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CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 401k Plan overview

Plan NameCEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN
Plan identification number 501

CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN Benefits

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

401k Sponsoring company profile

CEREBRAL PALSY OF WESTCHESTER, INC. has sponsored the creation of one or more 401k plans.

Company Name:CEREBRAL PALSY OF WESTCHESTER, INC.
Employer identification number (EIN):131690769
NAIC Classification:624100
NAIC Description: Individual and Family Services

Additional information about CEREBRAL PALSY OF WESTCHESTER, INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1964-06-11
Company Identification Number: 177298
Legal Registered Office Address: 1186 KING STREET
Westchester
RYE BROOK
United States of America (USA)
10573

More information about CEREBRAL PALSY OF WESTCHESTER, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01LINDA KUCK2023-05-15
5012021-01-01LINDA KUCK2022-06-16
5012020-01-01LINDA KUCK2021-07-22
5012019-01-01LINDA KUCK2020-10-15 LINDA KUCK2020-10-15
5012018-01-01EILEEN PODLOVITS2019-10-15 EILEEN PODLOVITS2019-10-15
5012017-01-01
5012016-01-01
5012015-01-01
5012014-01-01
5012013-01-01
5012012-01-01JAMES CRISCI
5012011-01-01JAMES CRISCI
5012010-01-01JAMES CRISCI
5012009-01-01JAMES CRISCI
5012009-01-01JAMES CRISCI

Plan Statistics for CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN

401k plan membership statisitcs for CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN

Measure Date Value
2022: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01144
Total number of active participants reported on line 7a of the Form 55002022-01-01117
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01117
Number of employers contributing to the scheme2022-01-010
2021: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01117
Total number of active participants reported on line 7a of the Form 55002021-01-01144
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01144
Number of employers contributing to the scheme2021-01-010
2020: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01190
Total number of active participants reported on line 7a of the Form 55002020-01-01117
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01117
Number of employers contributing to the scheme2020-01-010
2019: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01154
Total number of active participants reported on line 7a of the Form 55002019-01-01157
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-0132
Total of all active and inactive participants2019-01-01190
2018: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01176
Total number of active participants reported on line 7a of the Form 55002018-01-01154
Total of all active and inactive participants2018-01-01154
2017: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01198
Total number of active participants reported on line 7a of the Form 55002017-01-01176
Total of all active and inactive participants2017-01-01176
2016: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01215
Total number of active participants reported on line 7a of the Form 55002016-01-01198
Total of all active and inactive participants2016-01-01198
2015: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01263
Total number of active participants reported on line 7a of the Form 55002015-01-01215
Total of all active and inactive participants2015-01-01215
2014: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01295
Total number of active participants reported on line 7a of the Form 55002014-01-01263
Total of all active and inactive participants2014-01-01263
2013: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01295
Total number of active participants reported on line 7a of the Form 55002013-01-01295
Total of all active and inactive participants2013-01-01295
2012: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01295
Total number of active participants reported on line 7a of the Form 55002012-01-01295
Total of all active and inactive participants2012-01-01295
2011: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01273
Total number of active participants reported on line 7a of the Form 55002011-01-01295
Number of retired or separated participants receiving benefits2011-01-010
Total of all active and inactive participants2011-01-01295
2010: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01258
Total number of active participants reported on line 7a of the Form 55002010-01-01271
Number of retired or separated participants receiving benefits2010-01-012
Total of all active and inactive participants2010-01-01273
2009: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01824
Total number of active participants reported on line 7a of the Form 55002009-01-01838
Number of retired or separated participants receiving benefits2009-01-012
Total of all active and inactive participants2009-01-01840

Form 5500 Responses for CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN

2022: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH 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: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH 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: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH 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: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH 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: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH 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: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH 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: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH 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: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH 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: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2010: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – InsuranceYes
2009: CEREBRAL PALSY OF WESTCHESTER, INC HEALTH PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
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

