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MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 401k Plan overview

Plan NameMEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN
Plan identification number 501

MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Prepaid legal
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

MEDICAL INFORMATION TECHNOLOGY, INC has sponsored the creation of one or more 401k plans.

Company Name:MEDICAL INFORMATION TECHNOLOGY, INC
Employer identification number (EIN):042455639
NAIC Classification:339900

Additional information about MEDICAL INFORMATION TECHNOLOGY, INC

Jurisdiction of Incorporation: Georgia Department of States Corporations Division
Incorporation Date:
Company Identification Number: 1265918

More information about MEDICAL INFORMATION TECHNOLOGY, INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01JOANNE M. GATELY2023-10-10
5012021-01-01JOANNE M. GATELY2022-10-14
5012020-01-01JOANNE M. GATELY2021-10-14
5012019-01-01JOANNE GATELY2020-07-31
5012018-01-01JOANNE M. GATELY2019-07-31
5012017-01-01BARBARA A. MANZOLILLO BARBARA A. MANZOLILLO2018-07-26
5012016-01-01BARBARA A. MANZOLILLO
5012015-01-01BARBARA A. MANZOLILLO
5012015-01-01BARBARA A. MANZOLILLO
5012014-01-01BARBARA A. MANZOLILLO BARBARA A. MANZOLILLO2015-07-30
5012013-01-01BARBARA A. MANZOLILLO BARBARA A. MANZOLILLO2014-07-24
5012012-01-01BARBARA A. MANZOLILLO BARBARA A. MANZOLILLO2013-07-31
5012011-01-01BARBARA A. MANZOLILLO BARBARA A. MANZOLILLO2012-07-31
5012010-01-01BARBARA A. MANZOLILLO BARBARA A. MANZOLILLO2011-07-19
5012009-01-01BARBARA A. MANZOLILLO BARBARA A. MANZOLILLO2010-07-21
5012009-01-01BARBARA A. MANZOLILLO BARBARA A. MANZOLILLO2010-07-20

Plan Statistics for MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN

401k plan membership statisitcs for MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN

Measure Date Value
2022: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-013,483
Total number of active participants reported on line 7a of the Form 55002022-01-013,377
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-013,377
Number of employers contributing to the scheme2022-01-010
2021: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-013,483
Total number of active participants reported on line 7a of the Form 55002021-01-013,468
Number of retired or separated participants receiving benefits2021-01-0115
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-013,483
Number of employers contributing to the scheme2021-01-010
2020: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-013,566
Total number of active participants reported on line 7a of the Form 55002020-01-013,483
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-013,483
Number of employers contributing to the scheme2020-01-010
2019: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-013,699
Total number of active participants reported on line 7a of the Form 55002019-01-013,546
Number of retired or separated participants receiving benefits2019-01-0120
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-013,566
Number of employers contributing to the scheme2019-01-010
2018: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-013,737
Total number of active participants reported on line 7a of the Form 55002018-01-013,699
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-013,699
Number of employers contributing to the scheme2018-01-010
2017: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-013,710
Total number of active participants reported on line 7a of the Form 55002017-01-013,737
Total of all active and inactive participants2017-01-013,737
Total participants2017-01-013,737
2016: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-013,740
Total number of active participants reported on line 7a of the Form 55002016-01-013,710
Total of all active and inactive participants2016-01-013,710
Total participants2016-01-013,710
2015: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-013,941
Total number of active participants reported on line 7a of the Form 55002015-01-013,740
Total of all active and inactive participants2015-01-013,740
Total participants2015-01-013,740
2014: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-013,840
Total number of active participants reported on line 7a of the Form 55002014-01-013,941
Total of all active and inactive participants2014-01-013,941
Total participants2014-01-013,941
2013: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-013,873
Total number of active participants reported on line 7a of the Form 55002013-01-013,840
Total of all active and inactive participants2013-01-013,840
Total participants2013-01-013,840
2012: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-013,649
Total number of active participants reported on line 7a of the Form 55002012-01-013,873
Total of all active and inactive participants2012-01-013,873
Total participants2012-01-013,873
2011: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-013,295
Total number of active participants reported on line 7a of the Form 55002011-01-013,649
Total of all active and inactive participants2011-01-013,649
Total participants2011-01-013,649
2010: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-012,809
Total number of active participants reported on line 7a of the Form 55002010-01-013,295
Total of all active and inactive participants2010-01-013,295
Total participants2010-01-013,295
2009: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-012,741
Total number of active participants reported on line 7a of the Form 55002009-01-012,809
Total of all active and inactive participants2009-01-012,809
Total participants2009-01-012,809

