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WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 401k Plan overview

Plan NameWELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37
Plan identification number 501

WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 Benefits

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

401k Sponsoring company profile

NY CITY DISTRICT COUNCIL 37, AFSCME AFL- has sponsored the creation of one or more 401k plans.

Company Name:NY CITY DISTRICT COUNCIL 37, AFSCME AFL-
Employer identification number (EIN):135673101
NAIC Classification:921000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01HENRY A GARRIDO2023-10-16
5012021-01-01HENRY A GARRIDO2022-10-05
5012020-01-01HENRY A GARRIDO2021-10-12
5012019-01-01HENRY A GARRIDO2020-10-14
5012018-01-01HENRY A GARRIDO2019-10-10
5012017-01-01
5012016-01-01
5012015-01-01HENRY A GARRIDO HENRY A GARRIDO2016-10-13
5012014-01-01HENRY A GARRIDO HENRY A GARRIDO2015-10-13
5012013-01-01LILLIAN ROBERTS LILLIAN ROBERTS2014-10-14
5012012-01-01LILLIAN ROBERTA LILLIAN ROBERTA2013-07-24
5012011-01-01LILLIAN ROBERTS LILLIAN ROBERTS2012-07-31
5012009-01-01LILLIAN ROBERTS

Plan Statistics for WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37

401k plan membership statisitcs for WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37

Measure Date Value
2022: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2022 401k membership
Total participants, beginning-of-year2022-01-01464
Total number of active participants reported on line 7a of the Form 55002022-01-01313
Number of retired or separated participants receiving benefits2022-01-0168
Total of all active and inactive participants2022-01-01381
2021: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2021 401k membership
Total participants, beginning-of-year2021-01-01464
Total number of active participants reported on line 7a of the Form 55002021-01-01362
Number of retired or separated participants receiving benefits2021-01-01102
Total of all active and inactive participants2021-01-01464
2020: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2020 401k membership
Total participants, beginning-of-year2020-01-01909
Total number of active participants reported on line 7a of the Form 55002020-01-01362
Number of retired or separated participants receiving benefits2020-01-01102
Total of all active and inactive participants2020-01-01464
2019: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2019 401k membership
Total participants, beginning-of-year2019-01-01924
Total number of active participants reported on line 7a of the Form 55002019-01-01850
Number of retired or separated participants receiving benefits2019-01-0159
Total of all active and inactive participants2019-01-01909
2018: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2018 401k membership
Total participants, beginning-of-year2018-01-01925
Total number of active participants reported on line 7a of the Form 55002018-01-01857
Number of retired or separated participants receiving benefits2018-01-0167
Total of all active and inactive participants2018-01-01924
2017: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2017 401k membership
Total participants, beginning-of-year2017-01-01915
Total number of active participants reported on line 7a of the Form 55002017-01-01858
Number of retired or separated participants receiving benefits2017-01-0167
Total of all active and inactive participants2017-01-01925
2016: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2016 401k membership
Total participants, beginning-of-year2016-01-011,045
Total number of active participants reported on line 7a of the Form 55002016-01-01846
Number of retired or separated participants receiving benefits2016-01-0169
Total of all active and inactive participants2016-01-01915
2015: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2015 401k membership
Total participants, beginning-of-year2015-01-011,114
Total number of active participants reported on line 7a of the Form 55002015-01-01931
Number of retired or separated participants receiving benefits2015-01-01114
Total of all active and inactive participants2015-01-011,045
2014: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2014 401k membership
Total participants, beginning-of-year2014-01-011,126
Total number of active participants reported on line 7a of the Form 55002014-01-011,014
Number of retired or separated participants receiving benefits2014-01-01100
Total of all active and inactive participants2014-01-011,114
2013: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2013 401k membership
Total participants, beginning-of-year2013-01-011,143
Total number of active participants reported on line 7a of the Form 55002013-01-011,037
Number of retired or separated participants receiving benefits2013-01-0189
Total of all active and inactive participants2013-01-011,126
2012: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2012 401k membership
Total participants, beginning-of-year2012-01-011,159
Total number of active participants reported on line 7a of the Form 55002012-01-011,058
Number of retired or separated participants receiving benefits2012-01-0185
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-011,143
2011: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2011 401k membership
Total participants, beginning-of-year2011-01-011,139
Total number of active participants reported on line 7a of the Form 55002011-01-011,077
Number of retired or separated participants receiving benefits2011-01-0182
Total of all active and inactive participants2011-01-011,159
2009: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2009 401k membership
Total participants, beginning-of-year2009-01-011,120
Total number of active participants reported on line 7a of the Form 55002009-01-011,065
Number of retired or separated participants receiving benefits2009-01-0188
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-011,153

