SUPER ENTERPRISES-USA, INC. has sponsored the creation of one or more 401k plans.
Additional information about SUPER ENTERPRISES-USA, INC.
Submission information for form 5500 for 401k plan SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN
401k plan membership statisitcs for SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN
Measure | Date | Value |
---|
2020: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2020 401k membership |
---|
Total participants, beginning-of-year | 2020-05-01 | 137 |
Total number of active participants reported on line 7a of the Form 5500 | 2020-05-01 | 65 |
Total of all active and inactive participants | 2020-05-01 | 65 |
Total participants | 2020-05-01 | 65 |
2019: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2019 401k membership |
---|
Total participants, beginning-of-year | 2019-05-01 | 141 |
Total number of active participants reported on line 7a of the Form 5500 | 2019-05-01 | 137 |
Total of all active and inactive participants | 2019-05-01 | 137 |
Total participants | 2019-05-01 | 137 |
2018: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2018 401k membership |
---|
Total participants, beginning-of-year | 2018-05-01 | 145 |
Total number of active participants reported on line 7a of the Form 5500 | 2018-05-01 | 141 |
Total of all active and inactive participants | 2018-05-01 | 141 |
Total participants | 2018-05-01 | 141 |
2017: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2017 401k membership |
---|
Total participants, beginning-of-year | 2017-05-01 | 108 |
Total number of active participants reported on line 7a of the Form 5500 | 2017-05-01 | 145 |
Total of all active and inactive participants | 2017-05-01 | 145 |
Total participants | 2017-05-01 | 145 |
2016: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2016 401k membership |
---|
Total participants, beginning-of-year | 2016-05-01 | 110 |
Total number of active participants reported on line 7a of the Form 5500 | 2016-05-01 | 108 |
Total of all active and inactive participants | 2016-05-01 | 108 |
Total participants | 2016-05-01 | 108 |
2015: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2015 401k membership |
---|
Total participants, beginning-of-year | 2015-05-01 | 107 |
Total number of active participants reported on line 7a of the Form 5500 | 2015-05-01 | 110 |
Total of all active and inactive participants | 2015-05-01 | 110 |
Total participants | 2015-05-01 | 0 |
2014: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2014 401k membership |
---|
Total participants, beginning-of-year | 2014-05-01 | 109 |
Total number of active participants reported on line 7a of the Form 5500 | 2014-05-01 | 107 |
Total of all active and inactive participants | 2014-05-01 | 107 |
Total participants | 2014-05-01 | 0 |
2013: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2013 401k membership |
---|
Total participants, beginning-of-year | 2013-05-01 | 104 |
Total number of active participants reported on line 7a of the Form 5500 | 2013-05-01 | 109 |
Total of all active and inactive participants | 2013-05-01 | 109 |
Total participants | 2013-05-01 | 0 |
2012: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2012 401k membership |
---|
Total participants, beginning-of-year | 2012-05-01 | 107 |
Total number of active participants reported on line 7a of the Form 5500 | 2012-05-01 | 104 |
Total of all active and inactive participants | 2012-05-01 | 104 |
Total participants | 2012-05-01 | 0 |
2011: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2011 401k membership |
---|
Total participants, beginning-of-year | 2011-05-01 | 104 |
Total number of active participants reported on line 7a of the Form 5500 | 2011-05-01 | 107 |
Total of all active and inactive participants | 2011-05-01 | 107 |
Total participants | 2011-05-01 | 107 |
2010: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2010 401k membership |
---|
Total participants, beginning-of-year | 2010-05-01 | 108 |
Total number of active participants reported on line 7a of the Form 5500 | 2010-05-01 | 97 |
Number of retired or separated participants receiving benefits | 2010-05-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2010-05-01 | 0 |
Total of all active and inactive participants | 2010-05-01 | 104 |
2009: SUPER ENTERPRISES-USA, INC. HEALTH AND WELFARE PLAN 2009 401k membership |
---|
Total participants, beginning-of-year | 2009-05-01 | 119 |
Total number of active participants reported on line 7a of the Form 5500 | 2009-05-01 | 101 |
Number of retired or separated participants receiving benefits | 2009-05-01 | 7 |
Number of other retired or separated participants entitled to future benefits | 2009-05-01 | 0 |
Total of all active and inactive participants | 2009-05-01 | 108 |
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | SGE600426 |
Policy instance | 6 |
Insurance contract or identification number | SGE600426 | Number of Individuals Covered | 64 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-05-01 | Total amount of commissions paid to insurance broker | USD $3,238 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $27,759 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,238 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | NYK700161 |
Policy instance | 5 |
Insurance contract or identification number | NYK700161 | Number of Individuals Covered | 64 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-05-01 | Total amount of commissions paid to insurance broker | USD $2,454 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $30,436 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,454 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3335916 |
