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STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 401k Plan overview

Plan NameSTATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN
Plan identification number 501

STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN Benefits

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

401k Sponsoring company profile

STATEN ISLAND UNIVERSITY HOSPITAL has sponsored the creation of one or more 401k plans.

Company Name:STATEN ISLAND UNIVERSITY HOSPITAL
Employer identification number (EIN):112868878
NAIC Classification:622000
NAIC Description: Hospitals

Additional information about STATEN ISLAND UNIVERSITY HOSPITAL

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1987-06-16
Company Identification Number: 1179657
Legal Registered Office Address: ATTN ADMINISTRATION
475 SEAVIEW AVENUE
STATEN ISLAND
United States of America (USA)
10305

More information about STATEN ISLAND UNIVERSITY HOSPITAL

Form 5500 Filing Information

Submission information for form 5500 for 401k plan STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-01-01MARY BETH SPRINGSTEAD MARY BETH SPRINGSTEAD2018-09-24
5012016-01-01MARY BETH SPRINGSTEAD
5012015-01-01MARY BETH SPRINGSTEAD MARY BETH SPRINGSTEAD2016-07-25
5012014-01-01MARY BETH SPRINGSTEAD MARY BETH SPRINGSTEAD2015-09-22
5012013-01-01MARY BETH SPRINGSTEAD MARY BETH SPRINGSTEAD2014-10-14
5012012-01-01MARGARET DIALTO MARGARET DIALTO2013-10-08
5012011-01-01MARGARET DIALTO MARGARET DIALTO2012-07-31
5012009-01-01DEBRA SANTANGELO DEBRA SANTANGELO2010-10-14

Plan Statistics for STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN

401k plan membership statisitcs for STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN

Measure Date Value
2017: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-014,159
Total number of active participants reported on line 7a of the Form 55002017-01-014,276
Total of all active and inactive participants2017-01-014,276
Total participants2017-01-014,276
2016: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-015,441
Total number of active participants reported on line 7a of the Form 55002016-01-014,159
Total of all active and inactive participants2016-01-014,159
Total participants2016-01-014,159
2015: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-015,371
Total number of active participants reported on line 7a of the Form 55002015-01-015,441
Total of all active and inactive participants2015-01-015,441
Total participants2015-01-015,441
2014: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-017,214
Total number of active participants reported on line 7a of the Form 55002014-01-015,371
Total of all active and inactive participants2014-01-015,371
Total participants2014-01-015,371
2013: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-017,737
Total number of active participants reported on line 7a of the Form 55002013-01-017,214
Total of all active and inactive participants2013-01-017,214
Total participants2013-01-017,214
2012: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-017,907
Total number of active participants reported on line 7a of the Form 55002012-01-017,737
Total of all active and inactive participants2012-01-017,737
Total participants2012-01-017,737
2011: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-017,168
Total number of active participants reported on line 7a of the Form 55002011-01-017,907
Total of all active and inactive participants2011-01-017,907
Total participants2011-01-017,907
2009: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,460
Total number of active participants reported on line 7a of the Form 55002009-01-017,078
Total of all active and inactive participants2009-01-017,078
Total participants2009-01-017,078