Financial Data on WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37

Measure Date Value
2017 : WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2017 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Was this plan covered by a fidelity bond2017-12-31No
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
2016 : WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2016 401k financial data
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31No
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No

Form 5500 Responses for WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37

2022: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – InsuranceYes
2021: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – InsuranceYes
2020: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 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: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 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: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 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: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 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: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – InsuranceYes
2014: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – InsuranceYes
2013: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – InsuranceYes
2012: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – InsuranceYes
2011: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – InsuranceYes
2009: WELFARE PLAN FOR EMPLOYEES OF DISTRICT COUNCIL 37 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number11020521014
Policy instance 4
Insurance contract or identification number11020521014
Number of Individuals Covered559
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,593,835
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number11020521004
Policy instance 3
Insurance contract or identification number11020521004
Number of Individuals Covered82
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $786,315
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number11020521015
Policy instance 2
Insurance contract or identification number11020521015
Number of Individuals Covered46
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $413,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number11DBL0695400
Policy instance 1
Insurance contract or identification number11DBL0695400
Number of Individuals Covered212
Insurance policy start date2022-10-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $16,005
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $173,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,005
Insurance broker organization code?3
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYTK
Policy instance 6
Insurance contract or identification number00001GYTK
Number of Individuals Covered25
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $194,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYN4
Policy instance 2
Insurance contract or identification number00001GYN4
Number of Individuals Covered46
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $389,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number11DBL0695400
Policy instance 1
Insurance contract or identification number11DBL0695400
Number of Individuals Covered304
Insurance policy start date2021-10-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $15,916
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $170,678
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees15916
Insurance broker organization code?3
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYP3
Policy instance 3
Insurance contract or identification number00001GYP3
Number of Individuals Covered131
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,002,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYQ1
Policy instance 4
Insurance contract or identification number00001GYQ1
Number of Individuals Covered142
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,287,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYTL
Policy instance 5
Insurance contract or identification number00001GYTL
Number of Individuals Covered7
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $57,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number1102052014
Policy instance 7
Insurance contract or identification number1102052014
Number of Individuals Covered574
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,653,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number11DBL0695400
Policy instance 1
Insurance contract or identification number11DBL0695400
Number of Individuals Covered235
Insurance policy start date2020-10-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $5,751
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $142,622
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,751
Insurance broker organization code?3
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYN4
Policy instance 2
Insurance contract or identification number00001GYN4
Number of Individuals Covered46
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $389,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYP3
Policy instance 3
Insurance contract or identification number00001GYP3
Number of Individuals Covered131
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,002,220
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYQ1
Policy instance 4
Insurance contract or identification number00001GYQ1
Number of Individuals Covered142
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $1,287,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYTL
Policy instance 5
Insurance contract or identification number00001GYTL
Number of Individuals Covered7
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $57,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number00001GYTK
Policy instance 6
Insurance contract or identification number00001GYTK
Number of Individuals Covered25
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $194,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number1102052014
Policy instance 7
Insurance contract or identification number1102052014
Number of Individuals Covered574
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,653,826
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number1102052-1004
Policy instance 4
Insurance contract or identification number1102052-1004
Number of Individuals Covered59
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667
Policy instance 2
Insurance contract or identification number174667
Number of Individuals Covered850
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,269,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number11DBL0695400
Policy instance 1
Insurance contract or identification number11DBL0695400
Number of Individuals Covered323
Insurance policy start date2019-10-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,880
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,880
Insurance broker organization code?3
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberIP1 IPX IPY IPZ
Policy instance 3
Insurance contract or identification numberIP1 IPX IPY IPZ
Number of Individuals Covered374
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number1102052-004
Policy instance 4
Insurance contract or identification number1102052-004
Number of Individuals Covered132
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $980,527
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number11DBL0695400
Policy instance 1
Insurance contract or identification number11DBL0695400
Number of Individuals Covered241
Insurance policy start date2018-10-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,709
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $104,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,709
Insurance broker organization code?3
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667
Policy instance 2
Insurance contract or identification number174667
Number of Individuals Covered857
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,326,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number31D,675,7EY,7EX
Policy instance 3
Insurance contract or identification number31D,675,7EY,7EX
Number of Individuals Covered328