Policy instance | 4 |
Insurance contract or identification number | 3335916 | Number of Individuals Covered | 112 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $44,124 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $763,445 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $44,124 | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 500248 |
Policy instance | 3 |
Insurance contract or identification number | 500248 | Number of Individuals Covered | 37 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $1,577 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $15,765 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,577 | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 302327 |
Policy instance | 2 |
Insurance contract or identification number | 302327 | Number of Individuals Covered | 65 | Insurance policy start date | 2020-05-01 | Insurance policy end date | 2021-04-30 | Total amount of commissions paid to insurance broker | USD $1,944 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $13,958 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,393 | Insurance broker organization code? | 3 |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 1 |
Insurance contract or identification number | ABY960079 | Insurance policy start date | 2020-02-01 | Insurance policy end date | 2021-02-01 | Total amount of fees paid to insurance company | USD $37 | Other welfare benefits provided | ACCIDENTAL DEATH | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 37 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 1 |
Insurance contract or identification number | ABY960079 | Insurance policy start date | 2019-02-01 | Insurance policy end date | 2020-02-01 | Other welfare benefits provided | ACCIDENTAL DEATH | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Additional information about fees paid to insurance broker | SALES AND SERVICE OVERRIDE | Insurance broker organization code? | 3 |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | NYK700161 |
Policy instance | 5 |
Insurance contract or identification number | NYK700161 | Number of Individuals Covered | 137 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-05-01 | Total amount of commissions paid to insurance broker | USD $2,701 | Total amount of fees paid to insurance company | USD $1,751 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,025 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,701 | Amount paid for insurance broker fees | 1751 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3335916 |
Policy instance | 4 |
Insurance contract or identification number | 3335916 | Number of Individuals Covered | 211 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of fees paid to insurance company | USD $49,470 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $830,320 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 49470 | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 500248 |
Policy instance | 3 |
Insurance contract or identification number | 500248 | Number of Individuals Covered | 75 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $1,725 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,252 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,725 | Insurance broker organization code? | 3 |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | SGE600426 |
Policy instance | 6 |
Insurance contract or identification number | SGE600426 | Number of Individuals Covered | 137 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-05-01 | Total amount of commissions paid to insurance broker | USD $3,597 | Total amount of fees paid to insurance company | USD $1,597 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $31,947 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,597 | Amount paid for insurance broker fees | 1597 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 302327 |
Policy instance | 2 |
Insurance contract or identification number | 302327 | Number of Individuals Covered | 38 | Insurance policy start date | 2019-05-01 | Insurance policy end date | 2020-04-30 | Total amount of commissions paid to insurance broker | USD $2,935 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $16,564 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,054 | Insurance broker organization code? | 3 |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 1 |
Insurance contract or identification number | ABY960079 | Number of Individuals Covered | 131 | Insurance policy start date | 2018-02-01 | Insurance policy end date | 2019-02-01 | Total amount of commissions paid to insurance broker | USD $561 | Total amount of fees paid to insurance company | USD $196 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $3,737 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $561 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 187 | Additional information about fees paid to insurance broker | SALES AND SERVICE |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 302327 |
Policy instance | 2 |
Insurance contract or identification number | 302327 | Number of Individuals Covered | 131 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $861 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $17,439 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $861 | Insurance broker organization code? | 3 |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 500248 |
Policy instance | 3 |
Insurance contract or identification number | 500248 | Number of Individuals Covered | 72 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of commissions paid to insurance broker | USD $1,713 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $17,138 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,713 | Insurance broker organization code? | 3 |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3335916 |
