EYE CARE SPECIALISTS, P.C. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan EYE CARE SPECIALISTS WELFARE PLANS
Measure | Date | Value |
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2020: EYE CARE SPECIALISTS WELFARE PLANS 2020 401k membership |
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Total participants, beginning-of-year | 2020-07-01 | 122 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 120 |
Number of retired or separated participants receiving benefits | 2020-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
Total of all active and inactive participants | 2020-07-01 | 120 |
2019: EYE CARE SPECIALISTS WELFARE PLANS 2019 401k membership |
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Total participants, beginning-of-year | 2019-07-01 | 116 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 122 |
Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
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 | 122 |
2018: EYE CARE SPECIALISTS WELFARE PLANS 2018 401k membership |
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Total participants, beginning-of-year | 2018-07-01 | 119 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 114 |
Number of retired or separated participants receiving benefits | 2018-07-01 | 2 |
Number of other retired or separated participants entitled to future benefits | 2018-07-01 | 0 |
Total of all active and inactive participants | 2018-07-01 | 116 |
Total participants, beginning-of-year | 2018-06-01 | 118 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 119 |
Number of retired or separated participants receiving benefits | 2018-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
Total of all active and inactive participants | 2018-06-01 | 119 |
2017: EYE CARE SPECIALISTS WELFARE PLANS 2017 401k membership |
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Total participants, beginning-of-year | 2017-06-01 | 125 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 118 |
Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
Total of all active and inactive participants | 2017-06-01 | 118 |
2016: EYE CARE SPECIALISTS WELFARE PLANS 2016 401k membership |
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Total participants, beginning-of-year | 2016-06-01 | 118 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 125 |
Total of all active and inactive participants | 2016-06-01 | 125 |
2015: EYE CARE SPECIALISTS WELFARE PLANS 2015 401k membership |
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Total participants, beginning-of-year | 2015-06-01 | 113 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 116 |
Number of retired or separated participants receiving benefits | 2015-06-01 | 2 |
Total of all active and inactive participants | 2015-06-01 | 118 |
2014: EYE CARE SPECIALISTS WELFARE PLANS 2014 401k membership |
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Total participants, beginning-of-year | 2014-06-01 | 105 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 113 |
Total of all active and inactive participants | 2014-06-01 | 113 |
2013: EYE CARE SPECIALISTS WELFARE PLANS 2013 401k membership |
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Total participants, beginning-of-year | 2013-06-01 | 99 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 105 |
Total of all active and inactive participants | 2013-06-01 | 105 |
Measure | Date | Value |
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2020 : EYE CARE SPECIALISTS WELFARE PLANS 2020 401k financial data |
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Total unrealized appreciation/depreciation of assets | 2020-06-30 | $0 |
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $32,431 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $85,000 |
Total income from all sources (including contributions) | 2020-06-30 | $1,312,426 |
Total loss/gain on sale of assets | 2020-06-30 | $0 |
Total of all expenses incurred | 2020-06-30 | $1,082,607 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-06-30 | $950,781 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-06-30 | $1,183,876 |
Value of total assets at end of year | 2020-06-30 | $194,121 |
Value of total assets at beginning of year | 2020-06-30 | $16,871 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-06-30 | $131,826 |
Total interest from all sources | 2020-06-30 | $210 |
Total dividends received (eg from common stock, registered investment company shares) | 2020-06-30 | $0 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-06-30 | No |
Was this plan covered by a fidelity bond | 2020-06-30 | Yes |
Value of fidelity bond cover | 2020-06-30 | $500,000 |
If this is an individual account plan, was there a blackout period | 2020-06-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2020-06-30 | No |
Contributions received from participants | 2020-06-30 | $215,837 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-06-30 | $500 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-06-30 | $9,862 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-06-30 | $32,431 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-06-30 | $85,000 |
Other income not declared elsewhere | 2020-06-30 | $128,340 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-06-30 | No |
Value of net income/loss | 2020-06-30 | $229,819 |
Value of net assets at end of year (total assets less liabilities) | 2020-06-30 | $161,690 |
Value of net assets at beginning of year (total assets less liabilities) | 2020-06-30 | $-68,129 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-06-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2020-06-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2020-06-30 | No |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-06-30 | $193,621 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-06-30 | $7,009 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-06-30 | $7,009 |
Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-06-30 | $210 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2020-06-30 | $261,492 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-06-30 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2020-06-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2020-06-30 | No |
Contributions received in cash from employer | 2020-06-30 | $968,039 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-06-30 | $689,289 |
Contract administrator fees | 2020-06-30 | $131,826 |
Did the plan have assets held for investment | 2020-06-30 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-06-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-06-30 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-06-30 | No |
Opinion of an independent qualified public accountant for this plan | 2020-06-30 | Unqualified |