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1004018-004
Policy instance 4
Insurance contract or identification number1004018-004
Number of Individuals Covered130
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $942,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract number31D,675,7EY,7EX
Policy instance 3
Insurance contract or identification number31D,675,7EY,7EX
Number of Individuals Covered337
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667
Policy instance 2
Insurance contract or identification number174667
Number of Individuals Covered858
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract number11DBL0695400
Policy instance 1
Insurance contract or identification number11DBL0695400
Number of Individuals Covered245
Insurance policy start date2017-10-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,388
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $97,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,388
Insurance broker organization code?3
Insurance broker nameMMG AGENCY
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberX00001948
Policy instance 7
Insurance contract or identification numberX00001948
Number of Individuals Covered172
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
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 number00931955
Policy instance 8
Insurance contract or identification number00931955
Number of Individuals Covered660
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $32,925
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $164,623
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,925
Insurance broker organization code?3
Insurance broker nameMMG AGENCY INC
UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 )
Policy contract numberG# 84804
Policy instance 1
Insurance contract or identification numberG# 84804
Number of Individuals Covered58
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,226
Total amount of fees paid to insurance companyUSD $103
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $52,421
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,226
Amount paid for insurance broker fees103
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameWINSTON FINANCIAL SERVICES
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00003907
Policy instance 6
Insurance contract or identification numberN00003907
Number of Individuals Covered114
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1004018-004
Policy instance 5
Insurance contract or identification number1004018-004
Number of Individuals Covered127
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $893,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMALGAMATED LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 60216 )
Policy contract number260B68
Policy instance 4
Insurance contract or identification number260B68
Number of Individuals Covered204
Insurance policy start date2015-01-01
Insurance policy end date2015-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667
Policy instance 3
Insurance contract or identification number174667
Number of Individuals Covered851
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00002591
Policy instance 2
Insurance contract or identification numberN00002591
Number of Individuals Covered65
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-696
Policy instance 3
Insurance contract or identification number174667-696
Number of Individuals Covered164
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMALGAMATED LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 60216 )
Policy contract number260B68
Policy instance 4
Insurance contract or identification number260B68
Number of Individuals Covered214
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
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1004018-004
Policy instance 5
Insurance contract or identification number1004018-004
Number of Individuals Covered136
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $932,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00002591
Policy instance 2
Insurance contract or identification numberN00002591
Number of Individuals Covered70
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 )
Policy contract numberG# 84804
Policy instance 1
Insurance contract or identification numberG# 84804
Number of Individuals Covered67
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $4,429
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $61,505
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,429
Insurance broker organization code?3
Insurance broker nameWINSTON FINANCIAL SERVICES
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract numberR04160-002
Policy instance 7
Insurance contract or identification numberR04160-002
Number of Individuals Covered193
Insurance policy start date2014-01-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $915
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNY DBL
Welfare Benefit Premiums Paid to CarrierUSD $30,510
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $915
Insurance broker organization code?3
Insurance broker nameEG BOWMAN
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-000
Policy instance 8
Insurance contract or identification number174667-000
Number of Individuals Covered530
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
Health Insurance Welfare BenefitYes
Were dividends or retroactive rate refunds paid in cash?Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberX00001948
Policy instance 9
Insurance contract or identification numberX00001948
Number of Individuals Covered180
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
Health Insurance Welfare BenefitYes
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 number00931955
Policy instance 10
Insurance contract or identification number00931955
Number of Individuals Covered685
Insurance policy start date2014-10-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00003907
Policy instance 6
Insurance contract or identification numberN00003907
Number of Individuals Covered100
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract numberR04160-003
Policy instance 11
Insurance contract or identification numberR04160-003
Number of Individuals Covered88
Insurance policy start date2014-01-01
Insurance policy end date2014-09-30
Total amount of commissions paid to insurance brokerUSD $624
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNYS DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $20,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $624
Insurance broker organization code?3
Insurance broker nameEG BOWMAN
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract numberR04160-003
Policy instance 10
Insurance contract or identification numberR04160-003
Number of Individuals Covered88
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $843
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNYS DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $28,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $843
Insurance broker organization code?3
Insurance broker nameEG BOWMAN
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberX00001948
Policy instance 9
Insurance contract or identification numberX00001948
Number of Individuals Covered189
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-000
Policy instance 8
Insurance contract or identification number174667-000
Number of Individuals Covered535
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55247 )
Policy contract numberR04160-002
Policy instance 7
Insurance contract or identification numberR04160-002
Number of Individuals Covered193
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,241
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNY DBL
Welfare Benefit Premiums Paid to CarrierUSD $41,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,241
Insurance broker organization code?3
Insurance broker nameEG BOWMAN
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00003907
Policy instance 6
Insurance contract or identification numberN00003907
Number of Individuals Covered89
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00002591
Policy instance 2
Insurance contract or identification numberN00002591
Number of Individuals Covered74
