KEYSTONE SERVICE SYSTEMS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE
401k plan membership statisitcs for KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE
| Measure | Date | Value |
|---|
| 2021: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 1,615 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 1,532 |
| Number of retired or separated participants receiving benefits | 2021-07-01 | 4 |
| Total of all active and inactive participants | 2021-07-01 | 1,536 |
| 2020: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 1,715 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 1,611 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 4 |
| Total of all active and inactive participants | 2020-07-01 | 1,615 |
| 2019: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 1,698 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 1,715 |
| Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
| Total of all active and inactive participants | 2019-07-01 | 1,715 |
| 2018: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 1,635 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 1,691 |
| Number of retired or separated participants receiving benefits | 2018-07-01 | 7 |
| Total of all active and inactive participants | 2018-07-01 | 1,698 |
| 2017: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 1,579 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 1,934 |
| Total of all active and inactive participants | 2017-07-01 | 1,934 |
| 2016: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 1,587 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 1,579 |
| Total of all active and inactive participants | 2016-07-01 | 1,579 |
| 2015: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 1,635 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 1,587 |
| Total of all active and inactive participants | 2015-07-01 | 1,587 |
| 2014: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 1,953 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 1,635 |
| Total of all active and inactive participants | 2014-07-01 | 1,635 |
| 2013: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 1,096 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 1,953 |
| Total of all active and inactive participants | 2013-07-01 | 1,953 |
| Total participants | 2013-07-01 | 1,953 |
| 2012: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 1,253 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 1,096 |
| Total of all active and inactive participants | 2012-07-01 | 1,096 |
| Total participants | 2012-07-01 | 1,096 |
| 2011: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 1,284 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 1,253 |
| Total of all active and inactive participants | 2011-07-01 | 1,253 |
| Total participants | 2011-07-01 | 1,253 |
| 2010: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 1,178 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 1,284 |
| Number of retired or separated participants receiving benefits | 2010-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-07-01 | 0 |
| Total of all active and inactive participants | 2010-07-01 | 1,284 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-07-01 | 0 |
| Total participants | 2010-07-01 | 1,284 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2010-07-01 | 0 |
| 2009: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 1,094 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 1,178 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
| Total of all active and inactive participants | 2009-07-01 | 1,178 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-07-01 | 0 |
| Total participants | 2009-07-01 | 1,178 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-07-01 | 0 |
| 2021: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2021 form 5500 responses |
|---|
| 2021-07-01 | Type of plan entity | Single employer plan |
| 2021-07-01 | Submission has been amended | No |
| 2021-07-01 | This submission is the final filing | No |
| 2021-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-07-01 | Plan is a collectively bargained plan | No |
| 2021-07-01 | Plan funding arrangement – Insurance | Yes |
| 2021-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Submission has been amended | No |
| 2020-07-01 | This submission is the final filing | No |
| 2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-07-01 | Plan is a collectively bargained plan | No |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Submission has been amended | Yes |
| 2019-07-01 | This submission is the final filing | No |
| 2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-07-01 | Plan is a collectively bargained plan | No |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Submission has been amended | No |
| 2018-07-01 | This submission is the final filing | No |
| 2018-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-07-01 | Plan is a collectively bargained plan | No |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Submission has been amended | No |
| 2017-07-01 | This submission is the final filing | No |
| 2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-07-01 | Plan is a collectively bargained plan | No |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Submission has been amended | No |
| 2016-07-01 | This submission is the final filing | No |
| 2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-07-01 | Plan is a collectively bargained plan | No |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Submission has been amended | No |
| 2015-07-01 | This submission is the final filing | No |
| 2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-07-01 | Plan is a collectively bargained plan | No |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Submission has been amended | No |
| 2014-07-01 | This submission is the final filing | No |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-07-01 | Plan is a collectively bargained plan | No |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Submission has been amended | No |
| 2013-07-01 | This submission is the final filing | No |
| 2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-07-01 | Plan is a collectively bargained plan | No |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Submission has been amended | Yes |
| 2010-07-01 | This submission is the final filing | No |
| 2010-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-07-01 | Plan is a collectively bargained plan | No |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: KEYSTONE SERVICE SYSTEMS, INC. EMPLOYEE HOSPITAL MAJOR MEDICAL SURGICAL MEDICAL AND DENTAL INSURANCE 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Submission has been amended | Yes |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00531403 |
| Policy instance | 2 |
| Insurance contract or identification number | 00531403 | | Number of Individuals Covered | 2049 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $168,240 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,223,542 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $168,240 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 242651 |
| Policy instance | 1 |
| Insurance contract or identification number | 242651 | | Number of Individuals Covered | 2457 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $218,865 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $826,234 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $218,865 | | Insurance broker organization code? | 3 |
|
| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00531403 |
| Policy instance | 2 |
| Insurance contract or identification number | 00531403 | | Number of Individuals Covered | 4288 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $164,210 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,094,737 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $164,210 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 242651 |
