HOLY INNOCENTS EPISCOPAL SCHOOL, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN
401k plan membership statisitcs for HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN
| Measure | Date | Value |
|---|
| 2022: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-09-01 | 294 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-09-01 | 287 |
| Number of retired or separated participants receiving benefits | 2022-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-09-01 | 0 |
| Total of all active and inactive participants | 2022-09-01 | 287 |
| Number of employers contributing to the scheme | 2022-09-01 | 0 |
| 2021: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-09-01 | 283 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-09-01 | 297 |
| Number of retired or separated participants receiving benefits | 2021-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-09-01 | 0 |
| Total of all active and inactive participants | 2021-09-01 | 297 |
| Number of employers contributing to the scheme | 2021-09-01 | 0 |
| 2020: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-09-01 | 291 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-09-01 | 283 |
| Number of retired or separated participants receiving benefits | 2020-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-09-01 | 0 |
| Total of all active and inactive participants | 2020-09-01 | 283 |
| Number of employers contributing to the scheme | 2020-09-01 | 0 |
| 2019: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-09-01 | 292 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-09-01 | 291 |
| Number of retired or separated participants receiving benefits | 2019-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-09-01 | 0 |
| Total of all active and inactive participants | 2019-09-01 | 291 |
| Number of employers contributing to the scheme | 2019-09-01 | 0 |
| 2018: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-09-01 | 290 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-09-01 | 292 |
| Number of retired or separated participants receiving benefits | 2018-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-09-01 | 0 |
| Total of all active and inactive participants | 2018-09-01 | 292 |
| Number of employers contributing to the scheme | 2018-09-01 | 0 |
| 2017: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-09-01 | 289 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-09-01 | 279 |
| Number of retired or separated participants receiving benefits | 2017-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-09-01 | 0 |
| Total of all active and inactive participants | 2017-09-01 | 279 |
| Number of employers contributing to the scheme | 2017-09-01 | 0 |
| 2016: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-09-01 | 283 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-09-01 | 289 |
| Number of retired or separated participants receiving benefits | 2016-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-09-01 | 0 |
| Total of all active and inactive participants | 2016-09-01 | 289 |
| 2015: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-09-01 | 255 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-09-01 | 259 |
| Number of retired or separated participants receiving benefits | 2015-09-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2015-09-01 | 0 |
| Total of all active and inactive participants | 2015-09-01 | 261 |
| 2014: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-09-01 | 257 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-09-01 | 255 |
| Number of retired or separated participants receiving benefits | 2014-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-09-01 | 0 |
| Total of all active and inactive participants | 2014-09-01 | 255 |
| 2013: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-09-01 | 305 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-09-01 | 257 |
| Number of retired or separated participants receiving benefits | 2013-09-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-09-01 | 0 |
| Total of all active and inactive participants | 2013-09-01 | 257 |
| 2012: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-09-01 | 310 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-09-01 | 305 |
| Total of all active and inactive participants | 2012-09-01 | 305 |
| 2011: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-09-01 | 272 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-09-01 | 310 |
| Total of all active and inactive participants | 2011-09-01 | 310 |
| 2010: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-09-01 | 283 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-09-01 | 272 |
| Total of all active and inactive participants | 2010-09-01 | 272 |
| 2009: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-09-01 | 283 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-09-01 | 283 |
| Total of all active and inactive participants | 2009-09-01 | 283 |
| 2022: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2022 form 5500 responses |
|---|
| 2022-09-01 | Type of plan entity | Single employer plan |
| 2022-09-01 | Plan funding arrangement – Insurance | Yes |
| 2022-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2021 form 5500 responses |
|---|
| 2021-09-01 | Type of plan entity | Single employer plan |
| 2021-09-01 | Plan funding arrangement – Insurance | Yes |
| 2021-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2020 form 5500 responses |
|---|
| 2020-09-01 | Type of plan entity | Single employer plan |
| 2020-09-01 | Plan funding arrangement – Insurance | Yes |
| 2020-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2019 form 5500 responses |
|---|
| 2019-09-01 | Type of plan entity | Single employer plan |
| 2019-09-01 | Plan funding arrangement – Insurance | Yes |
| 2019-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2018 form 5500 responses |
|---|
| 2018-09-01 | Type of plan entity | Single employer plan |
| 2018-09-01 | Plan funding arrangement – Insurance | Yes |
| 2018-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2017 form 5500 responses |
|---|
| 2017-09-01 | Type of plan entity | Single employer plan |
| 2017-09-01 | Plan funding arrangement – Insurance | Yes |
| 2017-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2016 form 5500 responses |
|---|
| 2016-09-01 | Type of plan entity | Single employer plan |
| 2016-09-01 | Submission has been amended | No |
| 2016-09-01 | This submission is the final filing | No |
| 2016-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-09-01 | Plan is a collectively bargained plan | No |
| 2016-09-01 | Plan funding arrangement – Insurance | Yes |
| 2016-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2015 form 5500 responses |
|---|
| 2015-09-01 | Type of plan entity | Single employer plan |
| 2015-09-01 | Submission has been amended | No |
| 2015-09-01 | This submission is the final filing | No |
| 2015-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-09-01 | Plan is a collectively bargained plan | No |
| 2015-09-01 | Plan funding arrangement – Insurance | Yes |
| 2015-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2014 form 5500 responses |
|---|
| 2014-09-01 | Type of plan entity | Single employer plan |
| 2014-09-01 | Submission has been amended | No |
| 2014-09-01 | This submission is the final filing | No |
| 2014-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-09-01 | Plan is a collectively bargained plan | No |
| 2014-09-01 | Plan funding arrangement – Insurance | Yes |
| 2014-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2013 form 5500 responses |
|---|
| 2013-09-01 | Type of plan entity | Single employer plan |
| 2013-09-01 | Submission has been amended | No |
| 2013-09-01 | This submission is the final filing | No |
| 2013-09-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-09-01 | Plan is a collectively bargained plan | No |
| 2013-09-01 | Plan funding arrangement – Insurance | Yes |
| 2013-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2012 form 5500 responses |
|---|
| 2012-09-01 | Type of plan entity | Single employer plan |
| 2012-09-01 | Plan funding arrangement – Insurance | Yes |
| 2012-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2011 form 5500 responses |
|---|
