MARJAM SUPPLY CO. INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN
401k plan membership statisitcs for MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN
Measure | Date | Value |
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2022: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2022 401k membership |
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Total participants, beginning-of-year | 2022-07-01 | 307 |
Total number of active participants reported on line 7a of the Form 5500 | 2022-07-01 | 0 |
Number of retired or separated participants receiving benefits | 2022-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2022-07-01 | 0 |
Total of all active and inactive participants | 2022-07-01 | 0 |
2021: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2021 401k membership |
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Total participants, beginning-of-year | 2021-07-01 | 341 |
Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 307 |
Number of retired or separated participants receiving benefits | 2021-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
Total of all active and inactive participants | 2021-07-01 | 307 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2021-07-01 | 0 |
Total participants | 2021-07-01 | 307 |
2020: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2020 401k membership |
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Total participants, beginning-of-year | 2020-07-01 | 376 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 341 |
Number of retired or separated participants receiving benefits | 2020-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
Total of all active and inactive participants | 2020-07-01 | 341 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2020-07-01 | 0 |
Total participants | 2020-07-01 | 341 |
2019: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2019 401k membership |
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Total participants, beginning-of-year | 2019-07-01 | 399 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 376 |
Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
Total of all active and inactive participants | 2019-07-01 | 376 |
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2019-07-01 | 0 |
Total participants | 2019-07-01 | 376 |
2018: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2018 401k membership |
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Total participants, beginning-of-year | 2018-07-01 | 416 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 399 |
Number of retired or separated participants receiving benefits | 2018-07-01 | 0 |
Number of other retired or separated participants entitled to future benefits | 2018-07-01 | 0 |
Total of all active and inactive participants | 2018-07-01 | 399 |
Total participants | 2018-07-01 | 399 |
2017: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2017 401k membership |
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Total participants, beginning-of-year | 2017-07-01 | 398 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 416 |
Total of all active and inactive participants | 2017-07-01 | 416 |
Total participants | 2017-07-01 | 416 |
2016: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2016 401k membership |
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Total participants, beginning-of-year | 2016-07-01 | 393 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 398 |
Total of all active and inactive participants | 2016-07-01 | 398 |
Total participants | 2016-07-01 | 398 |
2015: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2015 401k membership |
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Total participants, beginning-of-year | 2015-07-01 | 413 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 393 |
Total of all active and inactive participants | 2015-07-01 | 393 |
Total participants | 2015-07-01 | 393 |
2014: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2014 401k membership |
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Total participants, beginning-of-year | 2014-07-01 | 275 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 413 |
Total of all active and inactive participants | 2014-07-01 | 413 |
Total participants | 2014-07-01 | 413 |
2013: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2013 401k membership |
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Total participants, beginning-of-year | 2013-07-01 | 159 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 275 |
Total of all active and inactive participants | 2013-07-01 | 275 |
Total participants | 2013-07-01 | 275 |
2012: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2012 401k membership |
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Total participants, beginning-of-year | 2012-07-01 | 273 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 159 |
Total of all active and inactive participants | 2012-07-01 | 159 |
Total participants | 2012-07-01 | 0 |
2011: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2011 401k membership |
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Total participants, beginning-of-year | 2011-07-01 | 338 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 273 |
Total of all active and inactive participants | 2011-07-01 | 273 |
Total participants | 2011-07-01 | 273 |
2010: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2010 401k membership |
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Total participants, beginning-of-year | 2010-07-01 | 392 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 338 |
Total of all active and inactive participants | 2010-07-01 | 338 |
Total participants | 2010-07-01 | 338 |
2009: MARJAM SUPPLY CO. INC. HOSPITALIZATON AND MAJOR MEDICAL INSURANCE PLAN 2009 401k membership |
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Total participants, beginning-of-year | 2009-07-01 | 366 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 389 |
Number of retired or separated participants receiving benefits | 2009-07-01 | 3 |