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number906358
Policy instance 1
Insurance contract or identification number906358
Number of Individuals Covered244
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $4,795
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,795
Amount paid for insurance broker fees0
Insurance broker organization code?3
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1130327
Policy instance 2
Insurance contract or identification number1130327
Number of Individuals Covered213
Insurance policy start date2021-03-01
Insurance policy end date2022-02-28
Total amount of commissions paid to insurance brokerUSD $80,890
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,346,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $80,890
Amount paid for insurance broker fees0
Insurance broker organization code?3
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1130327
Policy instance 2
Insurance contract or identification number1130327
Number of Individuals Covered243
Insurance policy start date2020-03-01
Insurance policy end date2021-02-28
Total amount of commissions paid to insurance brokerUSD $83,983
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,399,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $83,983
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number906358
Policy instance 1
Insurance contract or identification number906358
Number of Individuals Covered260
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $5,413
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $98,488
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,415
Amount paid for insurance broker fees0
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number906358
Policy instance 1
Insurance contract or identification number906358
Number of Individuals Covered267
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,971
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $119,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,947
Amount paid for insurance broker fees0
Insurance broker organization code?3
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberCP25678
Policy instance 2
Insurance contract or identification numberCP25678
Number of Individuals Covered265
Insurance policy start date2020-01-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $12,436
Total amount of fees paid to insurance companyUSD $2,170
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $362,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,239
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0098090
Policy instance 1
Insurance contract or identification number0098090
Number of Individuals Covered352
Insurance policy start date2019-03-01
Insurance policy end date2020-02-28
Total amount of commissions paid to insurance brokerUSD $3,516
Total amount of fees paid to insurance companyUSD $1,301
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $46,974
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,516
Insurance broker organization code?3
Amount paid for insurance broker fees1301
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number906358
Policy instance 2
Insurance contract or identification number906358
Number of Individuals Covered277
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $11,967
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,152
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0098090
Policy instance 2
Insurance contract or identification number0098090
Number of Individuals Covered379
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $3,319
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedSHORT TERM DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $36,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,319
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberCP25678
Policy instance 1
Insurance contract or identification numberCP25678
Number of Individuals Covered261
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $74,430
Total amount of fees paid to insurance companyUSD $27,482
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,104,377
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $74,430
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBONUS, ADMINISTRATIVE SERVICES, AND NON-MONETARY PAYMENT
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3319276
Policy instance 1
Insurance contract or identification number3319276
Number of Individuals Covered185
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $18,984
Total amount of fees paid to insurance companyUSD $10,854
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $452,435
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,984
Amount paid for insurance broker fees10854
Additional information about fees paid to insurance brokerSERVICE/GENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker namePROFESSIONAL GROUP MARKETING INC.
OXFORD HEALTH INSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 78026 )
Policy contract numberCP25678
Policy instance 2
Insurance contract or identification numberCP25678
Number of Individuals Covered296
Insurance policy start date2017-03-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $62,793
Total amount of fees paid to insurance companyUSD $22,736
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,544,058
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,793
Insurance broker organization code?3
Amount paid for insurance broker fees22736
Additional information about fees paid to insurance brokerADMINISTRATIVE SERVICES
Insurance broker namePROFESSIONAL GROUP MARKETING INC.
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number0906358
Policy instance 3
Insurance contract or identification number0906358
Number of Individuals Covered176
Insurance policy start date2017-03-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,360
Total amount of fees paid to insurance companyUSD $139
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,360
Amount paid for insurance broker fees139
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker namePROFESSIONAL GROUP MARKETING INC.
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number3319276
Policy instance 1
Insurance contract or identification number3319276
Number of Individuals Covered215
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $92,538
Total amount of fees paid to insurance companyUSD $46,985
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,283,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $92,538
Amount paid for insurance broker fees46985
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker namePROFESSIONAL GROUP MARKETING INC.
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 4
Insurance contract or identification numberGL043223
Number of Individuals Covered263
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,172
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 3
Insurance contract or identification numberGL043223
Number of Individuals Covered263
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPLOYEE BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberCPW
Policy instance 2
Insurance contract or identification numberCPW
Number of Individuals Covered222
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedDEDUCTIBLES
Welfare Benefit Premiums Paid to CarrierUSD $130,138
