INTEGRITY, INC. has sponsored the creation of one or more 401k plans.
Measure | Date | Value |
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2022: HEALTH PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-07-01 | 143 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 147 |
Number of retired or separated participants receiving benefits | 2022-07-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2022-07-01 | 0 |
Total of all active and inactive participants | 2022-07-01 | 149 |
2021: HEALTH PLAN 2021 401k membership |
---|
Total participants, beginning-of-year | 2021-07-01 | 139 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 138 |
Number of retired or separated participants receiving benefits | 2021-07-01 | 6 |
Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
Total of all active and inactive participants | 2021-07-01 | 144 |
2020: HEALTH PLAN 2020 401k membership |
---|
Total participants, beginning-of-year | 2020-07-01 | 157 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 139 |
Number of retired or separated participants receiving benefits | 2020-07-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 41 |
Total of all active and inactive participants | 2020-07-01 | 181 |
2019: HEALTH PLAN 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-07-01 | 156 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 155 |
Number of retired or separated participants receiving benefits | 2019-07-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
Total of all active and inactive participants | 2019-07-01 | 157 |
2018: HEALTH PLAN 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-07-01 | 204 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 175 |
Number of retired or separated participants receiving benefits | 2018-07-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2018-07-01 | 8 |
Total of all active and inactive participants | 2018-07-01 | 188 |
2017: HEALTH PLAN 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-07-01 | 202 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 203 |
Number of retired or separated participants receiving benefits | 2017-07-01 | 5 |
Number of other retired or separated participants entitled to future benefits | 2017-07-01 | 7 |
Total of all active and inactive participants | 2017-07-01 | 215 |
Number of employers contributing to the scheme | 2017-07-01 | 0 |
2016: HEALTH PLAN 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-07-01 | 181 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 206 |
Number of retired or separated participants receiving benefits | 2016-07-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2016-07-01 | 7 |
Total of all active and inactive participants | 2016-07-01 | 215 |
2015: HEALTH PLAN 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-07-01 | 182 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 181 |
Number of retired or separated participants receiving benefits | 2015-07-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2015-07-01 | 0 |
Total of all active and inactive participants | 2015-07-01 | 184 |
2014: HEALTH PLAN 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-07-01 | 156 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 167 |
Number of retired or separated participants receiving benefits | 2014-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2014-07-01 | 0 |
Total of all active and inactive participants | 2014-07-01 | 167 |
2013: HEALTH PLAN 2013 401k membership |
---|
Total participants, beginning-of-year | 2013-07-01 | 140 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 156 |
Number of retired or separated participants receiving benefits | 2013-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2013-07-01 | 0 |
Total of all active and inactive participants | 2013-07-01 | 156 |
2012: HEALTH PLAN 2012 401k membership |
---|
Total participants, beginning-of-year | 2012-07-01 | 140 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 141 |
Number of retired or separated participants receiving benefits | 2012-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2012-07-01 | 0 |
Total of all active and inactive participants | 2012-07-01 | 141 |
2011: HEALTH PLAN 2011 401k membership |
---|
Total participants, beginning-of-year | 2011-07-01 | 130 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 136 |
Number of retired or separated participants receiving benefits | 2011-07-01 | 3 |
Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 0 |
Total of all active and inactive participants | 2011-07-01 | 139 |
2010: HEALTH PLAN 2010 401k membership |
---|
Total participants, beginning-of-year | 2010-07-01 | 163 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 134 |
Number of retired or separated participants receiving benefits | 2010-07-01 | 1 |
Number of other retired or separated participants entitled to future benefits | 2010-07-01 | 0 |
Total of all active and inactive participants | 2010-07-01 | 135 |
2009: HEALTH PLAN 2009 401k membership |
---|
Total participants, beginning-of-year | 2009-07-01 | 170 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 165 |
Number of retired or separated participants receiving benefits | 2009-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
Total of all active and inactive participants | 2009-07-01 | 165 |
2022: HEALTH PLAN 2022 form 5500 responses |
---|
2022-07-01 | Type of plan entity | Single employer plan |
2022-07-01 | Submission has been amended | No |
2022-07-01 | This submission is the final filing | No |
2022-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2022-07-01 | Plan is a collectively bargained plan | No |
2022-07-01 | Plan funding arrangement – Insurance | Yes |
2022-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2022-07-01 | Plan benefit arrangement – Insurance | Yes |
2022-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2021: HEALTH PLAN 2021 form 5500 responses |
---|
2021-07-01 | Type of plan entity | Single employer plan |
2021-07-01 | Submission has been amended | No |
2021-07-01 | This submission is the final filing | No |
2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2021-07-01 | Plan is a collectively bargained plan | No |
2021-07-01 | Plan funding arrangement – Insurance | Yes |
2021-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2021-07-01 | Plan benefit arrangement – Insurance | Yes |
2021-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2020: HEALTH PLAN 2020 form 5500 responses |
---|
2020-07-01 | Type of plan entity | Single employer plan |
2020-07-01 | Submission has been amended | No |
2020-07-01 | This submission is the final filing | No |
2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2020-07-01 | Plan is a collectively bargained plan | No |
2020-07-01 | Plan funding arrangement – Insurance | Yes |
2020-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2020-07-01 | Plan benefit arrangement – Insurance | Yes |
2020-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2019: HEALTH PLAN 2019 form 5500 responses |
---|
2019-07-01 | Type of plan entity | Single employer plan |
2019-07-01 | Submission has been amended | No |
2019-07-01 | This submission is the final filing | No |
2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2019-07-01 | Plan is a collectively bargained plan | No |
2019-07-01 | Plan funding arrangement – Insurance | Yes |
2019-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2019-07-01 | Plan benefit arrangement – Insurance | Yes |
2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: HEALTH PLAN 2018 form 5500 responses |