Accountancy firm name | 2020-06-30 | STAMBAUGH NESS INC |
Accountancy firm EIN | 2020-06-30 | 232846715 |
2019 : EYE CARE SPECIALISTS WELFARE PLANS 2019 401k financial data |
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Total unrealized appreciation/depreciation of assets | 2019-06-30 | $0 |
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $85,000 |
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $0 |
Total income from all sources (including contributions) | 2019-06-30 | $1,267,463 |
Total loss/gain on sale of assets | 2019-06-30 | $0 |
Total of all expenses incurred | 2019-06-30 | $1,335,592 |
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-06-30 | $1,205,657 |
Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-06-30 | $975,369 |
Value of total assets at end of year | 2019-06-30 | $16,871 |
Value of total assets at beginning of year | 2019-06-30 | $0 |
Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-06-30 | $129,935 |
Total interest from all sources | 2019-06-30 | $38 |
Total dividends received (eg from common stock, registered investment company shares) | 2019-06-30 | $0 |
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-06-30 | No |
Was this plan covered by a fidelity bond | 2019-06-30 | Yes |
Value of fidelity bond cover | 2019-06-30 | $500,000 |
If this is an individual account plan, was there a blackout period | 2019-06-30 | No |
Were there any nonexempt tranactions with any party-in-interest | 2019-06-30 | No |
Contributions received from participants | 2019-06-30 | $283,392 |
Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-06-30 | $9,862 |
Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-06-30 | $0 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-06-30 | $85,000 |
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-06-30 | $0 |
Other income not declared elsewhere | 2019-06-30 | $292,056 |
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-06-30 | No |
Value of net income/loss | 2019-06-30 | $-68,129 |
Value of net assets at end of year (total assets less liabilities) | 2019-06-30 | $-68,129 |
Value of net assets at beginning of year (total assets less liabilities) | 2019-06-30 | $0 |
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-06-30 | No |
Were any loans by the plan or fixed income obligations due to the plan in default | 2019-06-30 | No |
Were any leases to which the plan was party in default or uncollectible | 2019-06-30 | No |
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-06-30 | $7,009 |
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-06-30 | $0 |
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-06-30 | $0 |
Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-06-30 | $38 |
Expenses. Payments to insurance carriers foe the provision of benefits | 2019-06-30 | $227,391 |
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-06-30 | Yes |
Was there a failure to transmit to the plan any participant contributions | 2019-06-30 | No |
Has the plan failed to provide any benefit when due under the plan | 2019-06-30 | No |
Contributions received in cash from employer | 2019-06-30 | $691,977 |
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-06-30 | $978,266 |
Contract administrator fees | 2019-06-30 | $129,935 |
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-06-30 | No |
Did the plan have assets held for investment | 2019-06-30 | Yes |
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-06-30 | No |
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-06-30 | No |
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-06-30 | No |
Opinion of an independent qualified public accountant for this plan | 2019-06-30 | Unqualified |
Accountancy firm name | 2019-06-30 | STAMBAUGH NESS INC |
Accountancy firm EIN | 2019-06-30 | 232846715 |
2020: EYE CARE SPECIALISTS WELFARE PLANS 2020 form 5500 responses |
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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) | Yes |
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: EYE CARE SPECIALISTS WELFARE PLANS 2019 form 5500 responses |
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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 – Trust | 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 - Trust | Yes |
2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
2018: EYE CARE SPECIALISTS WELFARE PLANS 2018 form 5500 responses |
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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 – Trust | Yes |
2018-07-01 | Plan benefit arrangement – Insurance | Yes |
2018-07-01 | Plan benefit arrangement - Trust | Yes |
2018-06-01 | Type of plan entity | Single employer plan |
2018-06-01 | Submission has been amended | No |
2018-06-01 | This submission is the final filing | No |
2018-06-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
2018-06-01 | Plan is a collectively bargained plan | No |
2018-06-01 | Plan funding arrangement – Insurance | Yes |
2018-06-01 | Plan benefit arrangement – Insurance | Yes |
2017: EYE CARE SPECIALISTS WELFARE PLANS 2017 form 5500 responses |
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2017-06-01 | Type of plan entity | Single employer plan |
2017-06-01 | Submission has been amended | No |
2017-06-01 | This submission is the final filing | No |
2017-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2017-06-01 | Plan is a collectively bargained plan | No |
2017-06-01 | Plan funding arrangement – Insurance | Yes |
2017-06-01 | Plan benefit arrangement – Insurance | Yes |
2016: EYE CARE SPECIALISTS WELFARE PLANS 2016 form 5500 responses |
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2016-06-01 | Type of plan entity | Single employer plan |
2016-06-01 | Submission has been amended | No |
2016-06-01 | This submission is the final filing | No |
2016-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2016-06-01 | Plan is a collectively bargained plan | No |
2016-06-01 | Plan funding arrangement – Insurance | Yes |
2016-06-01 | Plan benefit arrangement – Insurance | Yes |
2015: EYE CARE SPECIALISTS WELFARE PLANS 2015 form 5500 responses |
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2015-06-01 | Type of plan entity | Single employer plan |
2015-06-01 | Submission has been amended | No |
2015-06-01 | This submission is the final filing | No |
2015-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2015-06-01 | Plan is a collectively bargained plan | No |
2015-06-01 | Plan funding arrangement – Insurance | Yes |
2015-06-01 | Plan benefit arrangement – Insurance | Yes |
2014: EYE CARE SPECIALISTS WELFARE PLANS 2014 form 5500 responses |
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2014-06-01 | Type of plan entity | Single employer plan |
2014-06-01 | Submission has been amended | No |