| Policy instance | 1 |
| Insurance contract or identification number | 242651 | | Number of Individuals Covered | 2548 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $217,704 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $855,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $217,704 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 242651 |
| Policy instance | 1 |
| Insurance contract or identification number | 242651 | | Number of Individuals Covered | 1714 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $213,379 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $888,401 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $213,379 | | Insurance broker organization code? | 3 |
|
| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00531403 |
| Policy instance | 2 |
| Insurance contract or identification number | 00531403 | | Number of Individuals Covered | 1715 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $774,642 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 717031 |
| Policy instance | 1 |
| Insurance contract or identification number | 717031 | | Number of Individuals Covered | 483 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $1,145 | | Total amount of fees paid to insurance company | USD $263 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,900 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,145 | | Amount paid for insurance broker fees | 263 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 242651 |
| Policy instance | 2 |
| Insurance contract or identification number | 242651 | | Number of Individuals Covered | 1714 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $213,379 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $888,401 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $213,379 | | Insurance broker organization code? | 3 |
|
| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00531403 |
| Policy instance | 3 |
| Insurance contract or identification number | 00531403 | | Number of Individuals Covered | 1715 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $774,642 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00531403 |
| Policy instance | 1 |
| Insurance contract or identification number | 00531403 | | Number of Individuals Covered | 1681 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $79,533 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $530,217 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $79,533 | | Insurance broker organization code? | 3 |
|
| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00500069 |
| Policy instance | 1 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1551 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $27,947 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $186,311 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,947 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES, INC. |
|
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00500069 |
| Policy instance | 2 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1934 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $91,577 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision 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 $91,577 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES |
|
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00500069 |
| Policy instance | 2 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1587 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $184,201 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision 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 $184,201 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES |
|
| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00500069 |
| Policy instance | 1 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1587 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $56,569 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $335,616 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,569 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES, INC. |
|
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00500069 |
| Policy instance | 2 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1635 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $182,562 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision 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 $182,562 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES |
|
| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00500069 |
| Policy instance | 1 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1590 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $58,417 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $360,196 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,417 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES, INC. |
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| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00500069 |
| Policy instance | 1 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1546 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $22,633 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $180,967 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $22,633 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES, INC. |
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| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00500069 |
| Policy instance | 2 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1953 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $177,716 | | 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 $177,716 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES |
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| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00500069 |
| Policy instance | 2 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 2020 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $150,882 | | 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 $150,882 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES |
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| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | 50829 |
| Policy instance | 1 |
| Insurance contract or identification number | 50829 | | Number of Individuals Covered | 1894 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $2,092 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,851 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,092 | | Insurance broker organization code? | 3 | | Insurance broker name | ALLIANT INSURANCE SERVICES, INC. |
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| CHARTIS (National Association of Insurance Commissioners NAIC id number: 66842 ) |
| Policy contract number | 50829 |
| Policy instance | 1 |
| Insurance contract or identification number | 50829 | | Number of Individuals Covered | 1968 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $4,212 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00500069 |
| Policy instance | 2 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1253 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $130,101 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,023,298 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00500069 |
| Policy instance | 1 |
| Insurance contract or identification number | 00500069 | | Number of Individuals Covered | 1284 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $116,098 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 259120-000 |
| Policy instance | 2 |
| Insurance contract or identification number | 259120-000 | | Number of Individuals Covered | 1284 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $4,858 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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