---|
2018-07-01 | Type of plan entity | Single employer plan |
2018-07-01 | Submission has been amended | No |
2018-07-01 | This submission is the final filing | No |
2018-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2018-07-01 | Plan is a collectively bargained plan | No |
2018-07-01 | Plan funding arrangement – Insurance | Yes |
2018-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2018-07-01 | Plan benefit arrangement – Insurance | Yes |
2018-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2017: HEALTH PLAN 2017 form 5500 responses |
---|
2017-07-01 | Type of plan entity | Single employer plan |
2017-07-01 | Plan funding arrangement – Insurance | Yes |
2017-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2017-07-01 | Plan benefit arrangement – Insurance | Yes |
2017-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2016: HEALTH PLAN 2016 form 5500 responses |
---|
2016-07-01 | Type of plan entity | Single employer plan |
2016-07-01 | Submission has been amended | No |
2016-07-01 | This submission is the final filing | No |
2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-07-01 | Plan is a collectively bargained plan | No |
2016-07-01 | Plan funding arrangement – Insurance | Yes |
2016-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2016-07-01 | Plan benefit arrangement – Insurance | Yes |
2016-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2015: HEALTH PLAN 2015 form 5500 responses |
---|
2015-07-01 | Type of plan entity | Single employer plan |
2015-07-01 | Submission has been amended | No |
2015-07-01 | This submission is the final filing | No |
2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-07-01 | Plan is a collectively bargained plan | No |
2015-07-01 | Plan funding arrangement – Insurance | Yes |
2015-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
2015-07-01 | Plan benefit arrangement – Insurance | Yes |
2015-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2014: HEALTH PLAN 2014 form 5500 responses |
---|
2014-07-01 | Type of plan entity | Single employer plan |
2014-07-01 | Submission has been amended | No |
2014-07-01 | This submission is the final filing | No |
2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-07-01 | Plan is a collectively bargained plan | No |
2014-07-01 | Plan funding arrangement – Insurance | Yes |
2014-07-01 | Plan benefit arrangement – Insurance | Yes |
2013: HEALTH PLAN 2013 form 5500 responses |
---|
2013-07-01 | Type of plan entity | Single employer plan |
2013-07-01 | Submission has been amended | No |
2013-07-01 | This submission is the final filing | No |
2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-07-01 | Plan is a collectively bargained plan | No |
2013-07-01 | Plan funding arrangement – Insurance | Yes |
2013-07-01 | Plan benefit arrangement – Insurance | Yes |
2012: HEALTH PLAN 2012 form 5500 responses |
---|
2012-07-01 | Type of plan entity | Single employer plan |
2012-07-01 | Submission has been amended | No |
2012-07-01 | This submission is the final filing | No |
2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2012-07-01 | Plan is a collectively bargained plan | No |
2012-07-01 | Plan funding arrangement – Insurance | Yes |
2012-07-01 | Plan benefit arrangement – Insurance | Yes |
2011: HEALTH PLAN 2011 form 5500 responses |
---|
2011-07-01 | Type of plan entity | Single employer plan |
2011-07-01 | Submission has been amended | No |
2011-07-01 | This submission is the final filing | No |
2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2011-07-01 | Plan is a collectively bargained plan | No |
2011-07-01 | Plan funding arrangement – Insurance | Yes |
2011-07-01 | Plan benefit arrangement – Insurance | Yes |
2010: HEALTH PLAN 2010 form 5500 responses |
---|
2010-07-01 | Type of plan entity | Single employer plan |
2010-07-01 | Submission has been amended | No |
2010-07-01 | This submission is the final filing | No |
2010-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2010-07-01 | Plan is a collectively bargained plan | No |
2010-07-01 | Plan funding arrangement – Insurance | Yes |
2010-07-01 | Plan benefit arrangement – Insurance | Yes |
2009: HEALTH PLAN 2009 form 5500 responses |
---|
2009-07-01 | Type of plan entity | Single employer plan |
2009-07-01 | Submission has been amended | No |
2009-07-01 | This submission is the final filing | No |
2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2009-07-01 | Plan is a collectively bargained plan | No |
2009-07-01 | Plan funding arrangement – Insurance | Yes |
2009-07-01 | Plan benefit arrangement – Insurance | Yes |
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 2 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 141 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $10,396 | Total amount of fees paid to insurance company | USD $28 | 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 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 | No | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $52,541 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,396 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 28 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
|
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 1 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 136 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $27,500 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,339,114 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $27,500 | Insurance broker organization code? | 3 |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 2 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 138 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $6,399 | Total amount of fees paid to insurance company | USD $16 | 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 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 | No | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $48,403 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,399 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 16 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
|
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 1 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 133 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $24,753 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,217,015 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $24,753 | Insurance broker organization code? | 3 |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 2 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 139 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $6,407 | Total amount of fees paid to insurance company | USD $26 | 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 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 | No | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $49,103 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,407 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 26 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
|
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 1 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 138 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $21,926 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,066,809 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $21,926 | Insurance broker organization code? | 3 |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 2 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 154 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $8,204 | Total amount of fees paid to insurance company | USD $51 | 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 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 | No | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 Carrier | USD $57,237 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,204 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 37 | Additional information about fees paid to insurance broker | THIRD PARTY ADMIN FEES |
