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THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 401k Plan overview

Plan NameTHE ARC OF UNION COUNTY, INC. BENEFIT PLAN
Plan identification number 501

THE ARC OF UNION COUNTY, INC. BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

THE ARC OF UNION COUNTY, INC. has sponsored the creation of one or more 401k plans.

Company Name:THE ARC OF UNION COUNTY, INC.
Employer identification number (EIN):221686764
NAIC Classification:624100
NAIC Description: Individual and Family Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE ARC OF UNION COUNTY, INC. BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01CAROLYN SCOTT CAROLYN SCOTT2018-10-11
5012016-01-01CAROLYN SCOTT
5012015-01-01CAROLYN SCOTT CAROLYN SCOTT2016-06-21
5012014-01-01CAROLYN SCOTT CAROLYN SCOTT2016-05-12
5012014-01-01CAROLYN SCOTT CAROLYN SCOTT2015-10-15
5012013-01-01ROBBIN JORDAN
5012012-01-01ROBBIN JORDAN
5012011-01-01ROBBIN JORDAN
5012009-01-01DAVID LASKA DAVID LASKA2010-05-14

Plan Statistics for THE ARC OF UNION COUNTY, INC. BENEFIT PLAN

401k plan membership statisitcs for THE ARC OF UNION COUNTY, INC. BENEFIT PLAN

Measure Date Value
2022: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01360
Total number of active participants reported on line 7a of the Form 55002022-01-01195
Number of retired or separated participants receiving benefits2022-01-011
Total of all active and inactive participants2022-01-01196
Total participants2022-01-01196
2021: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01360
Total number of active participants reported on line 7a of the Form 55002021-01-01360
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01360
Total participants2021-01-01360
2020: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01370
Total number of active participants reported on line 7a of the Form 55002020-01-01360
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01360
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2020-01-010
Total participants2020-01-01360
Number of participants with account balances2020-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2020-01-010
Number of employers contributing to the scheme2020-01-010
2019: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01323
Total number of active participants reported on line 7a of the Form 55002019-01-01369
Number of retired or separated participants receiving benefits2019-01-011
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01370
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01370
Number of participants with account balances2019-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-010
2018: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01303
Total number of active participants reported on line 7a of the Form 55002018-01-01323
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01323
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01323
Number of participants with account balances2018-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01293
Total number of active participants reported on line 7a of the Form 55002017-01-01303
Total of all active and inactive participants2017-01-01303
Total participants2017-01-01303
2016: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01148
Total number of active participants reported on line 7a of the Form 55002016-01-01293
Total of all active and inactive participants2016-01-01293
Total participants2016-01-01293
2015: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01182
Total number of active participants reported on line 7a of the Form 55002015-01-01148
Total of all active and inactive participants2015-01-01148
Total participants2015-01-01148
2014: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01197
Total number of active participants reported on line 7a of the Form 55002014-01-01182
Total of all active and inactive participants2014-01-01182
Total participants2014-01-01182
2013: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01215
Total number of active participants reported on line 7a of the Form 55002013-01-01197
Total of all active and inactive participants2013-01-01197
Total participants2013-01-01197
2012: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01201
Total number of active participants reported on line 7a of the Form 55002012-01-01193
Number of retired or separated participants receiving benefits2012-01-012
Number of other retired or separated participants entitled to future benefits2012-01-0120
Total of all active and inactive participants2012-01-01215
Total participants2012-01-01215
2011: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01260
Total number of active participants reported on line 7a of the Form 55002011-01-01201
Total of all active and inactive participants2011-01-01201
Total participants2011-01-01201
2009: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01310
Total number of active participants reported on line 7a of the Form 55002009-01-01255
Number of retired or separated participants receiving benefits2009-01-011
Number of other retired or separated participants entitled to future benefits2009-01-017
Total of all active and inactive participants2009-01-01263

