MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN #501 has sponsored the creation of one or more 401k plans.
Additional information about MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN #501
Submission information for form 5500 for 401k plan MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN
401k plan membership statisitcs for MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN
| Measure | Date | Value |
|---|
| 2022: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 158 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 173 |
| Total of all active and inactive participants | 2022-01-01 | 173 |
| 2021: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 158 |
| Total of all active and inactive participants | 2021-01-01 | 158 |
| 2020: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 181 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 158 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 4 |
| Total of all active and inactive participants | 2020-01-01 | 162 |
| 2019: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 163 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 177 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 4 |
| Total of all active and inactive participants | 2019-01-01 | 181 |
| 2018: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 162 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 163 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 163 |
| 2017: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 156 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 162 |
| Total of all active and inactive participants | 2017-01-01 | 162 |
| 2016: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 156 |
| Total of all active and inactive participants | 2016-01-01 | 156 |
| 2015: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 123 |
| Total of all active and inactive participants | 2015-01-01 | 123 |
| 2014: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 109 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 112 |
| Total of all active and inactive participants | 2014-01-01 | 112 |
| 2013: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 154 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 109 |
| Total of all active and inactive participants | 2013-01-01 | 109 |
| 2012: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 154 |
| Total of all active and inactive participants | 2012-01-01 | 154 |
| 2011: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 121 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 103 |
| Total of all active and inactive participants | 2011-01-01 | 103 |
| 2010: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 121 |
| Total of all active and inactive participants | 2010-01-01 | 121 |
| 2009: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 117 |
| Total of all active and inactive participants | 2009-01-01 | 117 |
| 2022: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MAYER BROS. APPLE PRODUCTS, INC. HEALTH & WELFARE BENEFITS PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 296581 |
| Policy instance | 5 |
| Insurance contract or identification number | 296581 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2022-12-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,604 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $96,109 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,604 | | Insurance broker organization code? | 3 |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010263595 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010263595 | | Number of Individuals Covered | 317 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $3,699 | | Total amount of fees paid to insurance company | USD $1,699 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,989 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,699 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1699 |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010263600 |
| Policy instance | 3 |
| Insurance contract or identification number | 000010263600 | | Number of Individuals Covered | 420 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $3,651 | | Total amount of fees paid to insurance company | USD $2,964 | | Other welfare benefits provided | NY DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $111,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,651 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 2964 |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 13937 |
| Policy instance | 2 |
| Insurance contract or identification number | 13937 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $32,236 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $991,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,236 | | Insurance broker organization code? | 3 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 001207 |
| Policy instance | 1 |
| Insurance contract or identification number | 001207 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,774 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,774 | | Insurance broker organization code? | 3 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 001207 |
| Policy instance | 2 |
| Insurance contract or identification number | 001207 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 933233 |
| Policy instance | 3 |
| Insurance contract or identification number | 933233 | | Number of Individuals Covered | 279 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $1,018 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | NY DISABILITY BENEFITS LAW | | Welfare Benefit Premiums Paid to Carrier | USD $16,007 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,018 | | Insurance broker organization code? | 3 |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 13937 |
| Policy instance | 4 |
| Insurance contract or identification number | 13937 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $35,867 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,030,018 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $35,867 | | Insurance broker organization code? | 3 |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010263600 |
| Policy instance | 5 |
| Insurance contract or identification number | 000010263600 | | Number of Individuals Covered | 389 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $3,097 | | Total amount of fees paid to insurance company | USD $1,801 | | Other welfare benefits provided | NY DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $65,330 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,097 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1801 |
|
| LINCOLN LIFE AND ANNUITY CO OF NY (National Association of Insurance Commissioners NAIC id number: 62057 ) |
| Policy contract number | 000010263595 |
| Policy instance | 6 |
| Insurance contract or identification number | 000010263595 | | Number of Individuals Covered | 273 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $3,440 | | Total amount of fees paid to insurance company | USD $1,440 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,440 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1440 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 914376 |
| Policy instance | 1 |
| Insurance contract or identification number | 914376 | | Number of Individuals Covered | 262 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $222 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,495 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $222 | | Insurance broker organization code? | 3 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 933233 |
| Policy instance | 5 |
| Insurance contract or identification number | 933233 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $1,608 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | NY DISABILITY BENEFITS LAW | | Welfare Benefit Premiums Paid to Carrier | USD $53,979 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,608 | | Insurance broker organization code? | 3 |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | 001207 |
| Policy instance | 4 |
| Insurance contract or identification number | 001207 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,309 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,309 | | Insurance broker organization code? | 3 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 914376 |
| Policy instance | 3 |
| Insurance contract or identification number | 914376 | | Number of Individuals Covered | 262 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $4,342 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,947 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,342 | | Insurance broker organization code? | 3 |
|
| THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 ) |
| Policy contract number | 001207 |
| Policy instance | 2 |
| Insurance contract or identification number | 001207 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,813 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,813 | | Insurance broker organization code? | 3 |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00130490 |
| Policy instance | 1 |
| Insurance contract or identification number | 00130490 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-11-30 | | Total amount of commissions paid to insurance broker | USD $36,030 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,030 | | Insurance broker organization code? | 3 |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00130490 |
| Policy instance | 1 |
| Insurance contract or identification number | 00130490 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $45,390 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $45,390 | | Insurance broker organization code? | 3 |
|
| THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 ) |
| Policy contract number | 001207 |
| Policy instance | 2 |
| Insurance contract or identification number | 001207 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,366 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,366 | | Insurance broker organization code? | 3 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 914376 |
| Policy instance | 3 |
| Insurance contract or identification number | 914376 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $3,584 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $42,416 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,584 | | Insurance broker organization code? | 3 |
|
| THE FIRST REHABILITATION LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81434 ) |
| Policy contract number | 001207 |
| Policy instance | 3 |
| Insurance contract or identification number | 001207 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,343 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,343 | | Insurance broker organization code? | 3 | | Insurance broker name | M&T BANK |
|
| EXCELLUS BLUE CROSS/BLUE SHIELD PLAN (National Association of Insurance Commissioners NAIC id number: 55107 ) |
| Policy contract number | 00130490 |
| Policy instance | 2 |
| Insurance contract or identification number | 00130490 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $21,547 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,547 | | Insurance broker organization code? | 3 | | Insurance broker name | M&T INSURANCE AGENCY |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 11441551 |
| Policy instance | 1 |
| Insurance contract or identification number | 11441551 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-11-30 | | Total amount of commissions paid to insurance broker | USD $14,381 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,381 | | Insurance broker organization code? | 3 | | Insurance broker name | M&T BANK |
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