Form 5500 Responses for MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN

2022: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – InsuranceYes
2015: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: MEDICAL INFORMATION TECHNOLOGY, INC WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL161335
Policy instance 2
Insurance contract or identification numberGL161335
Number of Individuals Covered3377
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $31,104
Total amount of fees paid to insurance companyUSD $18,347
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $642,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,104
Amount paid for insurance broker fees18347
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number10191971001
Policy instance 1
Insurance contract or identification number10191971001
Number of Individuals Covered5283
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $282,866
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL161335
Policy instance 2
Insurance contract or identification numberGL161335
Number of Individuals Covered3468
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $30,622
Total amount of fees paid to insurance companyUSD $30,307
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $619,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,622
Amount paid for insurance broker fees30307
Additional information about fees paid to insurance brokerADMINISTRATIVE AND OTHER FEES
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )
Policy contract number10191971001
Policy instance 1
Insurance contract or identification number10191971001
Number of Individuals Covered5031
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $275,012
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )
Policy contract numberGL161335
Policy instance 1
Insurance contract or identification numberGL161335
Number of Individuals Covered3524
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $29,223
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $577,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,223
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211993
Policy instance 2
Insurance contract or identification number211993
Number of Individuals Covered3515
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $59,078
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $589,863
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,078
Amount paid for insurance broker fees0
Insurance broker organization code?3
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG12043
Policy instance 1
Insurance contract or identification numberG12043
Number of Individuals Covered3546
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $30,197
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $301,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,197
Amount paid for insurance broker fees0
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211993
Policy instance 4
Insurance contract or identification number211993
Number of Individuals Covered3755
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $59,534
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $59,534
Insurance broker organization code?3
Insurance broker nameRICHARD EISENBERG
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG12043
Policy instance 3
Insurance contract or identification numberG12043
Number of Individuals Covered3755
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $31,404
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $314,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,404
Insurance broker organization code?3
Insurance broker nameRICHARD EISENBERG, CLU
DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )
Policy contract number0000117341
Policy instance 2
Insurance contract or identification number0000117341
Number of Individuals Covered337
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,042
Dental Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $4,042
Insurance broker organization code?3
Insurance broker nameWELLS FARGO INSURANCE SERVICES USA
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number0101279
Policy instance 1
Insurance contract or identification number0101279
Number of Individuals Covered3463
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number0101279
Policy instance 1
Insurance contract or identification number0101279
Number of Individuals Covered3505
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )
Policy contract number0000117341
Policy instance 2
Insurance contract or identification number0000117341
Number of Individuals Covered342
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $3,935
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,935
Insurance broker nameWELLS FARGO INSURANCE SVCS USA, INC
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG12043
Policy instance 3
Insurance contract or identification numberG12043
Number of Individuals Covered3763
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $32,526
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $325,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,526
Insurance broker nameRICHARD EISENBERG, CLU
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211993
Policy instance 4
Insurance contract or identification number211993
Number of Individuals Covered3763
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $72,933
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $508,553
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $72,933
Insurance broker nameRICHARD EISENBERG
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG12043
Policy instance 3
Insurance contract or identification numberG12043
Number of Individuals Covered3960
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $33,643
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $336,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,643
Insurance broker nameRICHARD EISENBERG, CLU
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number0101279
Policy instance 1
Insurance contract or identification number0101279
Number of Individuals Covered3655
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55034 )
Policy contract number0000117341
Policy instance 2
Insurance contract or identification number0000117341
Number of Individuals Covered362
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,862
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,862
Insurance broker nameWELLS FARGO INSURANCE SVCS USA, INC
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211993
Policy instance 4
Insurance contract or identification number211993
Number of Individuals Covered3960
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $73,041
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $486,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $73,041
Insurance broker nameRICHARD EISENBERG
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211993
Policy instance 4
Insurance contract or identification number211993
Number of Individuals Covered3852
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $68,303
Long Term Disability Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $68,303
Insurance broker nameRICHARD EISENBERG
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG12043
Policy instance 3
Insurance contract or identification numberG12043
Number of Individuals Covered3852
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $32,276
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $32,276
Insurance broker nameRICHARD EISENBERG, CLU
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number130256500
Policy instance 2
Insurance contract or identification number130256500
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number0101279
Policy instance 1
Insurance contract or identification number0101279
Number of Individuals Covered3362
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number0101279
Policy instance 1
Insurance contract or identification number0101279
Number of Individuals Covered3400
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number130256500
Policy instance 2
Insurance contract or identification number130256500
Number of Individuals Covered170
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,889
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG12043
Policy instance 3
Insurance contract or identification numberG12043
Number of Individuals Covered3885
Total amount of commissions paid to insurance brokerUSD $31,644
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $316,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,644
Insurance broker nameRICHARD EISENBERG, CLU
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211993
Policy instance 4
Insurance contract or identification number211993
Number of Individuals Covered3885
Total amount of commissions paid to insurance brokerUSD $64,878
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $432,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,878
Insurance broker nameRICHARD EISENBERG
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211993
Policy instance 4
Insurance contract or identification number211993
Number of Individuals Covered3663
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $58,487
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $389,912
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number0101279
Policy instance 1
Insurance contract or identification number0101279
Number of Individuals Covered3257
Insurance policy start date2011-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number130256500
Policy instance 2
Insurance contract or identification number130256500
Number of Individuals Covered143
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG12043
Policy instance 3
Insurance contract or identification numberG12043
Number of Individuals Covered3663
Total amount of commissions paid to insurance brokerUSD $29,223
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $292,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )
Policy contract numberG12043
Policy instance 3
Insurance contract or identification numberG12043
Number of Individuals Covered3304
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $259,245
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $25,925
Insurance broker nameRICHARD EISENBERG, CLU
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211993
Policy instance 4
Insurance contract or identification number211993
Number of Individuals Covered3304
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $51,388
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $24,878
Insurance broker nameRICHARD EISENBERG
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number0101279
Policy instance 1
Insurance contract or identification number0101279
Number of Individuals Covered3014
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
BLUE CROSS AND BLUE SHIELD OF GEORGIA, INC/ (G0385) (National Association of Insurance Commissioners NAIC id number: 54801 )
Policy contract number130256500
Policy instance 2
Insurance contract or identification number130256500
Number of Individuals Covered115
Insurance policy start date2010-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $32,977
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $32,977
Insurance broker nameWELLS FARGO INSURANCE SERVICES

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