Form 5500 Responses for STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN

2017: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS 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: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS 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: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS 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: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS 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: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS 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: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: STATEN ISLAND UNIVERSITY HOSPITAL BENEFITS PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberNSH 084,C84,095
Policy instance 2
Insurance contract or identification numberNSH 084,C84,095
Number of Individuals Covered2513
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $165,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3215204
Policy instance 1
Insurance contract or identification number3215204
Number of Individuals Covered3050
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $40,051
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $1,391,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-52,789
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Insurance broker nameAON CONSULTING WORLDWIDE, INC.
RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 61360 )
Policy contract numberEXRK
Policy instance 3
Insurance contract or identification numberEXRK
Number of Individuals Covered3124
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $15,160
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $303,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees15160
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
Insurance broker nameTOWER WATSON DELAWARE INC
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberNSH 084
Policy instance 2
Insurance contract or identification numberNSH 084
Number of Individuals Covered2309
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $132,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3215204
Policy instance 1
Insurance contract or identification number3215204
Number of Individuals Covered2906
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $60,914
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $1,232,000
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,914
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON DELAWARE INC
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberNSH 084
Policy instance 2
Insurance contract or identification numberNSH 084
Number of Individuals Covered2252
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $141,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number616080D
Policy instance 3
Insurance contract or identification number616080D
Number of Individuals Covered1822
Insurance policy start date2014-01-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,210
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedWD-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $60,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,210
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameMERCER HUMAN RESOURCE
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number675324G
Policy instance 4
Insurance contract or identification number675324G
Number of Individuals Covered722
Insurance policy start date2014-01-01
Insurance policy end date2014-01-31
Total amount of commissions paid to insurance brokerUSD $1,276
Total amount of fees paid to insurance companyUSD $11,612
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $31,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,276
Amount paid for insurance broker fees11612
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PENNSYLVANIA INC
RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 61360 )
Policy contract numberEXRK
Policy instance 5
Insurance contract or identification numberEXRK
Number of Individuals Covered3151
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $30,001
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $600,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees29910
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
Insurance broker nameTOWER WATSON DELAWARE INC
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3215204
Policy instance 1
Insurance contract or identification number3215204
Number of Individuals Covered2864
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $53,635
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Other welfare benefits providedPREPAID DENTAL
Welfare Benefit Premiums Paid to CarrierUSD $1,176,728
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,635
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PA (NYC)
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number000TN613
Policy instance 6
Insurance contract or identification number000TN613
Number of Individuals Covered293
Insurance policy start date2012-11-01
Insurance policy end date2013-10-31
Total amount of commissions paid to insurance brokerUSD $3,629
Total amount of fees paid to insurance companyUSD $1,092
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,192
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,629
Amount paid for insurance broker fees1092
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Insurance broker nameINSMED INS. AGENCY INC
RELIASTAR LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 61360 )
Policy contract numberEXRK
Policy instance 5
Insurance contract or identification numberEXRK
Number of Individuals Covered3036
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $27,296
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $545,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees27296
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PENNSYLVANIA INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number675324G
Policy instance 4
Insurance contract or identification number675324G
Number of Individuals Covered755
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $14,292
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $358,467
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14,292
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PENNSYLVANIA INC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number616080D
Policy instance 3
Insurance contract or identification number616080D
Number of Individuals Covered2426
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,793
Other welfare benefits providedWD-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $237,321
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1793
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameMERCER HUMAN RESOURCE
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberNSH 084
Policy instance 2
Insurance contract or identification numberNSH 084
Number of Individuals Covered2217
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,883
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees5883
Additional information about fees paid to insurance brokerINSURANCE FEES
Insurance broker organization code?0
Insurance broker nameHM LIFE INSURANCE COMPANY
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3217144
Policy instance 1
Insurance contract or identification number3217144
Number of Individuals Covered1367
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $56,945
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,147,365
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,945
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PA (NYC)
OXFORD, LLC (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract numberSI1985
Policy instance 2
Insurance contract or identification numberSI1985
Number of Individuals Covered3107
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $216,242
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,224,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $216,242
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PENNSYLVANIA INC.
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3217144
Policy instance 1
Insurance contract or identification number3217144
Number of Individuals Covered1309
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $55,219
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,112,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,219
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PA (NYC)
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number616080D
Policy instance 3
Insurance contract or identification number616080D
Number of Individuals Covered2298
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,223
Other welfare benefits providedWD-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $258,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees5223
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameMERCER HUMAN RESOURCE
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number675324G
Policy instance 4
Insurance contract or identification number675324G
Number of Individuals Covered1023
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $15,149
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $434,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,149
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMISSIONS PAID
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PENNSYLVANIA INC
OXFORD, LLC (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract numberSI1985
Policy instance 2
Insurance contract or identification numberSI1985
Number of Individuals Covered3103
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $209,690
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,160,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number675324G
Policy instance 4
Insurance contract or identification number675324G
Number of Individuals Covered1232
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $20,765
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $750,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3217144
Policy instance 1
Insurance contract or identification number3217144
Number of Individuals Covered1287
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $45,929
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $925,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number616080D
Policy instance 3
Insurance contract or identification number616080D
Number of Individuals Covered2285
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,442
Other welfare benefits providedWD-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $348,108
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3217144
Policy instance 1
Insurance contract or identification number3217144
Number of Individuals Covered1210
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $45,576
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $919,766
Commission paid to Insurance BrokerUSD $45,576
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PA NYC
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number675324G
Policy instance 4
Insurance contract or identification number675324G
Number of Individuals Covered996
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
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $616,950
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract number616080D
Policy instance 3
Insurance contract or identification number616080D
Number of Individuals Covered2147
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 $1,705
Other welfare benefits providedWD-SUPP
Welfare Benefit Premiums Paid to CarrierUSD $330,238
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1705
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION PAID
Insurance broker organization code?3
Insurance broker nameMERCER HUMAN RESOURCE
OXFORD, LLC (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract numberSI1985
Policy instance 2
Insurance contract or identification numberSI1985
Number of Individuals Covered2815
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $197,379
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,067,332
Commission paid to Insurance BrokerUSD $197,379
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker nameTOWERS WATSON PENNSYLVANIA INC.

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