|
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 1 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 146 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $28,145 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,373,855 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $28,145 | Insurance broker organization code? | 3 |
|
HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 1 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 168 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $34,939 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,491,846 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,939 | Insurance broker organization code? | 3 |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 2 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 175 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | Total amount of commissions paid to insurance broker | USD $10,731 | Total amount of fees paid to insurance company | USD $61 | 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 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 | No | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | 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 Carrier | USD $62,934 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,731 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 61 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES |
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HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 2 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 186 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $34,263 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,419,448 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,263 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 7580 |
Policy instance | 1 |
Insurance contract or identification number | 7580 | Number of Individuals Covered | 203 | Insurance policy start date | 2017-07-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $7,850 | Total amount of fees paid to insurance company | USD $75 | Life Insurance Welfare Benefit | Yes | Long Term Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT, EMPLOYEE ASSISTANCE PROGRAM | Welfare Benefit Premiums Paid to Carrier | USD $65,631 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,850 | Amount paid for insurance broker fees | 0 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker name | AXA ASSISTANCE |
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HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 1 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 156 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $34,167 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,372,179 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $34,167 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
Policy contract number | 1152 |
Policy instance | 2 |
Insurance contract or identification number | 1152 | Number of Individuals Covered | 168 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $3,775 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $93,273 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,775 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 7580 |
Policy instance | 3 |
Insurance contract or identification number | 7580 | Number of Individuals Covered | 170 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $3,176 | Total amount of fees paid to insurance company | USD $1,108 | 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 | No | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $33,518 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,176 | Amount paid for insurance broker fees | 1047 | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMMISSIONS | Insurance broker organization code? | 3 | Insurance broker name | AXA ASSISTANCE, USA |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD605353 |
Policy instance | 4 |
Insurance contract or identification number | SGD605353 | Number of Individuals Covered | 181 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $3,996 | Total amount of fees paid to insurance company | USD $500 | 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $26,642 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,996 | Amount paid for insurance broker fees | 500 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12148767 |
Policy instance | 5 |
Insurance contract or identification number | 12148767 | Number of Individuals Covered | 167 | Insurance policy start date | 2015-07-01 | Insurance policy end date | 2016-06-30 | Total amount of commissions paid to insurance broker | USD $1,395 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 $1,395 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 7580 |
Policy instance | 3 |
Insurance contract or identification number | 7580 | Number of Individuals Covered | 167 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $3,476 | Total amount of fees paid to insurance company | USD $58 | 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 | No | 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 | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $39,533 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,476 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 58 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker name | AXA ASSISTANCE, USA |
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HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 1 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 154 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $54,377 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,830,090 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54,377 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
Policy contract number | 1152 |
Policy instance | 2 |
Insurance contract or identification number | 1152 | Number of Individuals Covered | 163 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $3,621 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $113,351 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,621 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
Policy contract number | SGD605353 |
Policy instance | 4 |
Insurance contract or identification number | SGD605353 | Number of Individuals Covered | 167 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2015-06-30 | Total amount of commissions paid to insurance broker | USD $4,038 | Total amount of fees paid to insurance company | USD $1,019 | 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | Yes | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $26,918 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,038 | Amount paid for insurance broker fees | 1019 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 7580 |
Policy instance | 4 |
