401k Plan data: MILL NECK MANOR SCHOOL FOR THE DEAF plan

MILL NECK MANOR SCHOOL FOR THE DEAF 401k Plan overview

Plan Name	MILL NECK MANOR SCHOOL FOR THE DEAF
Plan identification number	501

MILL NECK MANOR SCHOOL FOR THE DEAF Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Long-term disability cover

401k Sponsoring company profile

MILL NECK MANOR FAMILY ORGS. has sponsored the creation of one or more 401k plans.

Company Name: MILL NECK MANOR FAMILY ORGS.

Employer identification number (EIN): 111700961

NAIC Classification: 611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MILL NECK MANOR SCHOOL FOR THE DEAF

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-07-01
501 2015-07-01 ANDREW BERKO
501 2014-07-01 ANDREW BERKO
501 2013-07-01 ANDREW BERKO
501 2012-07-01 WILLIAM CHARON
501 2011-07-01 WILLIAM CHARON
501 2010-07-01 WILLIAM CHARON
501 2009-07-01 WILLIAM CHARON
501 2009-07-01 WILLIAM CHARON
501 2009-07-01 WILLIAM CHARON

Plan Statistics for MILL NECK MANOR SCHOOL FOR THE DEAF

401k plan membership statisitcs for MILL NECK MANOR SCHOOL FOR THE DEAF

Measure Date Value
2019: MILL NECK MANOR SCHOOL FOR THE DEAF 2019 401k membership
Total participants, beginning-of-year 2019-07-01 90
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 177
Total of all active and inactive participants 2019-07-01 177
Total participants 2019-07-01 177
2015: MILL NECK MANOR SCHOOL FOR THE DEAF 2015 401k membership
Total participants, beginning-of-year 2015-07-01 138
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 146
Total of all active and inactive participants 2015-07-01 146
Total participants 2015-07-01 0
2014: MILL NECK MANOR SCHOOL FOR THE DEAF 2014 401k membership
Total participants, beginning-of-year 2014-07-01 139
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 138
Total of all active and inactive participants 2014-07-01 138
Total participants 2014-07-01 0
2013: MILL NECK MANOR SCHOOL FOR THE DEAF 2013 401k membership
Total participants, beginning-of-year 2013-07-01 142
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 139
Total of all active and inactive participants 2013-07-01 139
Total participants 2013-07-01 0
2012: MILL NECK MANOR SCHOOL FOR THE DEAF 2012 401k membership
Total participants, beginning-of-year 2012-07-01 141
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 142
Total of all active and inactive participants 2012-07-01 142
Total participants 2012-07-01 0
2011: MILL NECK MANOR SCHOOL FOR THE DEAF 2011 401k membership
Total participants, beginning-of-year 2011-07-01 148
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 141
Total of all active and inactive participants 2011-07-01 141
Total participants 2011-07-01 141
2010: MILL NECK MANOR SCHOOL FOR THE DEAF 2010 401k membership
Total participants, beginning-of-year 2010-07-01 153
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 148
Total of all active and inactive participants 2010-07-01 148
Total participants 2010-07-01 148
2009: MILL NECK MANOR SCHOOL FOR THE DEAF 2009 401k membership
Total participants, beginning-of-year 2009-07-01 151
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 153
Total of all active and inactive participants 2009-07-01 153
Total participants 2009-07-01 153