Total of all active and inactive participants | 2009-07-01 | 392 |
Total participants | 2009-07-01 | 392 |
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | |
Policy instance | 4 |
Number of Individuals Covered | 149 | Insurance policy start date | 2022-03-01 | 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 | ORGAN TRANSPLANT COVERAGE | Welfare Benefit Premiums Paid to Carrier | USD $447,305 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 52-0807803 |
Policy instance | 3 |
Insurance contract or identification number | 52-0807803 | Number of Individuals Covered | 82 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $10,061 | Total amount of fees paid to insurance company | USD $248 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCER CARE, HOSPITALIZATION CVG | Welfare Benefit Premiums Paid to Carrier | USD $83,085 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,061 | Amount paid for insurance broker fees | 248 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 82-2723296 |
Policy instance | 2 |
Insurance contract or identification number | 82-2723296 | Number of Individuals Covered | 173 | Insurance policy start date | 2022-07-01 | Insurance policy end date | 2023-06-30 | Total amount of commissions paid to insurance broker | USD $23,260 | Total amount of fees paid to insurance company | USD $579 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCER CARE, HOSPITALIZATION CVG | Welfare Benefit Premiums Paid to Carrier | USD $152,332 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $23,260 | Amount paid for insurance broker fees | 579 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 14 |
Policy instance | 1 |
Insurance contract or identification number | 14 | Number of Individuals Covered | 9 | Insurance policy start date | 2022-03-01 | Insurance policy end date | 2023-02-28 | Total amount of commissions paid to insurance broker | USD $1,716 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $128,364 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,716 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 82-2723296 |
Policy instance | 2 |
Insurance contract or identification number | 82-2723296 | Number of Individuals Covered | 177 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $22,143 | Total amount of fees paid to insurance company | USD $136 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCER CARE, HOSPITALIZATION CVG | Welfare Benefit Premiums Paid to Carrier | USD $209,509 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $22,143 | Amount paid for insurance broker fees | 136 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 52-0807803 |
Policy instance | 3 |
Insurance contract or identification number | 52-0807803 | Number of Individuals Covered | 92 | Insurance policy start date | 2021-07-01 | Insurance policy end date | 2022-06-30 | Total amount of commissions paid to insurance broker | USD $10,535 | Total amount of fees paid to insurance company | USD $177 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCER CARE, HOSPITALIZATION CVG | Welfare Benefit Premiums Paid to Carrier | USD $100,720 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $10,535 | Amount paid for insurance broker fees | 177 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | |
Policy instance | 4 |
Number of Individuals Covered | 172 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2021-12-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT COVERAGE | Welfare Benefit Premiums Paid to Carrier | USD $414,236 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 0 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 2 |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 14 |
Policy instance | 1 |
Insurance contract or identification number | 14 | Number of Individuals Covered | 14 | Insurance policy start date | 2021-03-01 | Insurance policy end date | 2022-02-28 | Total amount of commissions paid to insurance broker | USD $2,964 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $139,150 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,964 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 82-2723296 |
Policy instance | 2 |
Insurance contract or identification number | 82-2723296 | Number of Individuals Covered | 209 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $54,365 | Total amount of fees paid to insurance company | USD $12,741 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCER CARE, HOSPITALIZATION CVG | Welfare Benefit Premiums Paid to Carrier | USD $271,503 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $54,365 | Amount paid for insurance broker fees | 12741 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 52-0807803 |
Policy instance | 3 |
Insurance contract or identification number | 52-0807803 | Number of Individuals Covered | 101 | Insurance policy start date | 2020-07-01 | Insurance policy end date | 2021-06-30 | Total amount of commissions paid to insurance broker | USD $17,795 | Total amount of fees paid to insurance company | USD $46 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCER CARE, HOSPITALIZATION CVG | Welfare Benefit Premiums Paid to Carrier | USD $95,759 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $17,795 | Amount paid for insurance broker fees | 46 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | |
Policy instance | 4 |
Number of Individuals Covered | 169 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $754 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT COVERAGE | Welfare Benefit Premiums Paid to Carrier | USD $25,130 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $754 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 14 |
Policy instance | 1 |
Insurance contract or identification number | 14 | Number of Individuals Covered | 12 | Insurance policy start date | 2020-03-01 | Insurance policy end date | 2021-02-28 | Total amount of commissions paid to insurance broker | USD $3,432 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $143,655 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,432 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 82-2723296 |