Insurance contract or identification number | 7580 | Number of Individuals Covered | 155 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $5,788 | Total amount of fees paid to insurance company | USD $53 | 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 | No | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT EMPLOYEE ASSISTANCE PROGRAM | 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 Carrier | USD $55,762 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,788 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 53 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEE | Insurance broker name | AXA ASSISTANCE, USA |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12148767 |
Policy instance | 3 |
Insurance contract or identification number | 12148767 | Number of Individuals Covered | 154 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $1,244 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 $1,244 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
Policy contract number | 1152 |
Policy instance | 2 |
Insurance contract or identification number | 1152 | Number of Individuals Covered | 152 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $3,382 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $76,082 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,382 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 1 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 148 | Insurance policy start date | 2013-07-01 | Insurance policy end date | 2014-06-30 | Total amount of commissions paid to insurance broker | USD $56,774 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,762,752 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $56,774 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 1 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 43 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY EMPLOYEE, SPOUSE AND CHILD LIFE | 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 Carrier | USD $16,359 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 2 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 137 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $5,546 | Total amount of fees paid to insurance company | USD $49 | 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 | No | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 Carrier | USD $34,698 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $5,546 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 49 | Additional information about fees paid to insurance broker | THIRD PARTY ADMINISTRATION FEES | Insurance broker name | AXA ASSISTANCE, USA |
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DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
Policy contract number | 1152 |
Policy instance | 3 |
Insurance contract or identification number | 1152 | Number of Individuals Covered | 141 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $3,162 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $77,258 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,162 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
|
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12148767 |
Policy instance | 4 |
Insurance contract or identification number | 12148767 | Number of Individuals Covered | 138 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $1,169 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $18,192 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,169 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 5 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 134 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $62,104 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,551,837 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $62,104 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE SYNERGIES GROUP, LLC |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 3 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 136 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $3,637 | Total amount of fees paid to insurance company | USD $2,367 | 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 | No | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 Carrier | USD $31,392 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
Policy contract number | 1152 |
Policy instance | 1 |
Insurance contract or identification number | 1152 | Number of Individuals Covered | 139 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $3,076 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $69,964 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 2 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 136 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $60,971 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,522,861 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12148767 |
Policy instance | 5 |
Insurance contract or identification number | 12148767 | Number of Individuals Covered | 139 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $1,143 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $19,321 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 4 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 47 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $1,574 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY EMPLOYEE, SPOUSE AND CHILD LIFE | 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 Carrier | USD $15,542 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 4 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 48 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | VOLUNTARY EMPLOYEE, SPOUSE AND CHILD LIFE | 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 Carrier | USD $15,552 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
Policy contract number | 12148767 |
Policy instance | 5 |
Insurance contract or identification number | 12148767 | Number of Individuals Covered | 132 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $1,175 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 |
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HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 55069 ) |
Policy contract number | 86259 |
Policy instance | 2 |
Insurance contract or identification number | 86259 | Number of Individuals Covered | 133 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $61,545 | Total amount of fees paid to insurance company | USD $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 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 | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $1,538,207 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 ) |
Policy contract number | 1152 |
Policy instance | 1 |
Insurance contract or identification number | 1152 | Number of Individuals Covered | 134 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $3,203 | Total amount of fees paid to insurance company | USD $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 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 | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | 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 Carrier | USD $51,532 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 ) |
Policy contract number | 07580 |
Policy instance | 3 |
Insurance contract or identification number | 07580 | Number of Individuals Covered | 132 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $5,272 | Total amount of fees paid to insurance company | USD $45 | 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 | No | 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 | Yes | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | AD&D | 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 Carrier | USD $32,099 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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