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HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 401k Plan overview

Plan NameHEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES
Plan identification number 505

HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Supplemental unemployment
  • Vision

401k Sponsoring company profile

W. W. NORTON AND COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name:W. W. NORTON AND COMPANY, INC.
Employer identification number (EIN):135283680
NAIC Classification:511190

Additional information about W. W. NORTON AND COMPANY, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1923-11-23
Company Identification Number: 19043
Legal Registered Office Address: ATT: JORIE KRUMPFER
500 FIFTH AVENUE
NEW YORK
United States of America (USA)
10110

More information about W. W. NORTON AND COMPANY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-05-01JORIE KRUMPFER2023-11-21
5052021-05-01JORIE KRUMPFER2022-09-19
5052020-05-01JORIE KRUMPFER2022-01-06
5052019-05-01JAMIE FINKELMAN2021-02-04
5052018-05-01JAMIE FINKELMAN2020-02-07
5052017-05-01
5052016-05-01JAMIE FINKELMAN
5052015-05-01JAMIE FINKELMAN
5052014-05-01JAMIE FINKELMAN
5052014-05-01JAMIE FINKELMAN
5052013-05-01JAMIE FINKELMAN
5052012-05-01LISA GAETH
5052011-05-01LISA GAETH

Plan Statistics for HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES

401k plan membership statisitcs for HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES

Measure Date Value
2022: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2022 401k membership
Total participants, beginning-of-year2022-05-01606
Total number of active participants reported on line 7a of the Form 55002022-05-01600
Number of retired or separated participants receiving benefits2022-05-010
Number of other retired or separated participants entitled to future benefits2022-05-010
Total of all active and inactive participants2022-05-01600
Number of employers contributing to the scheme2022-05-010
2021: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2021 401k membership
Total participants, beginning-of-year2021-05-01595
Total number of active participants reported on line 7a of the Form 55002021-05-01606
Number of retired or separated participants receiving benefits2021-05-010
Number of other retired or separated participants entitled to future benefits2021-05-010
Total of all active and inactive participants2021-05-01606
Number of employers contributing to the scheme2021-05-010
2020: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2020 401k membership
Total participants, beginning-of-year2020-05-01628
Total number of active participants reported on line 7a of the Form 55002020-05-01595
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-01595
Number of employers contributing to the scheme2020-05-010
2019: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2019 401k membership
Total participants, beginning-of-year2019-05-01626
Total number of active participants reported on line 7a of the Form 55002019-05-01628
Number of retired or separated participants receiving benefits2019-05-010
Number of other retired or separated participants entitled to future benefits2019-05-010
Total of all active and inactive participants2019-05-01628
Number of employers contributing to the scheme2019-05-010
2018: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2018 401k membership
Total participants, beginning-of-year2018-05-01555
Total number of active participants reported on line 7a of the Form 55002018-05-01626
Number of retired or separated participants receiving benefits2018-05-010
Number of other retired or separated participants entitled to future benefits2018-05-010
Total of all active and inactive participants2018-05-01626
Number of employers contributing to the scheme2018-05-010
2017: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2017 401k membership
Total participants, beginning-of-year2017-05-01629
Total number of active participants reported on line 7a of the Form 55002017-05-01555
Number of retired or separated participants receiving benefits2017-05-014
Number of other retired or separated participants entitled to future benefits2017-05-0168
Total of all active and inactive participants2017-05-01627
2016: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2016 401k membership
Total participants, beginning-of-year2016-05-01620
Total number of active participants reported on line 7a of the Form 55002016-05-011,258
Number of retired or separated participants receiving benefits2016-05-0194
Number of other retired or separated participants entitled to future benefits2016-05-010
Total of all active and inactive participants2016-05-011,352
2015: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2015 401k membership
Total participants, beginning-of-year2015-05-01587
Total number of active participants reported on line 7a of the Form 55002015-05-01620
Number of retired or separated participants receiving benefits2015-05-010
Number of other retired or separated participants entitled to future benefits2015-05-010
Total of all active and inactive participants2015-05-01620
2014: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2014 401k membership
Total participants, beginning-of-year2014-05-01587
Total number of active participants reported on line 7a of the Form 55002014-05-01587
Number of retired or separated participants receiving benefits2014-05-010
Number of other retired or separated participants entitled to future benefits2014-05-010
Total of all active and inactive participants2014-05-01587
2013: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2013 401k membership
Total participants, beginning-of-year2013-05-01560
Total number of active participants reported on line 7a of the Form 55002013-05-01587
Number of retired or separated participants receiving benefits2013-05-010
Number of other retired or separated participants entitled to future benefits2013-05-010
Total of all active and inactive participants2013-05-01587
2012: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2012 401k membership
Total participants, beginning-of-year2012-05-01558
Total number of active participants reported on line 7a of the Form 55002012-05-01558
Total of all active and inactive participants2012-05-01558
2011: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2011 401k membership
Total participants, beginning-of-year2011-05-01535
Total number of active participants reported on line 7a of the Form 55002011-05-01535
Number of retired or separated participants receiving benefits2011-05-015
Total of all active and inactive participants2011-05-01540