Measure	Date	Value
2019: MILL NECK MANOR SCHOOL FOR THE DEAF 2019 401k membership
Total participants, beginning-of-year	2019-07-01	90
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	177
Total of all active and inactive participants	2019-07-01	177
Total participants	2019-07-01	177
2015: MILL NECK MANOR SCHOOL FOR THE DEAF 2015 401k membership
Total participants, beginning-of-year	2015-07-01	138
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	146
Total of all active and inactive participants	2015-07-01	146
Total participants	2015-07-01	0
2014: MILL NECK MANOR SCHOOL FOR THE DEAF 2014 401k membership
Total participants, beginning-of-year	2014-07-01	139
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	138
Total of all active and inactive participants	2014-07-01	138
Total participants	2014-07-01	0
2013: MILL NECK MANOR SCHOOL FOR THE DEAF 2013 401k membership
Total participants, beginning-of-year	2013-07-01	142
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	139
Total of all active and inactive participants	2013-07-01	139
Total participants	2013-07-01	0
2012: MILL NECK MANOR SCHOOL FOR THE DEAF 2012 401k membership
Total participants, beginning-of-year	2012-07-01	141
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	142
Total of all active and inactive participants	2012-07-01	142
Total participants	2012-07-01	0
2011: MILL NECK MANOR SCHOOL FOR THE DEAF 2011 401k membership
Total participants, beginning-of-year	2011-07-01	148
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	141
Total of all active and inactive participants	2011-07-01	141
Total participants	2011-07-01	141
2010: MILL NECK MANOR SCHOOL FOR THE DEAF 2010 401k membership
Total participants, beginning-of-year	2010-07-01	153
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	148
Total of all active and inactive participants	2010-07-01	148
Total participants	2010-07-01	148
2009: MILL NECK MANOR SCHOOL FOR THE DEAF 2009 401k membership
Total participants, beginning-of-year	2009-07-01	151
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	153
Total of all active and inactive participants	2009-07-01	153
Total participants	2009-07-01	153

Form 5500 Responses for MILL NECK MANOR SCHOOL FOR THE DEAF

2019: MILL NECK MANOR SCHOOL FOR THE DEAF 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Submission has been amended	No
2019-07-01	This submission is the final filing	No
2019-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-07-01	Plan is a collectively bargained plan	No
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2015: MILL NECK MANOR SCHOOL FOR THE DEAF 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: MILL NECK MANOR SCHOOL FOR THE DEAF 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: MILL NECK MANOR SCHOOL FOR THE DEAF 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: MILL NECK MANOR SCHOOL FOR THE DEAF 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: MILL NECK MANOR SCHOOL FOR THE DEAF 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Submission has been amended	Yes
2011-07-01	Plan funding arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2010: MILL NECK MANOR SCHOOL FOR THE DEAF 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan funding arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2009: MILL NECK MANOR SCHOOL FOR THE DEAF 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Plan funding arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

SGE600530

Policy instance

Insurance contract or identification number	SGE600530
Number of Individuals Covered	118
Insurance policy start date	2019-10-01
Insurance policy end date	2020-10-01
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	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

01622

Policy instance

Insurance contract or identification number	01622
Number of Individuals Covered	177
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $728
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 $85,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	728

HEALTH FIRST INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16031 )

Policy contract number

CG0525

Policy instance

Insurance contract or identification number	CG0525
Number of Individuals Covered	41
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	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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

878792-0GL

Policy instance

Insurance contract or identification number	878792-0GL
Number of Individuals Covered	90
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $346
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,350
Insurance broker organization code?	3

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

878792-ADD

Policy instance

Insurance contract or identification number	878792-ADD
Number of Individuals Covered	90
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
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

878792-GLT

Policy instance

Insurance contract or identification number	878792-GLT
Number of Individuals Covered	90
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $408
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	Yes
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

SYK600468

Policy instance

Insurance contract or identification number	SYK600468
Number of Individuals Covered	118
Insurance policy start date	2019-10-01
Insurance policy end date	2020-10-01
Total amount of commissions paid to insurance broker	USD $108
Total amount of fees paid to insurance company	USD $117
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
Other welfare benefits provided	ACCIDENTAL DEATH
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $108
Amount paid for insurance broker fees	72

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

SGN600852

Policy instance

Insurance contract or identification number	SGN600852
Number of Individuals Covered	118
Insurance policy start date	2019-10-01
Insurance policy end date	2020-10-01
Are there contracts with allocated funds for individual policies?	0
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?	No
Are there contracts with unallocated funds for contracts of type guaranteed investment?	No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	No
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

NORTH SHORE LIJ CARECONNECT HEALTH INSURANCE INC. (National Association of Insurance Commissioners NAIC id number: 15309 )

Policy contract number

B005260001

Policy instance

Insurance contract or identification number	B005260001
Number of Individuals Covered	40
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

1622

Policy instance

Insurance contract or identification number	1622
Number of Individuals Covered	146
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $133,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

GL 130277

Policy instance

Insurance contract or identification number	GL 130277
Number of Individuals Covered	142
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $916
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $916
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

LTD 105647

Policy instance

Insurance contract or identification number	LTD 105647
Number of Individuals Covered	142
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Total amount of commissions paid to insurance broker	USD $2,754
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,754
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

