PHOTONIS has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN
401k plan membership statisitcs for PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN
| Measure | Date | Value |
|---|
| 2022: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-04-01 | 97 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-04-01 | 105 |
| Number of retired or separated participants receiving benefits | 2022-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-04-01 | 0 |
| Total of all active and inactive participants | 2022-04-01 | 105 |
| 2021: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-04-01 | 94 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-04-01 | 97 |
| Number of retired or separated participants receiving benefits | 2021-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-04-01 | 0 |
| Total of all active and inactive participants | 2021-04-01 | 97 |
| 2020: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-04-01 | 94 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-04-01 | 93 |
| Number of retired or separated participants receiving benefits | 2020-04-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2020-04-01 | 0 |
| Total of all active and inactive participants | 2020-04-01 | 94 |
| 2019: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-04-01 | 85 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-04-01 | 93 |
| Number of retired or separated participants receiving benefits | 2019-04-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2019-04-01 | 0 |
| Total of all active and inactive participants | 2019-04-01 | 94 |
| 2018: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-04-01 | 89 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-04-01 | 83 |
| Number of retired or separated participants receiving benefits | 2018-04-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2018-04-01 | 0 |
| Total of all active and inactive participants | 2018-04-01 | 85 |
| Total participants, beginning-of-year | 2018-01-01 | 89 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 83 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 2 |
| 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 | 85 |
| Total participants | 2018-01-01 | 85 |
| 2017: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-04-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-04-01 | 88 |
| Number of retired or separated participants receiving benefits | 2017-04-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2017-04-01 | 0 |
| Total of all active and inactive participants | 2017-04-01 | 89 |
| 2016: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-04-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-04-01 | 104 |
| Number of retired or separated participants receiving benefits | 2016-04-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-04-01 | 0 |
| Total of all active and inactive participants | 2016-04-01 | 104 |
| 2015: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-04-01 | 100 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-04-01 | 96 |
| Number of retired or separated participants receiving benefits | 2015-04-01 | 5 |
| Number of other retired or separated participants entitled to future benefits | 2015-04-01 | 0 |
| Total of all active and inactive participants | 2015-04-01 | 101 |
| Total participants, beginning-of-year | 2015-01-01 | 97 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 100 |
| 2014: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 86 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 93 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 96 |
| 2013: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 89 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 83 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 86 |
| 2012: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 245 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 88 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 1 |
| Total of all active and inactive participants | 2012-01-01 | 89 |
| Total participants | 2012-01-01 | 89 |
| 2011: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 251 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 100 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 145 |
| Total of all active and inactive participants | 2011-01-01 | 245 |
| Total participants | 2011-01-01 | 245 |
| 2010: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 267 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 90 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 160 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 250 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 1 |
| Total participants | 2010-01-01 | 251 |
| 2009: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 271 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 99 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 166 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 265 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 2 |
| Total participants | 2009-01-01 | 267 |
| Measure | Date | Value |
|---|
| 2022 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-03-31 | $0 |
| Total plan liabilities at beginning of year | 2022-03-31 | $33,911 |
| Total income from all sources | 2022-03-31 | $2,079,278 |
| Expenses. Total of all expenses incurred | 2022-03-31 | $1,593,834 |
| Benefits paid (including direct rollovers) | 2022-03-31 | $1,114,630 |
| Total plan assets at end of year | 2022-03-31 | $1,027,702 |
| Total plan assets at beginning of year | 2022-03-31 | $576,169 |
| Value of fidelity bond covering the plan | 2022-03-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2022-03-31 | $400,537 |
| Expenses. Other expenses not covered elsewhere | 2022-03-31 | $436,422 |
| Other income received | 2022-03-31 | $108 |
| Net income (gross income less expenses) | 2022-03-31 | $485,444 |
| Net plan assets at end of year (total assets less liabilities) | 2022-03-31 | $1,027,702 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-03-31 | $542,258 |
| Total contributions received or receivable from employer(s) | 2022-03-31 | $1,678,633 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-03-31 | $42,782 |
| 2021 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-03-31 | $33,911 |
| Total plan liabilities at beginning of year | 2021-03-31 | $83,754 |
| Total income from all sources | 2021-03-31 | $1,640,172 |
| Expenses. Total of all expenses incurred | 2021-03-31 | $1,315,743 |
| Benefits paid (including direct rollovers) | 2021-03-31 | $908,053 |
| Total plan assets at end of year | 2021-03-31 | $576,169 |
| Total plan assets at beginning of year | 2021-03-31 | $301,583 |
| Value of fidelity bond covering the plan | 2021-03-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2021-03-31 | $327,799 |
| Expenses. Other expenses not covered elsewhere | 2021-03-31 | $353,187 |
| Other income received | 2021-03-31 | $101 |
| Net income (gross income less expenses) | 2021-03-31 | $324,429 |
| Net plan assets at end of year (total assets less liabilities) | 2021-03-31 | $542,258 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-03-31 | $217,829 |
| Total contributions received or receivable from employer(s) | 2021-03-31 | $1,312,272 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-03-31 | $54,503 |
| 2020 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-03-31 | $83,754 |
| Total plan liabilities at beginning of year | 2020-03-31 | $71,823 |
| Total income from all sources | 2020-03-31 | $1,350,709 |
| Expenses. Total of all expenses incurred | 2020-03-31 | $1,327,673 |
| Benefits paid (including direct rollovers) | 2020-03-31 | $926,156 |
| Total plan assets at end of year | 2020-03-31 | $301,583 |
| Total plan assets at beginning of year | 2020-03-31 | $266,616 |
| Value of fidelity bond covering the plan | 2020-03-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2020-03-31 | $294,444 |
| Expenses. Other expenses not covered elsewhere | 2020-03-31 | $342,239 |
| Other income received | 2020-03-31 | $4,855 |
| Net income (gross income less expenses) | 2020-03-31 | $23,036 |
| Net plan assets at end of year (total assets less liabilities) | 2020-03-31 | $217,829 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-03-31 | $194,793 |
| Total contributions received or receivable from employer(s) | 2020-03-31 | $1,051,410 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-03-31 | $59,278 |
| 2019 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-03-31 | $71,823 |
| Total plan liabilities at beginning of year | 2019-03-31 | $0 |
| Total income from all sources | 2019-03-31 | $1,040,654 |
| Expenses. Total of all expenses incurred | 2019-03-31 | $1,476,619 |
| Benefits paid (including direct rollovers) | 2019-03-31 | $1,082,418 |
| