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PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 401k Plan overview

Plan NamePROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN
Plan identification number 501

PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C. has sponsored the creation of one or more 401k plans.

Company Name:PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C.
Employer identification number (EIN):113431170
NAIC Classification:621340
NAIC Description:Offices of Physical, Occupational and Speech Therapists, and Audiologists

Additional information about PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1998-04-22
Company Identification Number: 2251992
Legal Registered Office Address: 28 LIBERTY STREET
New York
NEW YORK
United States of America (USA)
10005

More information about PROFESSIONAL ORTHOPEDIC AND SPORTS PHYSICAL THERAPY, P.C.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01TIMOTHY GLEASON
5012017-01-01SCOTT COOPER
5012016-01-01ADAM ELBERG
5012015-01-01ADAM ELBERG
5012014-01-01ADAM ELBERG
5012013-01-01ADAM ELBERG
5012012-01-01ADAM ELBERG
5012011-01-01ADAM ELBERG
5012009-01-01ADAM ELBERG

Plan Statistics for PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN

401k plan membership statisitcs for PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN

Measure Date Value
2022: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-011,070
Total number of active participants reported on line 7a of the Form 55002022-01-011,087
Total of all active and inactive participants2022-01-011,087
2021: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-011,070
Total number of active participants reported on line 7a of the Form 55002021-01-011,070
Total of all active and inactive participants2021-01-011,070
2020: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-011,132
Total number of active participants reported on line 7a of the Form 55002020-01-01980
Total of all active and inactive participants2020-01-01980
2019: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-011,189
Total number of active participants reported on line 7a of the Form 55002019-01-011,132
Total of all active and inactive participants2019-01-011,132
2018: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01992
Total number of active participants reported on line 7a of the Form 55002018-01-011,189
Total of all active and inactive participants2018-01-011,189
2017: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01951
Total number of active participants reported on line 7a of the Form 55002017-01-01992
Total of all active and inactive participants2017-01-01992
2016: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01666
Total number of active participants reported on line 7a of the Form 55002016-01-01951
Total of all active and inactive participants2016-01-01951
2015: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01482
Total number of active participants reported on line 7a of the Form 55002015-01-01666
Total of all active and inactive participants2015-01-01666
2014: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01299
Total number of active participants reported on line 7a of the Form 55002014-01-01482
Total of all active and inactive participants2014-01-01482
2013: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01224
Total number of active participants reported on line 7a of the Form 55002013-01-01299
Total of all active and inactive participants2013-01-01299
2012: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01205
Total number of active participants reported on line 7a of the Form 55002012-01-01224
Total of all active and inactive participants2012-01-01224
2011: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01186
Total number of active participants reported on line 7a of the Form 55002011-01-01205
Total of all active and inactive participants2011-01-01205
2009: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01159
Total number of active participants reported on line 7a of the Form 55002009-01-01175
Total of all active and inactive participants2009-01-01175

Form 5500 Responses for PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN

2022: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE 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: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE 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: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE 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: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE 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: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE 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: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE 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: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: PROFESSIONAL ORTHOPEDIC & SPORTS PHYSICAL THERAPY EMPLOYEE WELFARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0010347544
Policy instance 5
Insurance contract or identification number0010347544
Number of Individuals Covered116
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,289
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,660
Insurance broker organization code?3
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract numberR0560508
Policy instance 4
Insurance contract or identification numberR0560508
Number of Individuals Covered434
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $6,084
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $119,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,974
Insurance broker organization code?3
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number953254
Policy instance 3
Insurance contract or identification number953254
Number of Individuals Covered135
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $23,228
Total amount of fees paid to insurance companyUSD $1,161
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $154,852
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,228
Amount paid for insurance broker fees1161
Insurance broker organization code?3
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10035021001
Policy instance 2
Insurance contract or identification number10035021001
Number of Individuals Covered1022
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $12,386
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $82,564
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,386
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0009L721
Policy instance 1
Insurance contract or identification number0009L721
Number of Individuals Covered1087
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $17,013
Total amount of fees paid to insurance companyUSD $5,309
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $163,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,013
Amount paid for insurance broker fees5309
Insurance broker organization code?3
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10035021001
Policy instance 2
Insurance contract or identification number10035021001
Number of Individuals Covered1014
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $13,357
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $77,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,651
Insurance broker organization code?3
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number953254
Policy instance 3
Insurance contract or identification number953254
Number of Individuals Covered127
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $17,117
Total amount of fees paid to insurance companyUSD $718
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $114,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,117
Amount paid for insurance broker fees718
Insurance broker organization code?3
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract numberR0560508
Policy instance 4
Insurance contract or identification numberR0560508
Number of Individuals Covered515
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $8,345
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $113,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,175
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0010347544
Policy instance 5
Insurance contract or identification number0010347544
Number of Individuals Covered137
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,375
Total amount of fees paid to insurance companyUSD $44
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,025
Amount paid for insurance broker fees44
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0009L721
Policy instance 1
Insurance contract or identification number0009L721
Number of Individuals Covered1070
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $17,520
Total amount of fees paid to insurance companyUSD $2,190
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $156,010
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,520
Amount paid for insurance broker fees2190
Insurance broker organization code?3
PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 )
Policy contract number0010347544
Policy instance 5
Insurance contract or identification number0010347544
Number of Individuals Covered152
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $21,759
Total amount of fees paid to insurance companyUSD $1,595
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,550
Amount paid for insurance broker fees1595
Insurance broker organization code?3
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract numberR0560508
Policy instance 4
Insurance contract or identification numberR0560508
Number of Individuals Covered558
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $25,705
Total amount of fees paid to insurance companyUSD $1,489
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $138,504
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,122
Amount paid for insurance broker fees1489
Insurance broker organization code?3
FIRST UNUM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 64297 )
Policy contract number953254
Policy instance 3
Insurance contract or identification number953254
Number of Individuals Covered99
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $16,542
Total amount of fees paid to insurance companyUSD $1,038
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $110,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,542
Amount paid for insurance broker fees1038
Insurance broker organization code?3
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10035021001
Policy instance 2
Insurance contract or identification number10035021001
Number of Individuals Covered966
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $12,207
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,207
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0009L721
Policy instance 1
Insurance contract or identification number0009L721
Number of Individuals Covered980
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $16,063
Total amount of fees paid to insurance companyUSD $7,221
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $143,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,063
Amount paid for insurance broker fees7221
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0009L721
Policy instance 1
Insurance contract or identification number0009L721
Number of Individuals Covered1132
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $16,682
Total amount of fees paid to insurance companyUSD $10,541
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $150,088
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,682
Amount paid for insurance broker fees10541
Insurance broker organization code?3
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10035021001
Policy instance 2
Insurance contract or identification number10035021001
Number of Individuals Covered1016
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $12,336
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $94,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,336
Insurance broker organization code?3
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number10035021001
Policy instance 2
Insurance contract or identification number10035021001
Number of Individuals Covered1071
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $12,721
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $72,437
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,721
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0009L721
Policy instance 1
Insurance contract or identification number0009L721
Number of Individuals Covered1189
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $18,337
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $162,271
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,337
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS O5-405348
Policy instance 1
Insurance contract or identification numberTS O5-405348
Number of Individuals Covered992
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $24,186
Total amount of fees paid to insurance companyUSD $3,179
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $729,138
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,571
Amount paid for insurance broker fees3163
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameJEFFREY BERNARD

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