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1004018-004
Policy instance 5
Insurance contract or identification number1004018-004
Number of Individuals Covered71
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $881,382
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMALGAMATED LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 60216 )
Policy contract number260B68
Policy instance 4
Insurance contract or identification number260B68
Number of Individuals Covered96
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
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $27,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-696
Policy instance 3
Insurance contract or identification number174667-696
Number of Individuals Covered168
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 )
Policy contract numberG# 84804
Policy instance 1
Insurance contract or identification numberG# 84804
Number of Individuals Covered73
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,679
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,679
Insurance broker organization code?3
Insurance broker nameWINSTON FINANCIAL SERVICES
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberX00001948
Policy instance 9
Insurance contract or identification numberX00001948
Number of Individuals Covered192
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-000
Policy instance 8
Insurance contract or identification number174667-000
Number of Individuals Covered541
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00003907
Policy instance 6
Insurance contract or identification numberN00003907
Number of Individuals Covered85
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract number53-57-661
Policy instance 7
Insurance contract or identification number53-57-661
Number of Individuals Covered792
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $5,022
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNY DBL
Welfare Benefit Premiums Paid to CarrierUSD $167,409
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,022
Insurance broker organization code?3
Insurance broker nameEG BOWMAN AND CO
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1004018-004
Policy instance 5
Insurance contract or identification number1004018-004
Number of Individuals Covered73
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $844,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMALGAMATED LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 60216 )
Policy contract number260B68
Policy instance 4
Insurance contract or identification number260B68
Number of Individuals Covered142
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
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-696
Policy instance 3
Insurance contract or identification number174667-696
Number of Individuals Covered174
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00002591
Policy instance 2
Insurance contract or identification numberN00002591
Number of Individuals Covered78
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 )
Policy contract numberG# 84804
Policy instance 1
Insurance contract or identification numberG# 84804
Number of Individuals Covered76
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,697
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $69,692
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,697
Insurance broker organization code?3
Insurance broker nameWINSTON FINANCIAL SERVICES
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-696
Policy instance 3
Insurance contract or identification number174667-696
Number of Individuals Covered179
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMALGAMATED LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 60216 )
Policy contract number260B68
Policy instance 4
Insurance contract or identification number260B68
Number of Individuals Covered94
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
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1004018-004
Policy instance 5
Insurance contract or identification number1004018-004
Number of Individuals Covered77
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $901,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00003907
Policy instance 6
Insurance contract or identification numberN00003907
Number of Individuals Covered82
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-000
Policy instance 8
Insurance contract or identification number174667-000
Number of Individuals Covered551
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberX00001948
Policy instance 9
Insurance contract or identification numberX00001948
Number of Individuals Covered193
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00002591
Policy instance 2
Insurance contract or identification numberN00002591
Number of Individuals Covered77
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
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 )
Policy contract numberG# 84804
Policy instance 1
Insurance contract or identification numberG# 84804
Number of Individuals Covered74
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,685
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $68,520
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract number53-57-661
Policy instance 7
Insurance contract or identification number53-57-661
Number of Individuals Covered531
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $5,669
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedNY DBL
Welfare Benefit Premiums Paid to CarrierUSD $188,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberX00001948
Policy instance 9
Insurance contract or identification numberX00001948
Number of Individuals Covered190
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00002591
Policy instance 2
Insurance contract or identification numberN00002591
Number of Individuals Covered76
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-696
Policy instance 3
Insurance contract or identification number174667-696
Number of Individuals Covered174
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMALGAMATED LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 60216 )
Policy contract number260B68
Policy instance 4
Insurance contract or identification number260B68
Number of Individuals Covered145
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
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,577
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EMBLEM HEALTH (National Association of Insurance Commissioners NAIC id number: 55239 )
Policy contract numberN00003907
Policy instance 6
Insurance contract or identification numberN00003907
Number of Individuals Covered86
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIP HEALTH PLANS (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number1004018-004
Policy instance 5
Insurance contract or identification number1004018-004
Number of Individuals Covered81
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $714,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract number53-57-661
Policy instance 7
Insurance contract or identification number53-57-661
Number of Individuals Covered531
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $6,188
Other welfare benefits providedNY DBL
Welfare Benefit Premiums Paid to CarrierUSD $206,267
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,188
Insurance broker organization code?3
Insurance broker nameEG BOWMAN AND CO
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number174667-000
Policy instance 8
Insurance contract or identification number174667-000
Number of Individuals Covered532
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
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNION SECURITY LIFE INSURANCE COMPANY OF NEW YORK 4D DENTAL (National Association of Insurance Commissioners NAIC id number: 81477 )
Policy contract numberG# 84804
Policy instance 1
Insurance contract or identification numberG# 84804
Number of Individuals Covered74
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,687
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $67,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,687
Insurance broker organization code?3
Insurance broker nameWINSTON FINANCIAL SERVICES

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