NORTH SHORE LIJ CARECONNECT HEALTH INSURANCE INC. (National Association of Insurance Commissioners NAIC id number: 15309 )

Policy contract number

B005260001

Policy instance

Insurance contract or identification number	B005260001
Number of Individuals Covered	36
Insurance policy start date	2015-01-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $4,252
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,093
Insurance broker organization code?	3
Insurance broker name	FNA INSURANCE SERVICES

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

1622

Policy instance

Insurance contract or identification number	1622
Number of Individuals Covered	132
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $125,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

1007686001

Policy instance

Insurance contract or identification number	1007686001
Number of Individuals Covered	30
Insurance policy start date	2014-07-01
Insurance policy end date	2014-12-31
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

GL 130277

Policy instance

Insurance contract or identification number	GL 130277
Number of Individuals Covered	137
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $880
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $880
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

LTD 105647

Policy instance

Insurance contract or identification number	LTD 105647
Number of Individuals Covered	138
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Total amount of commissions paid to insurance broker	USD $3,021
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,021
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

GL 130277

Policy instance

Insurance contract or identification number	GL 130277
Number of Individuals Covered	139
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $777
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $777
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 55247 )

Policy contract number

1007686001

Policy instance

Insurance contract or identification number	1007686001
Number of Individuals Covered	33
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

LTD 105647

Policy instance

Insurance contract or identification number	LTD 105647
Number of Individuals Covered	139
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Total amount of commissions paid to insurance broker	USD $2,695
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $2,695
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

1622

Policy instance

Insurance contract or identification number	1622
Number of Individuals Covered	132
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $124,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

LTD 105647

Policy instance

Insurance contract or identification number	LTD 105647
Number of Individuals Covered	142
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $3,008
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,008
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )

Policy contract number

18801G311

Policy instance

Insurance contract or identification number	18801G311
Number of Individuals Covered	35
Insurance policy start date	2012-02-01
Insurance policy end date	2013-01-31
Total amount of commissions paid to insurance broker	USD $17,626
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $17,626
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

GL 130277

Policy instance

Insurance contract or identification number	GL 130277
Number of Individuals Covered	142
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $884
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $884
Insurance broker organization code?	3
Insurance broker name	HUB INTERNATIONAL NORTHEAST

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

1622

Policy instance

Insurance contract or identification number	1622
Number of Individuals Covered	129
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $121,174
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

LTD 105647

Policy instance

Insurance contract or identification number	LTD 105647
Number of Individuals Covered	141
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $2,997
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

GL 130277

Policy instance

Insurance contract or identification number	GL 130277
Number of Individuals Covered	141
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $881
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

1622

Policy instance

Insurance contract or identification number	1622
Number of Individuals Covered	126
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $108,836
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )

Policy contract number

18801G311

Policy instance

Insurance contract or identification number	18801G311
Number of Individuals Covered	37
Insurance policy start date	2011-02-01
Insurance policy end date	2012-01-31
Total amount of commissions paid to insurance broker	USD $18,645
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

LTD 105647

Policy instance

Insurance contract or identification number	LTD 105647
Number of Individuals Covered	148
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $3,693
Long Term Disability Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 )

Policy contract number

GL 130277

Policy instance

Insurance contract or identification number	GL 130277
Number of Individuals Covered	148
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $1,004
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )

Policy contract number

18801G311

Policy instance

Insurance contract or identification number	18801G311
Number of Individuals Covered	42
Insurance policy start date	2010-02-01
Insurance policy end date	2011-01-31
Total amount of commissions paid to insurance broker	USD $18,540
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

1622

Policy instance

Insurance contract or identification number	1622
Number of Individuals Covered	141
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $110,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MILL NECK MANOR FAMILY ORGS.
Employer identification number (EIN):	111700961
NAIC Classification:	611000

Plan id#	Filing Submission Date	Name of Administrator
501	2019-07-01
501	2015-07-01	ANDREW BERKO
501	2014-07-01	ANDREW BERKO
501	2013-07-01	ANDREW BERKO
501	2012-07-01	WILLIAM CHARON
501	2011-07-01	WILLIAM CHARON
501	2010-07-01	WILLIAM CHARON
501	2009-07-01	WILLIAM CHARON
501	2009-07-01	WILLIAM CHARON
501	2009-07-01	WILLIAM CHARON