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THE HILLIARD CORPORATION UNION MEDICAL PLAN 401k Plan overview

Plan NameTHE HILLIARD CORPORATION UNION MEDICAL PLAN
Plan identification number 503

THE HILLIARD CORPORATION UNION MEDICAL PLAN Benefits

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

401k Sponsoring company profile

THE HILLIARD CORPORATION has sponsored the creation of one or more 401k plans.

Company Name:THE HILLIARD CORPORATION
Employer identification number (EIN):160480520
NAIC Classification:336990

Additional information about THE HILLIARD CORPORATION

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1905-04-27
Company Identification Number: 26976
Legal Registered Office Address: 100 WEST FOURTH STREET
Chemung
ELMIRA
United States of America (USA)
14901

More information about THE HILLIARD CORPORATION

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE HILLIARD CORPORATION UNION MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032017-01-01KELLY LONG
5032016-01-01KELLY LONG
5032015-01-01
5032014-01-01KELLY LONG KELLY LONG2017-08-23
5032013-01-01KELLY LONG KELLY LONG2016-09-08
5032012-01-01KELLY LONG KELLY LONG2016-09-08
5032011-01-01KELLY LONG KELLY LONG2016-09-08
5032010-01-01KELLY LONG KELLY LONG2016-09-08
5032009-01-01KELLY LONG KELLY LONG2016-09-08
5032008-01-01KELLY LONG KELLY LONG2016-09-08
5032007-01-01KELLY LONG KELLY LONG2016-09-08
5032006-01-01KELLY LONG KELLY LONG2016-09-08
5032005-01-01KELLY LONG KELLY LONG2016-09-08
5032004-01-01KELLY LONG KELLY LONG2016-09-08
5032003-01-01KELLY LONG KELLY LONG2016-09-08
5032002-01-01KELLY LONG KELLY LONG2016-09-08

Plan Statistics for THE HILLIARD CORPORATION UNION MEDICAL PLAN

401k plan membership statisitcs for THE HILLIARD CORPORATION UNION MEDICAL PLAN

Measure Date Value
2017: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01376
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-010
2016: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01391
Total number of active participants reported on line 7a of the Form 55002016-01-01376
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01376
2015: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01417
Total number of active participants reported on line 7a of the Form 55002015-01-01391
Total of all active and inactive participants2015-01-01391
2014: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01413
Total number of active participants reported on line 7a of the Form 55002014-01-01417
Total of all active and inactive participants2014-01-01417
Total participants2014-01-01417
2013: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01425
Total number of active participants reported on line 7a of the Form 55002013-01-01413
Total of all active and inactive participants2013-01-01413
Total participants2013-01-01413
2012: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01390
Total number of active participants reported on line 7a of the Form 55002012-01-01425
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01425
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01425
Number of participants with account balances2012-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
Number of employers contributing to the scheme2012-01-010
2011: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01411
Total number of active participants reported on line 7a of the Form 55002011-01-01390
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01390
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01390
Number of participants with account balances2011-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
Number of employers contributing to the scheme2011-01-010
2010: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01367
Total number of active participants reported on line 7a of the Form 55002010-01-01437
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01437
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-01437
Number of participants with account balances2010-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
Number of employers contributing to the scheme2010-01-010
2009: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01361
Total number of active participants reported on line 7a of the Form 55002009-01-01367
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01367
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01367
Number of participants with account balances2009-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010
Number of employers contributing to the scheme2009-01-010
2008: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2008 401k membership
Total participants, beginning-of-year2008-01-01356
Total number of active participants reported on line 7a of the Form 55002008-01-01361
Number of retired or separated participants receiving benefits2008-01-010
Number of other retired or separated participants entitled to future benefits2008-01-010
Total of all active and inactive participants2008-01-01361
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2008-01-010
Total participants2008-01-01361
Number of participants with account balances2008-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2008-01-010
Number of employers contributing to the scheme2008-01-010
2007: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2007 401k membership
Total participants, beginning-of-year2007-01-01276
Total number of active participants reported on line 7a of the Form 55002007-01-01356
Number of retired or separated participants receiving benefits2007-01-010
Number of other retired or separated participants entitled to future benefits2007-01-010
Total of all active and inactive participants2007-01-01356
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2007-01-010
Total participants2007-01-01356
Number of participants with account balances2007-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2007-01-010
Number of employers contributing to the scheme2007-01-010
2006: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2006 401k membership
Total participants, beginning-of-year2006-01-01263
Total number of active participants reported on line 7a of the Form 55002006-01-01276
Number of retired or separated participants receiving benefits2006-01-010
Number of other retired or separated participants entitled to future benefits2006-01-010
Total of all active and inactive participants2006-01-01276
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2006-01-010
Total participants2006-01-01276
Number of participants with account balances2006-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2006-01-010
Number of employers contributing to the scheme2006-01-010
2005: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2005 401k membership
Total participants, beginning-of-year2005-01-01262
Total number of active participants reported on line 7a of the Form 55002005-01-01263
Number of retired or separated participants receiving benefits2005-01-010
Number of other retired or separated participants entitled to future benefits2005-01-010
Total of all active and inactive participants2005-01-01263
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2005-01-010
Total participants2005-01-01263
Number of participants with account balances2005-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2005-01-010
Number of employers contributing to the scheme2005-01-010
2004: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2004 401k membership
Total participants, beginning-of-year2004-01-01234
Total number of active participants reported on line 7a of the Form 55002004-01-01262
Number of retired or separated participants receiving benefits2004-01-010
Number of other retired or separated participants entitled to future benefits2004-01-010
Total of all active and inactive participants2004-01-01262
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2004-01-010
Total participants2004-01-01262
Number of participants with account balances2004-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2004-01-010
Number of employers contributing to the scheme2004-01-010
2003: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2003 401k membership
Total participants, beginning-of-year2003-01-01236
Total number of active participants reported on line 7a of the Form 55002003-01-01234
Number of retired or separated participants receiving benefits2003-01-010
Number of other retired or separated participants entitled to future benefits2003-01-010
Total of all active and inactive participants2003-01-01234
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2003-01-010
Total participants2003-01-01234
Number of participants with account balances2003-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2003-01-010
Number of employers contributing to the scheme2003-01-010
2002: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2002 401k membership
Total participants, beginning-of-year2002-01-01234
Total number of active participants reported on line 7a of the Form 55002002-01-01236
Number of retired or separated participants receiving benefits2002-01-010
Number of other retired or separated participants entitled to future benefits2002-01-010
Total of all active and inactive participants2002-01-01236
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2002-01-010
Total participants2002-01-01236
Number of participants with account balances2002-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2002-01-010
Number of employers contributing to the scheme2002-01-010