Policy instance | 4 |
Insurance contract or identification number | 3335916 | Number of Individuals Covered | 212 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-04-30 | Total amount of fees paid to insurance company | USD $43,765 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $757,323 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 43765 | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | NYK700161 |
Policy instance | 5 |
Insurance contract or identification number | NYK700161 | Number of Individuals Covered | 141 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-05-01 | Total amount of commissions paid to insurance broker | USD $2,781 | Total amount of fees paid to insurance company | USD $2,998 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $36,611 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,781 | Amount paid for insurance broker fees | 2998 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | SGE600426 |
Policy instance | 6 |
Insurance contract or identification number | SGE600426 | Number of Individuals Covered | 141 | Insurance policy start date | 2018-05-01 | Insurance policy end date | 2019-05-01 | Total amount of commissions paid to insurance broker | USD $3,751 | Total amount of fees paid to insurance company | USD $2,877 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $35,013 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,751 | Amount paid for insurance broker fees | 2877 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | NYK700161 |
Policy instance | 5 |
Insurance contract or identification number | NYK700161 | Number of Individuals Covered | 145 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-05-01 | Total amount of commissions paid to insurance broker | USD $2,682 | Total amount of fees paid to insurance company | USD $1,732 | Temporary Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $34,633 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $2,682 | Insurance broker organization code? | 3 | Amount paid for insurance broker fees | 1732 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker name | PROFESSIONAL GROUP PLANS |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3335916 |
Policy instance | 4 |
Insurance contract or identification number | 3335916 | Number of Individuals Covered | 217 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of fees paid to insurance company | USD $100,668 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,639,226 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 54458 | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 | Insurance broker name | HEALTHY BUSINESS GROUP LLC |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | SGE600426 |
Policy instance | 6 |
Insurance contract or identification number | SGE600426 | Number of Individuals Covered | 145 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-05-01 | Total amount of commissions paid to insurance broker | USD $3,666 | Total amount of fees paid to insurance company | USD $1,666 | Long Term Disability Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $33,323 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $3,666 | Amount paid for insurance broker fees | 1666 | Additional information about fees paid to insurance broker | SALES & SERVICE OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | PROFESSIONAL GROUP PLANS |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 500248 |
Policy instance | 3 |
Insurance contract or identification number | 500248 | Number of Individuals Covered | 72 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $1,677 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $16,766 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,677 | Insurance broker organization code? | 3 | Insurance broker name | PAUL SHEPHERD |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 302327 |
Policy instance | 2 |
Insurance contract or identification number | 302327 | Number of Individuals Covered | 129 | Insurance policy start date | 2017-05-01 | Insurance policy end date | 2018-04-30 | Total amount of commissions paid to insurance broker | USD $1,498 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $15,304 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,498 | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 1 |
Insurance contract or identification number | ABY960079 | Number of Individuals Covered | 145 | Insurance policy start date | 2017-02-01 | Insurance policy end date | 2018-02-01 | Total amount of fees paid to insurance company | USD $9 | Other welfare benefits provided | ACCIDENTAL DEATH | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 9 | Additional information about fees paid to insurance broker | SALES AND SERVICE OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3335916 |
Policy instance | 4 |
Insurance contract or identification number | 3335916 | Number of Individuals Covered | 106 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of fees paid to insurance company | USD $43,405 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $2,099,502 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 43405 | Additional information about fees paid to insurance broker | SERVICE/GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 | Insurance broker name | PROFESSIONAL GROUP PLANS, INC |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 1 |