Form 5500 Responses for THE ARC OF UNION COUNTY, INC. BENEFIT PLAN

2022: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: THE ARC OF UNION COUNTY, INC. BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberCI961804
Policy instance 8
Insurance contract or identification numberCI961804
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $615
Other welfare benefits providedVOLUNTARY CRITICAL ILLNESS
Welfare Benefit Premiums Paid to CarrierUSD $4,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $256
Insurance broker organization code?3
CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 )
Policy contract number00633306
Policy instance 1
Insurance contract or identification number00633306
Number of Individuals Covered183
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $2,050
Total amount of fees paid to insurance companyUSD $125,275
Health Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $496,718
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees33544
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Commission paid to Insurance BrokerUSD $858
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberFLX969841
Policy instance 2
Insurance contract or identification numberFLX969841
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $1,546
Total amount of fees paid to insurance companyUSD $1,106
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,755
Insurance broker organization code?3
Amount paid for insurance broker fees1106
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK971281
Policy instance 3
Insurance contract or identification numberOK971281
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $485
Total amount of fees paid to insurance companyUSD $202
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,040
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $485
Insurance broker organization code?3
Amount paid for insurance broker fees202
Additional information about fees paid to insurance brokerINSURANCE AGENT OR BROKER
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberLK966520
Policy instance 4
Insurance contract or identification numberLK966520
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $3,050
Total amount of fees paid to insurance companyUSD $1,150
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $23,002
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,050
Insurance broker organization code?3
Amount paid for insurance broker fees1150
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberAI961892
Policy instance 7
Insurance contract or identification numberAI961892
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $612
Other welfare benefits providedACCIDENTAL INJURY
Welfare Benefit Premiums Paid to CarrierUSD $4,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $258
Insurance broker organization code?3
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSDJ960957
Policy instance 5
Insurance contract or identification numberSDJ960957
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $3,943
Total amount of fees paid to insurance companyUSD $4,965
Other welfare benefits providedSTATUTORY DISABILITY NJ
Welfare Benefit Premiums Paid to CarrierUSD $99,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,943
Insurance broker organization code?3
Amount paid for insurance broker fees4965
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberHC961082
Policy instance 6
Insurance contract or identification numberHC961082
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Other welfare benefits providedVOLUNTARY HOSPITAL CARE
Welfare Benefit Premiums Paid to CarrierUSD $96
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 number0009L488
Policy instance 1
Insurance contract or identification number0009L488
Number of Individuals Covered360
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $25,781
Total amount of fees paid to insurance companyUSD $8,090
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedV.C.I., ACCIDENT, AND A.D.D.
Welfare Benefit Premiums Paid to CarrierUSD $158,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $23,925
Amount paid for insurance broker fees8090
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0009L488
Policy instance 1
Insurance contract or identification number0009L488
Number of Individuals Covered370
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $33,966
Total amount of fees paid to insurance companyUSD $6,152
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedV.C.I., ACCIDENT, AND A.D.D.
Welfare Benefit Premiums Paid to CarrierUSD $223,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,966
Amount paid for insurance broker fees6152
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number0009L488
Policy instance 1
Insurance contract or identification number0009L488
Number of Individuals Covered369
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $28,396
Total amount of fees paid to insurance companyUSD $5,843
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedV.C.I., ACCIDENT, AND A.D.D.
Welfare Benefit Premiums Paid to CarrierUSD $184,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,396
Amount paid for insurance broker fees5843
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00474257
Policy instance 1
Insurance contract or identification number00474257
Number of Individuals Covered323
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $26,382
Total amount of fees paid to insurance companyUSD $5,371
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedV.C.I., ACCIDENT, AND A.D.D.
Welfare Benefit Premiums Paid to CarrierUSD $168,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,382
Amount paid for insurance broker fees5371
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00474257
Policy instance 1
Insurance contract or identification number00474257
Number of Individuals Covered316
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $22,931
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedV.C.I., ACCIDENT, AND A.D.D.
Welfare Benefit Premiums Paid to CarrierUSD $144,528
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $22,054
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Insurance broker nameMEEKER SHARKEY ASSOCIATES LLC
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00474257
