than 12 months)No
2011-08-01Plan is a collectively bargained planNo
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – InsuranceYes
2009: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01Submission has been amendedNo
2009-08-01This submission is the final filingNo
2009-08-01This return/report is a short plan year return/report (less than 12 months)No
2009-08-01Plan is a collectively bargained planNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – InsuranceYes
2008: CHOPTANK COMMUNITY HEALTH SYSTEM INC WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-08-01Type of plan entitySingle employer plan
2008-08-01First time form 5500 has been submittedYes
2008-08-01Submission has been amendedNo
2008-08-01This submission is the final filingNo
2008-08-01This return/report is a short plan year return/report (less than 12 months)No
2008-08-01Plan is a collectively bargained planNo
2008-08-01Plan funding arrangement – InsuranceYes
2008-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7602444
Policy instance 4
Insurance contract or identification numberE7602444
Number of Individuals Covered52
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $5,824
Total amount of fees paid to insurance companyUSD $101
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $63,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,010
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerFEES
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number907427-001
Policy instance 3
Insurance contract or identification number907427-001
Number of Individuals Covered320
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $10,758
Total amount of fees paid to insurance companyUSD $11,268
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $128,121
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $10,758
Amount paid for insurance broker fees6853
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30059699
Policy instance 2
Insurance contract or identification number30059699
Number of Individuals Covered146
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $1,195
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,051
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,195
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618184-0001
Policy instance 1
Insurance contract or identification number618184-0001
Number of Individuals Covered204
Insurance policy start date2022-08-01
Insurance policy end date2023-07-31
Total amount of commissions paid to insurance brokerUSD $6,870
Total amount of fees paid to insurance companyUSD $1,090
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $87,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,870
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618184-0001
Policy instance 1
Insurance contract or identification number618184-0001
Number of Individuals Covered198
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $6,681
Total amount of fees paid to insurance companyUSD $951
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to CarrierUSD $76,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,681
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30059699
Policy instance 2
Insurance contract or identification number30059699
Number of Individuals Covered127
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $1,022
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,022
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number907427-001
Policy instance 3
Insurance contract or identification number907427-001
Number of Individuals Covered308
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $10,767
Total amount of fees paid to insurance companyUSD $10,849
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $10,767
Amount paid for insurance broker fees6255
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7602444
Policy instance 4
Insurance contract or identification numberE7602444
Number of Individuals Covered53
Insurance policy start date2021-08-01
Insurance policy end date2022-07-31
Total amount of commissions paid to insurance brokerUSD $6,681
Total amount of fees paid to insurance companyUSD $584
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $68,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,387
Amount paid for insurance broker fees278
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7602444
Policy instance 4
Insurance contract or identification numberE7602444
Number of Individuals Covered55
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $6,489
Total amount of fees paid to insurance companyUSD $430
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $65,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,131
Amount paid for insurance broker fees238
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number907427-001
Policy instance 3
Insurance contract or identification number907427-001
Number of Individuals Covered284
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $7,024
Total amount of fees paid to insurance companyUSD $16,126
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,865
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $7,024
Amount paid for insurance broker fees9098
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30059699
Policy instance 2
Insurance contract or identification number30059699
Number of Individuals Covered132
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $1,603
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,597
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,045
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618184
Policy instance 1
Insurance contract or identification number618184
Number of Individuals Covered179
Insurance policy start date2020-08-01
Insurance policy end date2021-07-31
Total amount of commissions paid to insurance brokerUSD $5,972
Total amount of fees paid to insurance companyUSD $772
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $57,402
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,972
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30059699
Policy instance 2
Insurance contract or identification number30059699
Number of Individuals Covered109
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $896
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $896
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618184
Policy instance 1
Insurance contract or identification number618184
Number of Individuals Covered175
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $5,133
Total amount of fees paid to insurance companyUSD $613
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $53,397
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,133
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number907427-001
Policy instance 3
Insurance contract or identification number907427-001
Number of Individuals Covered248
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $9,041
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,429
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $9,041
Amount paid for insurance broker fees0
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7602444
Policy instance 4
Insurance contract or identification numberE7602444
Number of Individuals Covered55
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Total amount of commissions paid to insurance brokerUSD $6,686
Total amount of fees paid to insurance companyUSD $431
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $65,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,206
Amount paid for insurance broker fees317
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7602444
Policy instance 4
Insurance contract or identification numberE7602444
Number of Individuals Covered56
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $8,632
Total amount of fees paid to insurance companyUSD $589
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENT, CRITICAL ILLNESS, HOSPITAL, CANCER
Welfare Benefit Premiums Paid to CarrierUSD $69,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,090
Amount paid for insurance broker fees410
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618184
Policy instance 1
Insurance contract or identification number618184
Number of Individuals Covered189
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $5,959
Total amount of fees paid to insurance companyUSD $931
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $61,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,959
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30059699
Policy instance 2
Insurance contract or identification number30059699
Number of Individuals Covered106
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $861
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $861
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number907427-001
Policy instance 3
Insurance contract or identification number907427-001
Number of Individuals Covered213
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $9,829
Total amount of fees paid to insurance companyUSD $4,431
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,260
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $9,829
Amount paid for insurance broker fees4431
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE7602444
Policy instance 4
Insurance contract or identification numberE7602444
Number of Individuals Covered65
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $9,755
Total amount of fees paid to insurance companyUSD $1,231
Other welfare benefits providedVOLUNTARY BENEFITS
Welfare Benefit Premiums Paid to CarrierUSD $64,323
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,907
Amount paid for insurance broker fees1207
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
Insurance broker nameNICHOLAS CUSMANO
UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )
Policy contract number907427-000
Policy instance 3
Insurance contract or identification number907427-000
Number of Individuals Covered225
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $179
Total amount of fees paid to insurance companyUSD $3,726
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,368
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees3726
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameEMPLOYEE ONE BENEFIT SOLUTIONS, LLC
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number30059699
Policy instance 2
Insurance contract or identification number30059699
Number of Individuals Covered107
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $956
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,011
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $846
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameEMPLOYEE ONE BENEFIT SOLUTIONS, LLC
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number618184-0001
Policy instance 1
Insurance contract or identification number618184-0001
Number of Individuals Covered173
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $4,819
Total amount of fees paid to insurance companyUSD $937
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $37,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,819
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameGALLAGHER BENEFIT SERVICES, INC.

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