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WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 401k Plan overview

Plan NameWRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN
Plan identification number 501

WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN Benefits

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

401k Sponsoring company profile

WRNN-TV ASSOCIATES LIMITED PARTN has sponsored the creation of one or more 401k plans.

Company Name:WRNN-TV ASSOCIATES LIMITED PARTN
Employer identification number (EIN):141765447
NAIC Classification:515100

Additional information about WRNN-TV ASSOCIATES LIMITED PARTN

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 2337133

More information about WRNN-TV ASSOCIATES LIMITED PARTN

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-06-01
5012018-06-01
5012017-06-01DAVID SIFLINGER
5012016-06-01TOM O'HARA
5012015-06-01TOM O'HARA
5012014-06-01TOM O'HARA
5012013-06-01TOM O'HARA

Plan Statistics for WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN

401k plan membership statisitcs for WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN

Measure Date Value
2019: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01187
Total number of active participants reported on line 7a of the Form 55002019-06-0142
Number of retired or separated participants receiving benefits2019-06-018
Number of other retired or separated participants entitled to future benefits2019-06-010
Total of all active and inactive participants2019-06-0150
2018: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01202
Total number of active participants reported on line 7a of the Form 55002018-06-01202
Number of retired or separated participants receiving benefits2018-06-011
Number of other retired or separated participants entitled to future benefits2018-06-010
Total of all active and inactive participants2018-06-01203
2017: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01210
Total number of active participants reported on line 7a of the Form 55002017-06-01205
Number of retired or separated participants receiving benefits2017-06-0113
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-01218
2016: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01194
Total number of active participants reported on line 7a of the Form 55002016-06-01210
Number of retired or separated participants receiving benefits2016-06-018
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-01218
2015: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01179
Total number of active participants reported on line 7a of the Form 55002015-06-01190
Number of retired or separated participants receiving benefits2015-06-014
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01194
Total participants2015-06-01194
2014: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01185
Total number of active participants reported on line 7a of the Form 55002014-06-01179
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01179
Total participants2014-06-01179
2013: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01185
Total number of active participants reported on line 7a of the Form 55002013-06-01185
Number of retired or separated participants receiving benefits2013-06-010
Number of other retired or separated participants entitled to future benefits2013-06-010
Total of all active and inactive participants2013-06-01185
Total participants2013-06-01185