Insurance contract or identification number | ABY960079 | Number of Individuals Covered | 110 | Insurance policy start date | 2015-02-01 | Insurance policy end date | 2016-02-01 | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $1,979 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 302327 |
Policy instance | 2 |
Insurance contract or identification number | 302327 | Number of Individuals Covered | 118 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $396 | Total amount of fees paid to insurance company | USD $4 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $13,918 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $396 | Amount paid for insurance broker fees | 4 | Additional information about fees paid to insurance broker | OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 500248 |
Policy instance | 3 |
Insurance contract or identification number | 500248 | Number of Individuals Covered | 66 | Insurance policy start date | 2015-05-01 | Insurance policy end date | 2016-04-30 | Total amount of commissions paid to insurance broker | USD $1,472 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $14,702 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,472 | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 302327 |
Policy instance | 2 |
Insurance contract or identification number | 302327 | Number of Individuals Covered | 112 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $12,920 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 500248 |
Policy instance | 3 |
Insurance contract or identification number | 500248 | Number of Individuals Covered | 63 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of fees paid to insurance company | USD $1,249 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,491 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 1249 | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
Policy contract number | 3335916 |
Policy instance | 4 |
Insurance contract or identification number | 3335916 | Number of Individuals Covered | 99 | Insurance policy start date | 2014-05-01 | Insurance policy end date | 2015-04-30 | Total amount of fees paid to insurance company | USD $35,146 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,697,875 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 35146 | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 | Insurance broker name | PROFESSIONAL GROUP PLANS, INC |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 1 |
Insurance contract or identification number | ABY960079 | Number of Individuals Covered | 107 | Insurance policy start date | 2014-02-01 | Insurance policy end date | 2015-02-01 | Other welfare benefits provided | ACCIDENTAL DEATH | 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 number | 3335916 |
Policy instance | 4 |
Insurance contract or identification number | 3335916 | Number of Individuals Covered | 97 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of fees paid to insurance company | USD $38,781 | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,507,229 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 38781 | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 | Insurance broker name | PROFESSIONAL GROUP PLANS, INC |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 500248 |
Policy instance | 3 |
Insurance contract or identification number | 500248 | Number of Individuals Covered | 54 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Total amount of commissions paid to insurance broker | USD $1,221 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $12,208 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,221 | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 302327 |
Policy instance | 2 |
Insurance contract or identification number | 302327 | Number of Individuals Covered | 90 | Insurance policy start date | 2013-05-01 | Insurance policy end date | 2014-04-30 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | AD&D | Welfare Benefit Premiums Paid to Carrier | USD $11,970 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 1 |
Insurance contract or identification number | ABY960079 | Number of Individuals Covered | 109 | Insurance policy start date | 2013-02-01 | Insurance policy end date | 2014-02-01 | Other welfare benefits provided | ACCIDENTAL DEATH | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 500248 |
Policy instance | 2 |
Insurance contract or identification number | 500248 | Number of Individuals Covered | 54 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of commissions paid to insurance broker | USD $1,168 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $11,681 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $1,168 | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 4 |
Insurance contract or identification number | ABY960079 | Number of Individuals Covered | 105 | Insurance policy start date | 2012-02-01 | Insurance policy end date | 2013-01-31 | Total amount of commissions paid to insurance broker | USD $346 | Total amount of fees paid to insurance company | USD $1 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $1,698 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Commission paid to Insurance Broker | USD $346 | Amount paid for insurance broker fees | 1 | Additional information about fees paid to insurance broker | SUPP COMMISSION AND OVERRIDE | Insurance broker organization code? | 3 | Insurance broker name | WILLIS OF NEW YORK INC |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0716247 |
Policy instance | 3 |
Insurance contract or identification number | 0716247 | Number of Individuals Covered | 268 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $61,412 | 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 number | 3335916 |
