THE FOUNTAINHEAD GROUP, INC. has sponsored the creation of one or more 401k plans.
Additional information about THE FOUNTAINHEAD GROUP, INC.
Submission information for form 5500 for 401k plan THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN
401k plan membership statisitcs for THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-02-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-02-01 | 116 |
| Total of all active and inactive participants | 2022-02-01 | 116 |
| 2021: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-02-01 | 115 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-02-01 | 122 |
| Total of all active and inactive participants | 2021-02-01 | 122 |
| 2020: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-02-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-02-01 | 115 |
| Total of all active and inactive participants | 2020-02-01 | 115 |
| 2019: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-02-01 | 176 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-02-01 | 106 |
| Total of all active and inactive participants | 2019-02-01 | 106 |
| 2018: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-02-01 | 189 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-02-01 | 176 |
| Total of all active and inactive participants | 2018-02-01 | 176 |
| 2017: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-02-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-02-01 | 189 |
| Total of all active and inactive participants | 2017-02-01 | 189 |
| 2016: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-02-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-02-01 | 114 |
| Total of all active and inactive participants | 2016-02-01 | 114 |
| 2015: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-02-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-02-01 | 122 |
| Total of all active and inactive participants | 2015-02-01 | 122 |
| 2014: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-02-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-02-01 | 116 |
| Total of all active and inactive participants | 2014-02-01 | 116 |
| 2013: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-02-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-02-01 | 106 |
| Total of all active and inactive participants | 2013-02-01 | 106 |
| 2012: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-02-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-02-01 | 109 |
| Total of all active and inactive participants | 2012-02-01 | 109 |
| 2011: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-02-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-02-01 | 111 |
| Total of all active and inactive participants | 2011-02-01 | 111 |
| 2010: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-02-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-02-01 | 114 |
| Total of all active and inactive participants | 2010-02-01 | 114 |
| 2022: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2022 form 5500 responses |
|---|
| 2022-02-01 | Type of plan entity | Mulitple employer plan |
| 2022-02-01 | Plan funding arrangement – Insurance | Yes |
| 2022-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2021 form 5500 responses |
|---|
| 2021-02-01 | Type of plan entity | Mulitple employer plan |
| 2021-02-01 | Plan funding arrangement – Insurance | Yes |
| 2021-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2020 form 5500 responses |
|---|
| 2020-02-01 | Type of plan entity | Mulitple employer plan |
| 2020-02-01 | Plan funding arrangement – Insurance | Yes |
| 2020-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2019 form 5500 responses |
|---|
| 2019-02-01 | Type of plan entity | Mulitple employer plan |
| 2019-02-01 | Plan funding arrangement – Insurance | Yes |
| 2019-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-02-01 | Type of plan entity | Mulitple employer plan |
| 2018-02-01 | Plan funding arrangement – Insurance | Yes |
| 2018-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2017 form 5500 responses |
|---|
| 2017-02-01 | Type of plan entity | Mulitple employer plan |
| 2017-02-01 | Plan funding arrangement – Insurance | Yes |
| 2017-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2016 form 5500 responses |
|---|
| 2016-02-01 | Type of plan entity | Single employer plan |
| 2016-02-01 | Plan funding arrangement – Insurance | Yes |
| 2016-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-02-01 | Type of plan entity | Single employer plan |
| 2015-02-01 | Plan funding arrangement – Insurance | Yes |
| 2015-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-02-01 | Type of plan entity | Single employer plan |
| 2014-02-01 | Plan funding arrangement – Insurance | Yes |
| 2014-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-02-01 | Type of plan entity | Single employer plan |
| 2013-02-01 | Plan funding arrangement – Insurance | Yes |
| 2013-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-02-01 | Type of plan entity | Single employer plan |
| 2012-02-01 | Plan funding arrangement – Insurance | Yes |
| 2012-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2011 form 5500 responses |
|---|
| 2011-02-01 | Type of plan entity | Single employer plan |
| 2011-02-01 | Plan funding arrangement – Insurance | Yes |
| 2011-02-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: THE FOUNTAINHEAD GROUP, INC. WELFARE PLAN 2010 form 5500 responses |
|---|
| 2010-02-01 | Type of plan entity | Single employer plan |
| 2010-02-01 | First time form 5500 has been submitted | Yes |
| 2010-02-01 | Plan funding arrangement – Insurance | Yes |
| 2010-02-01 | Plan benefit arrangement – Insurance | Yes |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00362333 |
| Policy instance | 2 |
| Insurance contract or identification number | 00362333 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $9,915 | | Total amount of fees paid to insurance company | USD $2,564 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACC. DEATH AND DISMEM., ST DISABIL | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,915 | | Amount paid for insurance broker fees | 2564 | | Additional information about fees paid to insurance broker | ADMINSTRATIVE SERVICES & FEES | | Insurance broker organization code? | 3 |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00015034 |
| Policy instance | 1 |
| Insurance contract or identification number | 00015034 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00362333 |
| Policy instance | 2 |
| Insurance contract or identification number | 00362333 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $9,193 | | Total amount of fees paid to insurance company | USD $6,320 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,193 | | Amount paid for insurance broker fees | 6320 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES & FEES | | Insurance broker organization code? | 3 |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00015034 |