| 2011-09-01 | Type of plan entity | Single employer plan |
| 2011-09-01 | Plan funding arrangement – Insurance | Yes |
| 2011-09-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-09-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2010 form 5500 responses |
|---|
| 2010-09-01 | Type of plan entity | Single employer plan |
| 2010-09-01 | Plan funding arrangement – Insurance | Yes |
| 2010-09-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: HOLY INNOCENTS' EPISCOPAL SCHOOL EMPLOYEE HEALTH & LIFE PLAN 2009 form 5500 responses |
|---|
| 2009-09-01 | Type of plan entity | Single employer plan |
| 2009-09-01 | This submission is the final filing | No |
| 2009-09-01 | Plan funding arrangement – Insurance | Yes |
| 2009-09-01 | Plan benefit arrangement – Insurance | Yes |
| EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 7859 |
| Policy instance | 3 |
| Insurance contract or identification number | 7859 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | 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 $6,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 804579G |
| Policy instance | 2 |
| Insurance contract or identification number | 804579G | | Number of Individuals Covered | 280 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $26,667 | | Total amount of fees paid to insurance company | USD $0 | | 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 $162,197 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,667 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 486220 |
| Policy instance | 1 |
| Insurance contract or identification number | 486220 | | Number of Individuals Covered | 315 | | Insurance policy start date | 2022-09-01 | | Insurance policy end date | 2023-08-31 | | Total amount of commissions paid to insurance broker | USD $23,865 | | Total amount of fees paid to insurance company | USD $4,830 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $161,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,732 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | 2022 SIGNATURE DENTAL AND VISION RETENTION INCENTIVE RISK |
|
| EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 7859 |
| Policy instance | 3 |
| Insurance contract or identification number | 7859 | | Number of Individuals Covered | 289 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | 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 $6,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 804579G |
| Policy instance | 2 |
| Insurance contract or identification number | 804579G | | Number of Individuals Covered | 297 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $17,317 | | Total amount of fees paid to insurance company | USD $0 | | 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 $125,946 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,317 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 486220 |
| Policy instance | 1 |
| Insurance contract or identification number | 486220 | | Number of Individuals Covered | 320 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $22,529 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $141,352 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,529 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 7859 |
| Policy instance | 3 |
| Insurance contract or identification number | 7859 | | Number of Individuals Covered | 289 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | 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 $6,090 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 804579G |
| Policy instance | 2 |
| Insurance contract or identification number | 804579G | | Number of Individuals Covered | 272 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $18,892 | | Total amount of fees paid to insurance company | USD $0 | | 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 $125,946 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,892 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 486220 |
| Policy instance | 1 |
| Insurance contract or identification number | 486220 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $16,959 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $123,804 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,959 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 7859 |
| Policy instance | 3 |
| Insurance contract or identification number | 7859 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | 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 $6,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 804579G |
| Policy instance | 2 |
| Insurance contract or identification number | 804579G | | Number of Individuals Covered | 279 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $18,892 | | Total amount of fees paid to insurance company | USD $0 | | 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 $125,946 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,892 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 486220 |
| Policy instance | 1 |
| Insurance contract or identification number | 486220 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $17,393 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $114,091 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,393 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 7859 |
| Policy instance | 1 |
| Insurance contract or identification number | 7859 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | 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 $6,090 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 285074 |
| Policy instance | 2 |
| Insurance contract or identification number | 285074 | | Number of Individuals Covered | 292 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $31,540 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $210,630 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,540 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80012 ) |
| Policy contract number | 486220 |
| Policy instance | 2 |
| Insurance contract or identification number | 486220 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $35,669 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $244,202 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EAP CONSULTANTS, LLC (National Association of Insurance Commissioners NAIC id number: 62419 ) |
| Policy contract number | 7859 |
| Policy instance | 1 |
| Insurance contract or identification number | 7859 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | 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 $6,081 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE INTEGRITY BENEFIT NETWORK (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 145 |
| Policy instance | 1 |
| Insurance contract or identification number | 145 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | Total amount of commissions paid to insurance broker | USD $50,104 | | Total amount of fees paid to insurance company | USD $56,358 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | PRECERT AND COMPLIANCE FEES | | 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? | No | | Commission paid to Insurance Broker | USD $50,104 | | Amount paid for insurance broker fees | 56358 | | Additional information about fees paid to insurance broker | COMPENSATION | | Insurance broker organization code? | 5 | | Insurance broker name | THE INTEGRITY BENEFIT NETWORK |
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| THE INTEGRITY BENEFIT NETWORK (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | 145 |
| Policy instance | 1 |
| Insurance contract or identification number | 145 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | Total amount of commissions paid to insurance broker | USD $46,897 | | Total amount of fees paid to insurance company | USD $55,817 | | 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 | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | PRECERT AND COMPLIANCE FEES | | 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? | No | | Commission paid to Insurance Broker | USD $46,897 | | Amount paid for insurance broker fees | 55817 | | Additional information about fees paid to insurance broker | COMPENSATION | | Insurance broker organization code? | 5 | | Insurance broker name | THE INTEGRITY BENEFIT NETWORK |
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