Policy instance | 2 |
Insurance contract or identification number | 82-2723296 | Number of Individuals Covered | 311 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $36,158 | Total amount of fees paid to insurance company | USD $2,353 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCER CARE, HOSPITALIZATION CVG | Welfare Benefit Premiums Paid to Carrier | USD $198,487 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $36,158 | Amount paid for insurance broker fees | 2353 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | 52-0807803 |
Policy instance | 3 |
Insurance contract or identification number | 52-0807803 | Number of Individuals Covered | 131 | Insurance policy start date | 2019-07-01 | Insurance policy end date | 2020-06-30 | Total amount of commissions paid to insurance broker | USD $11,011 | Total amount of fees paid to insurance company | USD $674 | Dental Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | Yes | Other welfare benefits provided | CANCER CARE, HOSPITALIZATION CVG | Welfare Benefit Premiums Paid to Carrier | USD $95,108 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $11,011 | Amount paid for insurance broker fees | 674 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 14 |
Policy instance | 1 |
Insurance contract or identification number | 14 | Number of Individuals Covered | 11 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-29 | Total amount of commissions paid to insurance broker | USD $3,276 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $128,266 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,276 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
Policy contract number | |
Policy instance | 4 |
Number of Individuals Covered | 217 | Insurance policy start date | 2019-03-01 | Insurance policy end date | 2020-02-28 | Total amount of commissions paid to insurance broker | USD $918 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT COVERAGE | Welfare Benefit Premiums Paid to Carrier | USD $30,590 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $918 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 14 |
Policy instance | 1 |
Insurance contract or identification number | 14 | Number of Individuals Covered | 10 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $3,549 | Total amount of fees paid to insurance company | USD $0 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $113,771 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,549 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
Policy contract number | |
Policy instance | 4 |
Number of Individuals Covered | 237 | Insurance policy start date | 2018-03-01 | Insurance policy end date | 2019-02-28 | Total amount of commissions paid to insurance broker | USD $1,004 | Total amount of fees paid to insurance company | USD $0 | Other welfare benefits provided | ORGAN TRANSPLANT COVERAGE | Welfare Benefit Premiums Paid to Carrier | USD $33,452 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,004 | Additional information about fees paid to insurance broker | N/A | Insurance broker organization code? | 3 |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | |
Policy instance | 3 |
Number of Individuals Covered | 14 | Insurance policy start date | 2017-03-01 | Insurance policy end date | 2018-02-28 | Total amount of commissions paid to insurance broker | USD $4,468 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $132,896 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | |
Policy instance | 3 |
Number of Individuals Covered | 18 | Insurance policy start date | 2015-03-01 | Insurance policy end date | 2016-02-29 | Total amount of commissions paid to insurance broker | USD $6,438 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $131,471 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $6,438 | Insurance broker organization code? | 3 | Insurance broker name | PREFERRED NY FINANCIAL GROUP LLC |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | |
Policy instance | 4 |
Number of Individuals Covered | 17 | Insurance policy start date | 2014-03-01 | Insurance policy end date | 2015-02-28 | Total amount of commissions paid to insurance broker | USD $4,420 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $117,352 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $4,420 | Insurance broker organization code? | 3 | Insurance broker name | PREFERRED NY FINANCIAL GROUP LLC |
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HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
Policy contract number | 853819G |
Policy instance | 1 |
Insurance contract or identification number | 853819G | Number of Individuals Covered | 83 | Insurance policy start date | 2014-07-01 | Insurance policy end date | 2014-08-31 | Total amount of commissions paid to insurance broker | USD $284 | Total amount of fees paid to insurance company | USD $84 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ADD-SUPP | Welfare Benefit Premiums Paid to Carrier | USD $1,115 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $0 | Amount paid for insurance broker fees | 84 | Insurance broker organization code? | 3 | Insurance broker name | PROFESSIONAL GROUP PLANS INC |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N9385 |
Policy instance | 7 |
Insurance contract or identification number | N9385 | Number of Individuals Covered | 107 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $14,166 | Total amount of fees paid to insurance company | USD $264 | Unemployment Insurance Welfare Benefit | Yes | Other welfare benefits provided | SUPPLEMENTAL HEALTH INSURANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $91,189 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Commission paid to Insurance Broker | USD $2 | Amount paid for insurance broker fees | 12 | Additional information about fees paid to insurance broker | FEES, AWARDS, PRIZES, BONUSES, NON-MONETARY COMPENSATION | Insurance broker name | ANN FISCHER |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 123057 |