Policy instance 2
Insurance contract or identification number00474257
Number of Individuals Covered161
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $10,825
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $106,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $4,185
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerINSURANCE AGENT/BROKER
Insurance broker organization code?3
Insurance broker nameMEEKER SHARKEY ASSOCIATES LLC
QUALCARE, INC. (National Association of Insurance Commissioners NAIC id number: 95821 )
Policy contract number626001
Policy instance 1
Insurance contract or identification number626001
Number of Individuals Covered148
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Welfare Benefit Premiums Paid to CarrierUSD $437,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
QUALCARE, INC. (National Association of Insurance Commissioners NAIC id number: 95821 )
Policy contract number626001
Policy instance 1
Insurance contract or identification number626001
Number of Individuals Covered198
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Welfare Benefit Premiums Paid to CarrierUSD $374,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00474257
Policy instance 2
Insurance contract or identification number00474257
Number of Individuals Covered267
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $15,156
Total amount of fees paid to insurance companyUSD $1,132
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $137,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Vision Insurance Welfare BenefitYes
Commission paid to Insurance BrokerUSD $1,144
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameTRIBEN INSURANCE SOLUTIONS
QUALCARE, INC. (National Association of Insurance Commissioners NAIC id number: 95821 )
Policy contract number626001
Policy instance 1
Insurance contract or identification number626001
Number of Individuals Covered197
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Welfare Benefit Premiums Paid to CarrierUSD $321,016
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 number00474257
Policy instance 2
Insurance contract or identification number00474257
Number of Individuals Covered341
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $15,156
Total amount of fees paid to insurance companyUSD $1,132
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $136,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,393
Amount paid for insurance broker fees1132
Insurance broker organization code?3
Insurance broker nameBOLLINGER INC
QUALCARE, INC. (National Association of Insurance Commissioners NAIC id number: 95821 )
Policy contract number626001
Policy instance 1
Insurance contract or identification number626001
Number of Individuals Covered193
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Welfare Benefit Premiums Paid to CarrierUSD $277,556
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 number00474257
Policy instance 2
Insurance contract or identification number00474257
Number of Individuals Covered334
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $13,812
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $124,345
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,232
Insurance broker organization code?3
Insurance broker nameMARSH & MCLENNAN AGENCY LLC
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK009518
Policy instance 3
Insurance contract or identification numberOK009518
Number of Individuals Covered375
Insurance policy start date2010-12-01
Insurance policy end date2011-11-30
Total amount of commissions paid to insurance brokerUSD $11
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $72
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
QUALCARE, INC. (National Association of Insurance Commissioners NAIC id number: 95821 )
Policy contract number626001
Policy instance 1
Insurance contract or identification number626001
Number of Individuals Covered197
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Welfare Benefit Premiums Paid to CarrierUSD $210,618
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 number454-3456-00
Policy instance 2
Insurance contract or identification number454-3456-00
Number of Individuals Covered270
Insurance policy start date2011-01-01
Insurance policy end date2012-01-01
Total amount of commissions paid to insurance brokerUSD $8,057
Dental Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $120,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 )
Policy contract number454-3456-00
Policy instance 2
Insurance contract or identification number454-3456-00
Number of Individuals Covered257
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $7,313
Total amount of fees paid to insurance companyUSD $3,201
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND 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 $159,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $7,313
Amount paid for insurance broker fees3201
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES INC.
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberOK009518
Policy instance 3
Insurance contract or identification numberOK009518
Number of Individuals Covered257
Insurance policy start date2009-12-01
Insurance policy end date2010-11-30
Total amount of commissions paid to insurance brokerUSD $14
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND 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 $96
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $14
Insurance broker organization code?3
Insurance broker nameFELLER AND FEIST
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95287 )
Policy contract numberUS368476
Policy instance 1
Insurance contract or identification numberUS368476
Number of Individuals Covered457
Insurance policy start date2010-01-01
Insurance policy end date2010-07-31
Total amount of commissions paid to insurance brokerUSD $36,894
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 BenefitNo
Vision Insurance Welfare BenefitNo
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 $870,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,894
Insurance broker organization code?3
Insurance broker nameGALLAGHER BENEFIT SERVICES INC.

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