| Policy instance | 1 |
| Insurance contract or identification number | 00015034 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $40,710 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,710 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES & FEES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00362333 |
| Policy instance | 2 |
| Insurance contract or identification number | 00362333 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $9,677 | | Total amount of fees paid to insurance company | USD $5,062 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,432 | | Amount paid for insurance broker fees | 5062 | | Insurance broker organization code? | 3 |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00015034 |
| Policy instance | 1 |
| Insurance contract or identification number | 00015034 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $37,950 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $37,950 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES & FEES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00362333 |
| Policy instance | 4 |
| Insurance contract or identification number | 00362333 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $6,299 | | Total amount of fees paid to insurance company | USD $4,434 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,072 | | Amount paid for insurance broker fees | 4434 | | Insurance broker organization code? | 3 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 819903 |
| Policy instance | 3 |
| Insurance contract or identification number | 819903 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $2,399 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,399 | | Insurance broker organization code? | 3 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 819904 |
| Policy instance | 2 |
| Insurance contract or identification number | 819904 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $307 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PAID FAMILY LEAVE | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $307 | | Insurance broker organization code? | 3 |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00015034 |
| Policy instance | 1 |
| Insurance contract or identification number | 00015034 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $78,511 | | Total amount of fees paid to insurance company | USD $147,151 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,703 | | Amount paid for insurance broker fees | 147151 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICES & FEES | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00362333 |
| Policy instance | 4 |
| Insurance contract or identification number | 00362333 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $3,863 | | Total amount of fees paid to insurance company | USD $4,280 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,787 | | Amount paid for insurance broker fees | 4280 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE AND FEES | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANCE ADVISORY GROUP, INC. |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 819903 |
| Policy instance | 3 |
| Insurance contract or identification number | 819903 | | Number of Individuals Covered | 66 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $3,849 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,849 | | Insurance broker organization code? | 3 | | Insurance broker name | GILROY KERNAN & GILROY, INC. |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 819904 |
| Policy instance | 2 |
| Insurance contract or identification number | 819904 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $949 | | Total amount of fees paid to insurance company | USD $0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PAID FAMILY LEAVE | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $949 | | Insurance broker organization code? | 3 | | Insurance broker name | GILROY KERNAN & GILROY, INC. |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00015034 |
| Policy instance | 1 |
| Insurance contract or identification number | 00015034 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $34,188 | | Total amount of fees paid to insurance company | USD $123,595 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,188 | | Amount paid for insurance broker fees | 123595 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE AND FEES | | Insurance broker organization code? | 3 | | Insurance broker name | GILROY KERNAN & GILROY, INC. |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00015034 |
| Policy instance | 1 |
| Insurance contract or identification number | 00015034 | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $26,566 | | Total amount of fees paid to insurance company | USD $82,667 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,566 | | Amount paid for insurance broker fees | 82667 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE AND FEES | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN & BROWN NEW YORK - ROME |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00015034 |
| Policy instance | 1 |
| Insurance contract or identification number | 00015034 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $24,491 | | Total amount of fees paid to insurance company | USD $76,210 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,491 | | Amount paid for insurance broker fees | 76210 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE AND FEES | | Insurance broker organization code? | 3 | | Insurance broker name | AFS AGENCY |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00015034 |
| Policy instance | 1 |
| Insurance contract or identification number | 00015034 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $21,275 | | Total amount of fees paid to insurance company | USD $66,203 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,275 | | Amount paid for insurance broker fees | 66203 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE AND FEES | | Insurance broker organization code? | 3 | | Insurance broker name | AFS AGENCY |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00015034 |
| Policy instance | 1 |
| Insurance contract or identification number | 00015034 | | Number of Individuals Covered | 114 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $11,937 | | Total amount of fees paid to insurance company | USD $37,146 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,937 | | Amount paid for insurance broker fees | 37146 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE SERVICE AND FEES | | Insurance broker organization code? | 3 | | Insurance broker name | AFS AGENCY |
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