Policy instance | 2 |
Insurance contract or identification number | 123057 | Number of Individuals Covered | 36 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $8,611 | Welfare Benefit Premiums Paid to Carrier | USD $155,446 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $8,611 | Insurance broker name | WILLIAMS AGENCY INC |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | AJ207 |
Policy instance | 1 |
Insurance contract or identification number | AJ207 | Number of Individuals Covered | 177 | Insurance policy start date | 2013-01-01 | Insurance policy end date | 2013-12-31 | Total amount of commissions paid to insurance broker | USD $32,745 | Total amount of fees paid to insurance company | USD $25 | Other welfare benefits provided | SUPPLEMENTAL HEALTH INSURANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $107,908 | 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 | Amount paid for insurance broker fees | 1 | Additional information about fees paid to insurance broker | FEES, AWARDS, PRIZES, BONUSES, NON-MONETARY COMPENSATION | Insurance broker name | DOMENICO V MAUTARELLI |
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HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | 00965361 |
Policy instance | 3 |
Insurance contract or identification number | 00965361 | Number of Individuals Covered | 3 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $691 | Other welfare benefits provided | POS, RX | Welfare Benefit Premiums Paid to Carrier | USD $17,269 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $691 | Insurance broker organization code? | 3 | Insurance broker name | CORPORATE BENEFIT PLANNING LLC |
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AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | 477231 |
Policy instance | 4 |
Insurance contract or identification number | 477231 | Number of Individuals Covered | 186 | Insurance policy start date | 2012-03-01 | Insurance policy end date | 2013-02-28 | Total amount of commissions paid to insurance broker | USD $62,764 | Total amount of fees paid to insurance company | USD $19,460 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $926,912 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $19,494 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 19460 | Additional information about fees paid to insurance broker | 2011 SUPPLEMENTAL MEDICAL NEW BUSINESS COMPENSATION | Insurance broker name | PILOT BENEFITS GROUP LLC |
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HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
Policy contract number | 853819G |
Policy instance | 5 |
Insurance contract or identification number | 853819G | Number of Individuals Covered | 89 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $1,042 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $7,604 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $521 | Insurance broker organization code? | 3 | Insurance broker name | ADMIN TASKS & THINGS CORP |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
Policy contract number | 30000109 |
Policy instance | 6 |
Insurance contract or identification number | 30000109 | Number of Individuals Covered | 145 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $1,117 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $20,381 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,117 | Insurance broker organization code? | 3 | Insurance broker name | PILOT BENEFITS GROUP LLC |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | AJ207 |
Policy instance | 8 |
Insurance contract or identification number | AJ207 | Insurance policy start date | 2012-07-01 | Insurance policy end date | 2013-06-30 | Total amount of commissions paid to insurance broker | USD $22,456 | Total amount of fees paid to insurance company | USD $66 | Other welfare benefits provided | SUPPLEMENTAL HEALTH INSURANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $79,846 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2 | Insurance broker organization code? | 3 | Additional information about fees paid to insurance broker | FEES, AWARDS, PRIZES, BONUSES, NON-MONETARY COMPENSATION | Amount paid for insurance broker fees | 8 | Insurance broker name | DOMENICO MAUTARELLI |
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HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | 00965361 |
Policy instance | 2 |
Insurance contract or identification number | 00965361 | Number of Individuals Covered | 5 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $585 | Other welfare benefits provided | POS, RX | Welfare Benefit Premiums Paid to Carrier | USD $14,623 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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BLUE CROSS BLUE SHIELD OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 53287 ) |
Policy contract number | 123057 |
Policy instance | 1 |
Insurance contract or identification number | 123057 | Number of Individuals Covered | 34 | Insurance policy start date | 2011-03-01 | Insurance policy end date | 2012-02-29 | Total amount of commissions paid to insurance broker | USD $8,888 | Welfare Benefit Premiums Paid to Carrier | USD $158,733 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
Policy contract number | OGL-853819 |
Policy instance | 3 |
Insurance contract or identification number | OGL-853819 | Number of Individuals Covered | 154 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $1,314 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,126 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
Policy contract number | 30000109 |
Policy instance | 4 |
Insurance contract or identification number | 30000109 | Number of Individuals Covered | 167 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $1,265 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $23,423 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N9385 |