Form 5500 Responses for THE HILLIARD CORPORATION UNION MEDICAL PLAN

2017: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes
2008: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2008 form 5500 responses
2008-01-01Type of plan entitySingle employer plan
2008-01-01Submission has been amendedNo
2008-01-01This submission is the final filingNo
2008-01-01This return/report is a short plan year return/report (less than 12 months)No
2008-01-01Plan is a collectively bargained planNo
2008-01-01Plan funding arrangement – InsuranceYes
2008-01-01Plan benefit arrangement – InsuranceYes
2007: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2007 form 5500 responses
2007-01-01Type of plan entitySingle employer plan
2007-01-01Submission has been amendedNo
2007-01-01This submission is the final filingNo
2007-01-01This return/report is a short plan year return/report (less than 12 months)No
2007-01-01Plan is a collectively bargained planNo
2007-01-01Plan funding arrangement – InsuranceYes
2007-01-01Plan benefit arrangement – InsuranceYes
2006: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2006 form 5500 responses
2006-01-01Type of plan entitySingle employer plan
2006-01-01Submission has been amendedNo
2006-01-01This submission is the final filingNo
2006-01-01This return/report is a short plan year return/report (less than 12 months)No
2006-01-01Plan is a collectively bargained planNo
2006-01-01Plan funding arrangement – InsuranceYes
2006-01-01Plan benefit arrangement – InsuranceYes
2005: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2005 form 5500 responses
2005-01-01Type of plan entitySingle employer plan
2005-01-01Submission has been amendedNo
2005-01-01This submission is the final filingNo
2005-01-01This return/report is a short plan year return/report (less than 12 months)No
2005-01-01Plan is a collectively bargained planNo
2005-01-01Plan funding arrangement – InsuranceYes
2005-01-01Plan benefit arrangement – InsuranceYes
2004: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2004 form 5500 responses
2004-01-01Type of plan entitySingle employer plan
2004-01-01Submission has been amendedNo
2004-01-01This submission is the final filingNo
2004-01-01This return/report is a short plan year return/report (less than 12 months)No
2004-01-01Plan is a collectively bargained planNo
2004-01-01Plan funding arrangement – InsuranceYes
2004-01-01Plan benefit arrangement – InsuranceYes
2003: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2003 form 5500 responses
2003-01-01Type of plan entitySingle employer plan
2003-01-01Submission has been amendedNo
2003-01-01This submission is the final filingNo
2003-01-01This return/report is a short plan year return/report (less than 12 months)No
2003-01-01Plan is a collectively bargained planNo
2003-01-01Plan funding arrangement – InsuranceYes
2003-01-01Plan benefit arrangement – InsuranceYes
2002: THE HILLIARD CORPORATION UNION MEDICAL PLAN 2002 form 5500 responses
2002-01-01Type of plan entitySingle employer plan
2002-01-01Submission has been amendedNo
2002-01-01This submission is the final filingNo
2002-01-01This return/report is a short plan year return/report (less than 12 months)No
2002-01-01Plan is a collectively bargained planNo
2002-01-01Plan funding arrangement – InsuranceYes
2002-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00045271
Policy instance 1
Insurance contract or identification number00045271
Number of Individuals Covered323
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $111,870
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $111,870
Insurance broker organization code?3
Insurance broker nameBROWN AND BROWN EMPIRE STATE
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00045271
Policy instance 1
Insurance contract or identification number00045271
Number of Individuals Covered391
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $121,856
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $121,856
Insurance broker nameBROWN AND BROWN EMPIRE STATE
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00045271
Policy instance 1
Insurance contract or identification number00045271
Number of Individuals Covered413
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $89,449
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $89,449
Insurance broker nameBROWN & BROWN EMPIRE STATE
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number00045271
Policy instance 1
Insurance contract or identification number00045271
Number of Individuals Covered425
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $71,559
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $71,559
Insurance broker nameBROWN & BROWN EMPIRE STATE
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number0045271
Policy instance 1
Insurance contract or identification number0045271
Number of Individuals Covered390
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $80,426
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $80,426
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN EMPIRE STATE
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number0045271
Policy instance 1
Insurance contract or identification number0045271
Number of Individuals Covered437
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $73,474
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $73,474
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN EMPIRE STATE
EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 )
Policy contract number0045271
Policy instance 1
Insurance contract or identification number0045271
Number of Individuals Covered367
Insurance policy start date2009-01-01
Insurance policy end date2009-12-31
Total amount of commissions paid to insurance brokerUSD $90,275
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $90,275
Insurance broker organization code?3
Insurance broker nameBROWN & BROWN EMPIRE STATE

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