2014-06-01 | This submission is the final filing | No |
2014-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2014-06-01 | Plan is a collectively bargained plan | No |
2014-06-01 | Plan funding arrangement – Insurance | Yes |
2014-06-01 | Plan benefit arrangement – Insurance | Yes |
2013: EYE CARE SPECIALISTS WELFARE PLANS 2013 form 5500 responses |
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2013-06-01 | Type of plan entity | Single employer plan |
2013-06-01 | Submission has been amended | No |
2013-06-01 | This submission is the final filing | No |
2013-06-01 | This return/report is a short plan year return/report (less than 12 months) | No |
2013-06-01 | Plan is a collectively bargained plan | No |
2013-06-01 | Plan funding arrangement – Insurance | Yes |
2013-06-01 | Plan benefit arrangement – Insurance | Yes |
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 116615 |
Policy instance | 2 |
Insurance contract or identification number | 116615 | Number of Individuals Covered | 103 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $7,040 | 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 $600 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,040 | Insurance broker organization code? | 3 |
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DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 17094 |
Policy instance | 1 |
Insurance contract or identification number | 17094 | Number of Individuals Covered | 170 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2020-12-31 | Total amount of commissions paid to insurance broker | USD $1,360 | 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 | 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 $27,197 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,360 | Insurance broker organization code? | 3 |
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EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | 31000019 |
Policy instance | 2 |
Insurance contract or identification number | 31000019 | Number of Individuals Covered | 112 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | 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 | 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 $256,730 | 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 PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 17094 |
Policy instance | 1 |
Insurance contract or identification number | 17094 | Number of Individuals Covered | 176 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $2,820 | 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 | 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 $2,820 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,586 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 |
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EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
Policy contract number | VERIS |
Policy instance | 2 |
Insurance contract or identification number | VERIS | Number of Individuals Covered | 116 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | 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 | 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 $215,962 | 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 PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 17094 |
Policy instance | 1 |
Insurance contract or identification number | 17094 | Number of Individuals Covered | 115 | Insurance policy start date | 2018-07-01 | Insurance policy end date | 2019-06-30 | 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 | 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 $56,948 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7433592 |
Policy instance | 3 |
Insurance contract or identification number | E7433592 | Number of Individuals Covered | 0 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2018-06-30 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT, CANCER, CRITICAL ILLNESS, HOSPITAL CONFINEMENT | 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 $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 116615 |
Policy instance | 2 |
Insurance contract or identification number | 116615 | Number of Individuals Covered | 172 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2018-06-30 | Total amount of commissions paid to insurance broker | USD $748 | 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 $77,361 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $748 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 | Insurance broker name | THE C3 GROUP LLC |
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DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 17094 |
Policy instance | 1 |
Insurance contract or identification number | 17094 | Number of Individuals Covered | 194 | Insurance policy start date | 2018-06-01 | Insurance policy end date | 2018-06-30 | 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 | 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 $4,621 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
Policy contract number | E7433592 |
Policy instance | 3 |
Insurance contract or identification number | E7433592 | Number of Individuals Covered | 0 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | 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 | Yes | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENT, CANCER, CRITICAL ILLNESS, HOSPITAL CONFINEMENT | 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 $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
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HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
Policy contract number | 116615 |
Policy instance | 2 |
Insurance contract or identification number | 116615 | Number of Individuals Covered | 171 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $9,201 | 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 $909,324 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $7,009 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 | Insurance broker name | THE C3 GROUP LLC |
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DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
Policy contract number | 17094 |
Policy instance | 1 |
Insurance contract or identification number | 17094 | Number of Individuals Covered | 191 | Insurance policy start date | 2017-06-01 | Insurance policy end date | 2018-05-31 | Total amount of commissions paid to insurance broker | USD $2,241 | 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 | 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 $58,421 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,241 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | NONE | Insurance broker organization code? | 3 | Insurance broker name | CREATIVE BENEFITS, INC. |
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