Policy instance | 5 |
Insurance contract or identification number | N9385 | Number of Individuals Covered | 100 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $14,932 | Total amount of fees paid to insurance company | USD $26 | Unemployment Insurance Welfare Benefit | Yes | Other welfare benefits provided | SUPPLEMENTAL HEALTH INSURANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $92,754 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | AJ207 |
Policy instance | 6 |
Insurance contract or identification number | AJ207 | Number of Individuals Covered | 92 | Insurance policy start date | 2011-07-01 | Insurance policy end date | 2012-06-30 | Total amount of commissions paid to insurance broker | USD $13,670 | Total amount of fees paid to insurance company | USD $2 | Other welfare benefits provided | SUPPLEMENTAL HEALTH INSURANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $60,024 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
Policy contract number | OGL-853819 |
Policy instance | 9 |
Insurance contract or identification number | OGL-853819 | Number of Individuals Covered | 99 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $1,180 | Life Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $8,621 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AFLAC (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | AJ207 |
Policy instance | 12 |
Insurance contract or identification number | AJ207 | Number of Individuals Covered | 68 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $16,734 | Total amount of fees paid to insurance company | USD $1,013 | Other welfare benefits provided | SUPPLEMENTAL HEALTH INSURANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $51,409 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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AMERICAN FAMILY LIFE INSURANCE COMPANY OF COLUMBUS (National Association of Insurance Commissioners NAIC id number: 60380 ) |
Policy contract number | N9385 |
Policy instance | 11 |
Insurance contract or identification number | N9385 | Number of Individuals Covered | 106 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $14,131 | Total amount of fees paid to insurance company | USD $130 | Unemployment Insurance Welfare Benefit | Yes | Other welfare benefits provided | SUPPLEMENTAL HEALTH INSURANCE PLAN | Welfare Benefit Premiums Paid to Carrier | USD $95,903 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
Policy contract number | GLT-853819 |
Policy instance | 8 |
Insurance contract or identification number | GLT-853819 | Number of Individuals Covered | 154 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010129525 |
Policy instance | 1 |
Insurance contract or identification number | 000010129525 | Number of Individuals Covered | 96 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $1,308 | Total amount of fees paid to insurance company | USD $60 | Other welfare benefits provided | WEEKLY INCOME | Welfare Benefit Premiums Paid to Carrier | USD $12,285 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
Policy contract number | 000010129524 |
Policy instance | 2 |
Insurance contract or identification number | 000010129524 | Number of Individuals Covered | 91 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $2,598 | Total amount of fees paid to insurance company | USD $96 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $19,445 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
Policy contract number | JB490 |
Policy instance | 3 |
Insurance contract or identification number | JB490 | Number of Individuals Covered | 262 | Insurance policy start date | 2010-08-01 | Insurance policy end date | 2011-07-31 | Total amount of commissions paid to insurance broker | USD $5,408 | Total amount of fees paid to insurance company | USD $1,282 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D, OPTIONAL LIFE | Welfare Benefit Premiums Paid to Carrier | USD $43,005 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
Policy contract number | 3333040 |
Policy instance | 4 |
Insurance contract or identification number | 3333040 | Number of Individuals Covered | 542 | Insurance policy start date | 2010-03-01 | Insurance policy end date | 2011-02-28 | Total amount of commissions paid to insurance broker | USD $105,283 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $311,859 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 ) |
Policy contract number | 30000109 |
Policy instance | 10 |
Insurance contract or identification number | 30000109 | Number of Individuals Covered | 168 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $1,229 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $24,108 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
Policy contract number | TM05595669 |
Policy instance | 6 |
Insurance contract or identification number | TM05595669 | Number of Individuals Covered | 427 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Total amount of commissions paid to insurance broker | USD $4,234 | Total amount of fees paid to insurance company | USD $1,476 | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $155,522 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
Policy contract number | GRH-853819 |
Policy instance | 7 |
Insurance contract or identification number | GRH-853819 | Number of Individuals Covered | 154 | Insurance policy start date | 2010-07-01 | Insurance policy end date | 2011-06-30 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
Policy contract number | 00965361 |
Policy instance | 5 |
Insurance contract or identification number | 00965361 | Number of Individuals Covered | 1 | Insurance policy start date | 2009-05-01 | Insurance policy end date | 2010-04-30 | Total amount of commissions paid to insurance broker | USD $614 | Other welfare benefits provided | POS, RX | Welfare Benefit Premiums Paid to Carrier | USD $15,359 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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