Form 5500 Responses for WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN

2019: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Submission has been amendedNo
2019-06-01This submission is the final filingNo
2019-06-01This return/report is a short plan year return/report (less than 12 months)No
2019-06-01Plan is a collectively bargained planNo
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – General assets of the sponsorYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – General assets of the sponsorYes
2018: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Submission has been amendedNo
2018-06-01This submission is the final filingNo
2018-06-01This return/report is a short plan year return/report (less than 12 months)No
2018-06-01Plan is a collectively bargained planNo
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan funding arrangement – General assets of the sponsorYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – General assets of the sponsorYes
2017: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Submission has been amendedNo
2017-06-01This submission is the final filingNo
2017-06-01This return/report is a short plan year return/report (less than 12 months)No
2017-06-01Plan is a collectively bargained planNo
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – General assets of the sponsorYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – General assets of the sponsorYes
2016: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – General assets of the sponsorYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement – General assets of the sponsorYes
2015: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – General assets of the sponsorYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement – General assets of the sponsorYes
2014: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – General assets of the sponsorYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-06-01Plan benefit arrangement – General assets of the sponsorYes
2013: WRNN-TV ASSOCIATES LIMITED PARTNERSHIP HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01First time form 5500 has been submittedYes
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – General assets of the sponsorYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-06-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number300177
Policy instance 2
Insurance contract or identification number300177
Number of Individuals Covered45
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $31,119
Total amount of fees paid to insurance companyUSD $25,377
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $940,213
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,119
Insurance broker organization code?3
Amount paid for insurance broker fees23565
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 )
Policy contract numberAL00006730
Policy instance 1
Insurance contract or identification numberAL00006730
Number of Individuals Covered42
Insurance policy start date2019-06-01
Insurance policy end date2020-05-31
Total amount of commissions paid to insurance brokerUSD $4,390
Total amount of fees paid to insurance companyUSD $1,563
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $32,549
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,390
Insurance broker organization code?3
Amount paid for insurance broker fees1563
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract number300177
Policy instance 2
Insurance contract or identification number300177
Number of Individuals Covered133
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $44,240
Total amount of fees paid to insurance companyUSD $42,628
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,195,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,240
Amount paid for insurance broker fees15755
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0224651
Policy instance 1
Insurance contract or identification number0224651
Number of Individuals Covered208
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $17,152
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $54,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $11,584
Insurance broker organization code?3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number0224651
Policy instance 1
Insurance contract or identification number0224651
Number of Individuals Covered365
Insurance policy start date2017-06-01
Insurance policy end date2018-05-31
Total amount of commissions paid to insurance brokerUSD $80,089
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,414,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $60,519
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS AND FINANCIAL SVCS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNYK700070
Policy instance 3
Insurance contract or identification numberNYK700070
Number of Individuals Covered194
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $2,123
Total amount of fees paid to insurance companyUSD $1,195
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,907
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,123
Insurance broker organization code?3
Amount paid for insurance broker fees1195
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker nameBENEFITMALL
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberSGN600463
Policy instance 4
Insurance contract or identification numberSGN600463
Number of Individuals Covered59
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,085
Total amount of fees paid to insurance companyUSD $779
Life Insurance Welfare BenefitYes
Other welfare benefits providedSUPPLEMENTAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $9,183
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,085
Insurance broker organization code?3
Amount paid for insurance broker fees779
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker nameBENEFITMALL
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSYK600169
Policy instance 5
Insurance contract or identification numberSYK600169
Number of Individuals Covered194
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $390
Total amount of fees paid to insurance companyUSD $162
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $390
Insurance broker organization code?3
Amount paid for insurance broker fees162
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker nameBENEFITMALL
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00611208
Policy instance 6
Insurance contract or identification number00611208
Number of Individuals Covered134
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $66,292
Total amount of fees paid to insurance companyUSD $3,438
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,450
Insurance broker organization code?3
Amount paid for insurance broker fees3438
Additional information about fees paid to insurance brokerINCENTIVE COMPENSATION
Insurance broker nameCENTERSTONE INS & FNCL SVCS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGE600226
Policy instance 2
Insurance contract or identification numberSGE600226
Number of Individuals Covered194
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $1,681
Total amount of fees paid to insurance companyUSD $560
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,207
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,681
Insurance broker organization code?3
Amount paid for insurance broker fees560
Additional information about fees paid to insurance brokerSALES & SERVICE OVERRIDE
Insurance broker nameBENEFITMALL
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number0611208
Policy instance 1
Insurance contract or identification number0611208
Number of Individuals Covered148
Insurance policy start date2015-06-01
Insurance policy end date2016-05-31
Total amount of commissions paid to insurance brokerUSD $5,190
Total amount of fees paid to insurance companyUSD $3,487
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,190
Insurance broker organization code?3
Amount paid for insurance broker fees3487
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker nameCENTERSTONE INS. & FIN SVCS., INC.
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00611208
Policy instance 1
Insurance contract or identification number00611208
Number of Individuals Covered133
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $29,838
Total amount of fees paid to insurance companyUSD $14,610
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $736,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,838
Insurance broker organization code?3
Amount paid for insurance broker fees14610
Additional information about fees paid to insurance brokerGENERAL AGENT FEES
Insurance broker nameCENTERSTONE INS & FNCL SVCS
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGE600226
Policy instance 2
Insurance contract or identification numberSGE600226
Number of Individuals Covered175
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $1,386
Total amount of fees paid to insurance companyUSD $462
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,238
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,386
Insurance broker organization code?3
Amount paid for insurance broker fees462
Additional information about fees paid to insurance brokerSERVICE OVERRIDE
Insurance broker nameBENEFITMALL
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberNYK700070
Policy instance 3
Insurance contract or identification numberNYK700070
Number of Individuals Covered179
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $1,846
Total amount of fees paid to insurance companyUSD $997
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,846
Insurance broker organization code?3
Amount paid for insurance broker fees997
Additional information about fees paid to insurance brokerSALES OVERRIDE
Insurance broker nameBENEFITMALL
CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )
Policy contract numberSGN600463
Policy instance 4
Insurance contract or identification numberSGN600463
Number of Individuals Covered49
Insurance policy start date2014-06-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,082
Total amount of fees paid to insurance companyUSD $615
Life Insurance Welfare BenefitYes
Other welfare benefits providedSUPPLEMENTAL LIFE
Welfare Benefit Premiums Paid to CarrierUSD $9,988
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,082
Insurance broker organization code?3
Amount paid for insurance broker fees499
Additional information about fees paid to insurance brokerSERVICE OVERRIDE
Insurance broker nameANDREW ROTHSTEIN
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSYK600169
Policy instance 5
Insurance contract or identification numberSYK600169
Number of Individuals Covered51
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $361
Total amount of fees paid to insurance companyUSD $150
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $3,006
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $361
Insurance broker organization code?3
Amount paid for insurance broker fees150
Additional information about fees paid to insurance brokerSERVICE OVERRIDE
Insurance broker nameBENEFITMALL
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number0611208
Policy instance 6
Insurance contract or identification number0611208
Number of Individuals Covered150
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $4,697
Total amount of fees paid to insurance companyUSD $3,163
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $64,653
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
Amount paid for insurance broker fees3163
Additional information about fees paid to insurance brokerGENERAL AGENT PAYMENTS
Insurance broker nameCENTERSTONE INS & FNCL SVCS
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number755030
Policy instance 3
Insurance contract or identification number755030
Number of Individuals Covered185
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $5,956
Total amount of fees paid to insurance companyUSD $1,382
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $54,624
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,956
Amount paid for insurance broker fees1382
Additional information about fees paid to insurance brokerBONUS AMOUNT
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FNCL SVCS
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number303643
Policy instance 2
Insurance contract or identification number303643
Number of Individuals Covered144
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $1,721
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $15,483
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,721
Insurance broker organization code?3
Insurance broker nameMIKE BRACHLOW
OXFORD HEALTH INSURANCE, INC (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberWA9444
Policy instance 1
Insurance contract or identification numberWA9444
Number of Individuals Covered120
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $19,228
Total amount of fees paid to insurance companyUSD $16,546
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $652,752
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,228
Amount paid for insurance broker fees880
Additional information about fees paid to insurance brokerADMINISTRATION FEES
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FNCL SVCS

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