MOUNT NITTANY MEDICAL CENTER has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER
401k plan membership statisitcs for HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER
| Measure | Date | Value |
|---|
| 2023: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2023 401k membership |
|---|
| Total participants, beginning-of-year | 2023-01-01 | 1,590 |
| Total number of active participants reported on line 7a of the Form 5500 | 2023-01-01 | 1,608 |
| Number of retired or separated participants receiving benefits | 2023-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2023-01-01 | 15 |
| Total of all active and inactive participants | 2023-01-01 | 1,624 |
| Number of employers contributing to the scheme | 2023-01-01 | 0 |
| 2022: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 1,674 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 1,627 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 37 |
| Total of all active and inactive participants | 2022-01-01 | 1,676 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 1,715 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 1,627 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 23 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 37 |
| Total of all active and inactive participants | 2021-01-01 | 1,687 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 1,842 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 1,619 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 85 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 12 |
| Total of all active and inactive participants | 2020-01-01 | 1,716 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 1,741 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 1,740 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 102 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 88 |
| Total of all active and inactive participants | 2019-01-01 | 1,930 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 1,718 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 1,727 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 175 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 22 |
| Total of all active and inactive participants | 2018-01-01 | 1,924 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 1,839 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 1,834 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 1,846 |
| 2016: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 1,636 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 1,699 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 12 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 128 |
| Total of all active and inactive participants | 2016-01-01 | 1,839 |
| 2015: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 1,698 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 1,968 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 1,968 |
| 2014: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 1,597 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 1,568 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 130 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 1,698 |
| 2013: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 1,576 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 1,479 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 118 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 1,597 |
| 2012: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 1,446 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 1,454 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 122 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 1,576 |
| 2011: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 1,285 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 1,323 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 123 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 1,446 |
| 2010: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 1,244 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 1,170 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 115 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 1,285 |
| 2009: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 1,190 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 1,132 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 112 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 1,244 |
| 2023: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan is a collectively bargained plan | Yes |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | Yes |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | Yes |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | Yes |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | Yes |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | Yes |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | Yes |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | Yes |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: HEALTH AND WELFARE PLAN FOR EMPLOYEES OF MOUNT NITTANY MEDICAL CENTER 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | Yes |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10198114 |
| Policy instance | 4 |
| Insurance contract or identification number | 10198114 | | Number of Individuals Covered | 1749 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $332,222 | | Total amount of fees paid to insurance company | USD $69,998 | | 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 | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,214,816 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 265321 |
| Policy instance | 3 |
| Insurance contract or identification number | 265321 | | Number of Individuals Covered | 2983 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $22,788 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $833,698 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 3062 |
| Policy instance | 2 |
| Insurance contract or identification number | 3062 | | Number of Individuals Covered | 1032 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 1 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 2478 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $21,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 3062 |
| Policy instance | 2 |
| Insurance contract or identification number | 3062 | | Number of Individuals Covered | 968 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 265321 |
| Policy instance | 3 |
| Insurance contract or identification number | 265321 | | Number of Individuals Covered | 3935 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $30,880 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,032,405 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10198117 |
| Policy instance | 4 |
| Insurance contract or identification number | 10198117 | | Number of Individuals Covered | 1558 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $412,877 | | Total amount of fees paid to insurance company | USD $47,577 | | 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 | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,752,513 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 1 |
| Insurance contract or identification number | 00 | | Number of Individuals Covered | 2398 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $15,749 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 1 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 31 |
| Policy instance | 2 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 265321 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10198117 |
| Policy instance | 4 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 31 |
| Policy instance | 2 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10198114 |
| Policy instance | 3 |
| CAREBRIDGE CORPORATION (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 1 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 31 |
| Policy instance | 2 |
| AETNA EMPLOYEE ASSISTANCE PLAN (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 575769 |
| Policy instance | 1 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10198115 |
| Policy instance | 3 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 031 |
| Policy instance | 2 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 575769 |
| Policy instance | 1 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10198117 |
| Policy instance | 4 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 00001D035705 |
| Policy instance | 3 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 031 |
| Policy instance | 2 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10198116 |
| Policy instance | 4 |
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 902882 ET AL |
| Policy instance | 3 |
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 575769 |
| Policy instance | 1 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 10198114 |
| Policy instance | 4 |
| MHN (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 575769 |
| Policy instance | 3 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 207897 |
| Policy instance | 2 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 31 |
| Policy instance | 1 |
| AETNA EMPLOYEE ASSISTANCE PLAN (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 846133 |
| Policy instance | 3 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 207897 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 213195 |
| Policy instance | 2 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 31 |
| Policy instance | 1 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 31 |
| Policy instance | 1 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 502666 ET AL |
| Policy instance | 4 |
| CHILD, ADULT AND FAMILY PSYCHOLOGICAL CENTER (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 00 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 213195 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 116791 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 305135 |
| Policy instance | 2 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 147491 |
| Policy instance | 8 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 136846 |
| Policy instance | 7 |
| THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
| Policy contract number | 000001000213 |
| Policy instance | 6 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 031/3062 |
| Policy instance | 5 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 502355 |
| Policy instance | 3 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502666 |
| Policy instance | 4 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 305135 |
| Policy instance | 2 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502666 |
| Policy instance | 4 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 031/3062 |
| Policy instance | 5 |
| THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
| Policy contract number | 000001000213 |
| Policy instance | 6 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 136846 |
| Policy instance | 7 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 147491 |
| Policy instance | 8 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 502355 |
| Policy instance | 3 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 116791 |
| Policy instance | 1 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 05026660001/2/5 |
| Policy instance | 6 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 05026660001/2/5 |
| Policy instance | 5 |
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 147491 |
| Policy instance | 11 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 136846 |
| Policy instance | 10 |
| THE PAUL REVERE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67598 ) |
| Policy contract number | 000001000213 |
| Policy instance | 9 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 031/3062 |
| Policy instance | 8 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 116791 |
| Policy instance | 1 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 305135 0001 |
| Policy instance | 2 |
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 502355 0001 |
| Policy instance | 3 |
| NATIONAL VISION ADMINISTRATORS, LLC (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | 05026660001/2/5 |
| Policy instance | 7 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 843385/387 |
| Policy instance | 4 |