Form 5500 Responses for HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES

2022: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2022 form 5500 responses
2022-05-01Type of plan entitySingle employer plan
2022-05-01Plan funding arrangement – InsuranceYes
2022-05-01Plan funding arrangement – General assets of the sponsorYes
2022-05-01Plan benefit arrangement – InsuranceYes
2022-05-01Plan benefit arrangement – General assets of the sponsorYes
2021: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2021 form 5500 responses
2021-05-01Type of plan entitySingle employer plan
2021-05-01Plan funding arrangement – InsuranceYes
2021-05-01Plan benefit arrangement – InsuranceYes
2020: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2020 form 5500 responses
2020-05-01Type of plan entitySingle employer plan
2020-05-01Plan funding arrangement – InsuranceYes
2020-05-01Plan benefit arrangement – InsuranceYes
2019: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2019 form 5500 responses
2019-05-01Type of plan entitySingle employer plan
2019-05-01Plan funding arrangement – InsuranceYes
2019-05-01Plan benefit arrangement – InsuranceYes
2018: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2018 form 5500 responses
2018-05-01Type of plan entitySingle employer plan
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan benefit arrangement – InsuranceYes
2017: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2017 form 5500 responses
2017-05-01Type of plan entitySingle employer plan
2017-05-01Plan funding arrangement – InsuranceYes
2017-05-01Plan benefit arrangement – InsuranceYes
2016: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2016 form 5500 responses
2016-05-01Type of plan entitySingle employer plan
2016-05-01Submission has been amendedNo
2016-05-01This submission is the final filingNo
2016-05-01This return/report is a short plan year return/report (less than 12 months)No
2016-05-01Plan is a collectively bargained planNo
2016-05-01Plan funding arrangement – InsuranceYes
2016-05-01Plan benefit arrangement – InsuranceYes
2015: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2015 form 5500 responses
2015-05-01Type of plan entitySingle employer plan
2015-05-01Submission has been amendedNo
2015-05-01This submission is the final filingNo
2015-05-01This return/report is a short plan year return/report (less than 12 months)No
2015-05-01Plan is a collectively bargained planNo
2015-05-01Plan funding arrangement – InsuranceYes
2015-05-01Plan benefit arrangement – InsuranceYes
2014: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2014 form 5500 responses
2014-05-01Type of plan entitySingle employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planNo
2014-05-01Plan funding arrangement – InsuranceYes
2014-05-01Plan benefit arrangement – InsuranceYes
2013: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2013 form 5500 responses
2013-05-01Type of plan entitySingle employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planNo
2013-05-01Plan funding arrangement – InsuranceYes
2013-05-01Plan benefit arrangement – InsuranceYes
2012: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2012 form 5500 responses
2012-05-01Type of plan entitySingle employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planNo
2012-05-01Plan funding arrangement – InsuranceYes
2012-05-01Plan benefit arrangement – InsuranceYes
2011: HEALTH INSURANCE FOR EMPLOYEES OF WW NORTON AND COMPANY AND ITS WHOLLY OWNED SUBSIDIARIES 2011 form 5500 responses
2011-05-01Type of plan entitySingle employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planNo
2011-05-01Plan funding arrangement – InsuranceYes
2011-05-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered1031
Insurance policy start date2022-05-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $23,705
Total amount of fees paid to insurance companyUSD $4,858
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,655,788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,705
Amount paid for insurance broker fees4858
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered1037
Insurance policy start date2021-05-01
Insurance policy end date2022-04-30
Total amount of commissions paid to insurance brokerUSD $270,255
Total amount of fees paid to insurance companyUSD $12,544
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,737,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $270,255
Amount paid for insurance broker fees12544
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered980
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $264,376
Total amount of fees paid to insurance companyUSD $23,840
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,963,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $264,376
Amount paid for insurance broker fees23840
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered1087
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $275,110
Total amount of fees paid to insurance companyUSD $9,686
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,148,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $275,110
Amount paid for insurance broker fees9686
Additional information about fees paid to insurance brokerFEES
Insurance broker organization code?3
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered1083
Insurance policy start date2018-05-01
Insurance policy end date2019-04-30
Total amount of commissions paid to insurance brokerUSD $250,950
Total amount of fees paid to insurance companyUSD $460
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,674,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $229,007
Amount paid for insurance broker fees460
Insurance broker organization code?3
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered1107
Insurance policy start date2017-05-01
Insurance policy end date2018-04-30
Total amount of commissions paid to insurance brokerUSD $257,913
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,249,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $257,913
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES LLC
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered1086
Insurance policy start date2015-05-01
Insurance policy end date2016-04-30
Total amount of commissions paid to insurance brokerUSD $254,643
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,910,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $212,936
Insurance broker organization code?3
Insurance broker nameTRAVERS O KEEFE AND ASSOCIATES INC.
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered587
Insurance policy start date2014-05-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $275,157
Insurance broker organization code?3
Insurance broker nameTRAVES O KEEFE AND ASSOCIATES INC.
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered1038
Insurance policy start date2013-05-01
Insurance policy end date2014-04-30
Total amount of commissions paid to insurance brokerUSD $261,550
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,647,919
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $260,265
Insurance broker organization code?3
Insurance broker nameTRAVERS OKEEFE AND ASSOCIATES
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered558
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
Total amount of commissions paid to insurance brokerUSD $267,785
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,097,478
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $267,785
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTRAVERS O'KEEFE @ ASSOCIATES
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number219151
Policy instance 1
Insurance contract or identification number219151
Number of Individuals Covered540
Insurance policy start date2011-05-01
Insurance policy end date2012-04-30
Total amount of commissions paid to insurance brokerUSD $279,453
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,591,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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