PRECISION VALVE & AUTOMATION, INC. has sponsored the creation of one or more 401k plans.
Additional information about PRECISION VALVE & AUTOMATION, INC.
Submission information for form 5500 for 401k plan PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN
401k plan membership statisitcs for PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN
| Measure | Date | Value |
|---|
| 2022: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-01 | 184 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 206 |
| Total of all active and inactive participants | 2022-04-01 | 206 |
| 2021: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 173 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 184 |
| Total of all active and inactive participants | 2021-04-01 | 184 |
| 2020: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 173 |
| Total of all active and inactive participants | 2020-04-01 | 173 |
| 2019: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 184 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 188 |
| Total of all active and inactive participants | 2019-04-01 | 188 |
| 2018: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 180 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 184 |
| Total of all active and inactive participants | 2018-04-01 | 184 |
| 2017: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 169 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 180 |
| Total of all active and inactive participants | 2017-04-01 | 180 |
| 2016: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 157 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 169 |
| Total of all active and inactive participants | 2016-04-01 | 169 |
| 2015: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 150 |
| Number of retired or separated participants receiving benefits | 2015-04-01 | 157 |
| Total of all active and inactive participants | 2015-04-01 | 157 |
| 2014: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-04-01 | 164 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-04-01 | 150 |
| Total of all active and inactive participants | 2014-04-01 | 150 |
| 2013: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-04-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-04-01 | 164 |
| Total of all active and inactive participants | 2013-04-01 | 164 |
| 2012: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-04-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-04-01 | 160 |
| Total of all active and inactive participants | 2012-04-01 | 160 |
| 2011: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-04-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-04-01 | 150 |
| Total of all active and inactive participants | 2011-04-01 | 150 |
| 2022: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2022 form 5500 responses |
|---|
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2021 form 5500 responses |
|---|
| 2021-04-01 | Type of plan entity | Single employer plan |
| 2021-04-01 | Plan funding arrangement – Insurance | Yes |
| 2021-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2020 form 5500 responses |
|---|
| 2020-04-01 | Type of plan entity | Single employer plan |
| 2020-04-01 | Plan funding arrangement – Insurance | Yes |
| 2020-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2019 form 5500 responses |
|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | Plan funding arrangement – Insurance | Yes |
| 2019-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2018 form 5500 responses |
|---|
| 2018-04-01 | Type of plan entity | Single employer plan |
| 2018-04-01 | Plan funding arrangement – Insurance | Yes |
| 2018-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2017 form 5500 responses |
|---|
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | Plan funding arrangement – Insurance | Yes |
| 2017-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2016 form 5500 responses |
|---|
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2015 form 5500 responses |
|---|
| 2015-04-01 | Type of plan entity | Single employer plan |
| 2015-04-01 | Plan funding arrangement – Insurance | Yes |
| 2015-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2014 form 5500 responses |
|---|
| 2014-04-01 | Type of plan entity | Single employer plan |
| 2014-04-01 | Plan funding arrangement – Insurance | Yes |
| 2014-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2013 form 5500 responses |
|---|
| 2013-04-01 | Type of plan entity | Single employer plan |
| 2013-04-01 | Plan funding arrangement – Insurance | Yes |
| 2013-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2012 form 5500 responses |
|---|
| 2012-04-01 | Type of plan entity | Single employer plan |
| 2012-04-01 | Plan funding arrangement – Insurance | Yes |
| 2012-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: PRECISION VALVE & AUTOMATION - GROUP INSURANCE HEALTH PREMIUM PAYMENT PLAN 2011 form 5500 responses |
|---|
| 2011-04-01 | Type of plan entity | Single employer plan |
| 2011-04-01 | First time form 5500 has been submitted | Yes |
| 2011-04-01 | Plan funding arrangement – Insurance | Yes |
| 2011-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-04-01 | Plan benefit arrangement – Insurance | Yes |
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $70,527 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,434,397 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,527 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 206 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Total amount of commissions paid to insurance broker | USD $17,521 | | Total amount of fees paid to insurance company | USD $4,900 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPT. LIFE, ACCIDENT, DISEASE | | Welfare Benefit Premiums Paid to Carrier | USD $149,165 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,521 | | Amount paid for insurance broker fees | 4900 | | Additional information about fees paid to insurance broker | OTHER CONTRACT FEES | | Insurance broker organization code? | 3 |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 400 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $66,201 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,289,141 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $66,201 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2021-04-01 | | Insurance policy end date | 2022-03-31 | | Total amount of commissions paid to insurance broker | USD $12,695 | | Total amount of fees paid to insurance company | USD $3,582 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $104,334 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,695 | | Amount paid for insurance broker fees | 3582 | | Additional information about fees paid to insurance broker | OTHER CONTRACT FEES | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $12,671 | | Total amount of fees paid to insurance company | USD $4,663 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $104,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,671 | | Amount paid for insurance broker fees | 4663 | | Additional information about fees paid to insurance broker | OTHER CONTRACT FEES | | Insurance broker organization code? | 3 |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 429 | | Insurance policy start date | 2020-04-01 | | Insurance policy end date | 2021-03-31 | | Total amount of commissions paid to insurance broker | USD $68,271 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,228,826 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $68,271 | | Insurance broker organization code? | 3 |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 429 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $67,139 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,402,109 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,139 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2020-03-31 | | Total amount of commissions paid to insurance broker | USD $13,467 | | Total amount of fees paid to insurance company | USD $4,578 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $111,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,467 | | Amount paid for insurance broker fees | 4578 | | Additional information about fees paid to insurance broker | OTHER CONTRACT FEES | | Insurance broker organization code? | 3 |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 408 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $63,669 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,089,629 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $63,669 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2018-04-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $13,165 | | Total amount of fees paid to insurance company | USD $4,559 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $108,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,165 | | Amount paid for insurance broker fees | 4559 | | Additional information about fees paid to insurance broker | OTHER CONTRACT FEES | | Insurance broker organization code? | 3 |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 420 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $61,245 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,816,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,245 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2018-03-31 | | Total amount of commissions paid to insurance broker | USD $13,201 | | Total amount of fees paid to insurance company | USD $4,985 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $106,228 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,201 | | Amount paid for insurance broker fees | 4985 | | Additional information about fees paid to insurance broker | OTHER CONTRACT FEES | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 349 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $49,839 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,555,248 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $49,839 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | Total amount of commissions paid to insurance broker | USD $10,106 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $161,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,106 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 170 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $10,563 | | Total amount of fees paid to insurance company | USD $8,299 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $174,593 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,563 | | Amount paid for insurance broker fees | 8299 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 331 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $52,143 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,525,337 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,143 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 318 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $45,294 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,163,063 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 45294 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $8,691 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $154,514 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 8691 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $43,430 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,071,265 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $43,430 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $10,005 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $157,776 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,005 | | Insurance broker organization code? | 3 | | Insurance broker name | ROSE & KIERNAN INC |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00412420 |
| Policy instance | 1 |
| Insurance contract or identification number | 00412420 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $10,590 | | Total amount of fees paid to insurance company | USD $7,413 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D, OPTIONAL LIFE | | Welfare Benefit Premiums Paid to Carrier | USD $149,565 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 ) |
| Policy contract number | 20020817 |
| Policy instance | 2 |
| Insurance contract or identification number | 20020817 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $36,897 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $925,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