Policy instance | 1 |
Insurance contract or identification number | 3335916 | Number of Individuals Covered | 93 | Insurance policy start date | 2012-05-01 | Insurance policy end date | 2013-04-30 | Total amount of fees paid to insurance company | USD $27,866 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,393,306 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | Amount paid for insurance broker fees | 27866 | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | Insurance broker organization code? | 3 | Insurance broker name | PROFESSIONAL GROUP PLANS, INC. |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 11-3051991 |
Policy instance | 1 |
Insurance contract or identification number | 11-3051991 | Number of Individuals Covered | 100 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2011-05-31 | Total amount of commissions paid to insurance broker | USD $87 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $872 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | 500248 |
Policy instance | 2 |
Insurance contract or identification number | 500248 | Number of Individuals Covered | 40 | Insurance policy start date | 2011-06-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $925 | Vision Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $9,242 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | SM00901 |
Policy instance | 3 |
Insurance contract or identification number | SM00901 | Number of Individuals Covered | 249 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $4,359 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $1,503,150 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 0716247 |
Policy instance | 4 |
Insurance contract or identification number | 0716247 | Number of Individuals Covered | 107 | Insurance policy start date | 2011-05-01 | Insurance policy end date | 2012-04-30 | Total amount of commissions paid to insurance broker | USD $342 | Health Insurance Welfare Benefit | Yes | Welfare Benefit Premiums Paid to Carrier | USD $62,246 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 5 |
Insurance contract or identification number | ABY960079 | Number of Individuals Covered | 116 | Insurance policy start date | 2011-02-01 | Insurance policy end date | 2012-01-31 | Total amount of fees paid to insurance company | USD $239 | Life Insurance Welfare Benefit | Yes | Other welfare benefits provided | ACCIDENTAL DEATH | Welfare Benefit Premiums Paid to Carrier | USD $1,148 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 ) |
Policy contract number | ABY960079 |
Policy instance | 1 |
Insurance contract or identification number | ABY960079 | Number of Individuals Covered | 116 | Insurance policy start date | 2010-02-01 | Insurance policy end date | 2011-01-31 | Total amount of commissions paid to insurance broker | USD $0 | Total amount of fees paid to insurance company | USD $5 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | BUSINESS TRAVEL ACCIDENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $0 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
HM LIFE INSURANCE COMPANY OF NY (National Association of Insurance Commissioners NAIC id number: 60213 ) |
Policy contract number | SUP001 002 COB |
Policy instance | 2 |
Insurance contract or identification number | SUP001 002 COB | Number of Individuals Covered | 101 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $1,115 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | Yes | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $11,156 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 ) |
Policy contract number | SM00901 |
Policy instance | 3 |
Insurance contract or identification number | SM00901 | Number of Individuals Covered | 266 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $52,424 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | Yes | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $1,326,122 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 716247 |
Policy instance | 5 |
Insurance contract or identification number | 716247 | Number of Individuals Covered | 111 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $4,091 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | Yes | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | No | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $82,145 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
Policy contract number | 302327 |
Policy instance | 4 |
Insurance contract or identification number | 302327 | Number of Individuals Covered | 116 | Insurance policy start date | 2010-05-01 | Insurance policy end date | 2011-04-30 | Total amount of commissions paid to insurance broker | USD $1,338 | Total amount of fees paid to insurance company | USD $0 | Are there contracts with allocated funds for individual policies? | No | Are there contracts with allocated funds for group deferred annuity? | No | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | Contracts With Unallocated Funds Deposit Administration | 0 | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | Health Insurance Welfare Benefit | No | Dental Insurance Welfare Benefit | No | Vision Insurance Welfare Benefit | No | Life Insurance Welfare Benefit | Yes | Temporary Disability Insurance Welfare Benefit | No | Long Term Disability Insurance Welfare Benefit | No | Unemployment Insurance Welfare Benefit | No | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | Were dividends or retroactive rate refunds paid in cash? | No | Were dividends or retroactive rate refunds paid as a credit? | No | Welfare Benefit Premiums Paid to Carrier | USD $13,329 | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|