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 number3319276
Policy instance 1
Insurance contract or identification number3319276
Number of Individuals Covered222
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $87,978
Total amount of fees paid to insurance companyUSD $44,558
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,169,679
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $87,978
Amount paid for insurance broker fees44558
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker namePROFESSIONAL GROUP MARKETING, INC.
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 3
Insurance contract or identification numberGL043223
Number of Individuals Covered273
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPLOYEE BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberCPW
Policy instance 2
Insurance contract or identification numberCPW
Number of Individuals Covered205
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedDEDUCTIBLES
Welfare Benefit Premiums Paid to CarrierUSD $175,790
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 number3319276
Policy instance 1
Insurance contract or identification number3319276
Number of Individuals Covered220
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $78,173
Total amount of fees paid to insurance companyUSD $39,497
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,927,923
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $78,173
Amount paid for insurance broker fees39497
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker organization code?3
Insurance broker namePROFESSIONAL GROUP MARKETING, INC.
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 4
Insurance contract or identification numberGL043223
Number of Individuals Covered273
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,433
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPLOYEE BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberCPW
Policy instance 2
Insurance contract or identification numberCPW
Number of Individuals Covered187
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedDEDUCTIBLES
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 3
Insurance contract or identification numberGL043223
Number of Individuals Covered267
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 4
Insurance contract or identification numberGL043223
Number of Individuals Covered267
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTCARE DELIVERY SYSTEMS (National Association of Insurance Commissioners NAIC id number: 47112 )
Policy contract numberGG-059
Policy instance 5
Insurance contract or identification numberGG-059
Insurance policy start date2012-01-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
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 number3319276
Policy instance 7
Insurance contract or identification number3319276
Number of Individuals Covered199
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 number3319276
Policy instance 1
Insurance contract or identification number3319276
Number of Individuals Covered203
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $70,668
Total amount of fees paid to insurance companyUSD $35,674
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,668
Amount paid for insurance broker fees35674
Insurance broker organization code?3
Insurance broker namePROFESSIONAL GROUP MARKETING, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00453378
Policy instance 6
Insurance contract or identification number00453378
Insurance policy start date2012-05-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 4
Insurance contract or identification numberGL043223
Number of Individuals Covered295
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,494
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 number3319276
Policy instance 1
Insurance contract or identification number3319276
Number of Individuals Covered201
Insurance policy start date2011-03-01
Insurance policy end date2012-02-29
Total amount of commissions paid to insurance brokerUSD $65,846
Total amount of fees paid to insurance companyUSD $32,923
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,646,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTCARE DELIVERY SYSTEMS (National Association of Insurance Commissioners NAIC id number: 47112 )
Policy contract numberGG-059
Policy instance 5
Insurance contract or identification numberGG-059
Insurance policy start date2011-01-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPLOYEE BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberCPW
Policy instance 2
Insurance contract or identification numberCPW
Number of Individuals Covered201
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedDEDUCTIBLES
Welfare Benefit Premiums Paid to CarrierUSD $190,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 3
Insurance contract or identification numberGL043223
Number of Individuals Covered295
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 $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $29,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00453378
Policy instance 6
Insurance contract or identification number00453378
Number of Individuals Covered214
Insurance policy start date2011-05-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $117,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DENTCARE DELIVERY SYSTEMS (National Association of Insurance Commissioners NAIC id number: 47112 )
Policy contract numberGG-059
Policy instance 5
Insurance contract or identification numberGG-059
Number of Individuals Covered0
Insurance policy start date2010-01-01
Insurance policy end date2010-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 4
Insurance contract or identification numberGL043223
Number of Individuals Covered256
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
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00453378
Policy instance 6
Insurance contract or identification number00453378
Number of Individuals Covered241
Insurance policy start date2010-05-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,955
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 number3319276
Policy instance 1
Insurance contract or identification number3319276
Number of Individuals Covered196
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $56,131
Total amount of fees paid to insurance companyUSD $28,066
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,403,287
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPLOYEE BENEFIT SOLUTIONS (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract numberCPW
Policy instance 2
Insurance contract or identification numberCPW
Number of Individuals Covered198
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
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedDEDUCTIBLES
Welfare Benefit Premiums Paid to CarrierUSD $239,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE BUSINESS COUNCIL OF NYS INC. INSURANCE FUND (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberGL043223
Policy instance 3
Insurance contract or identification numberGL043223
Number of Individuals Covered256
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
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,779
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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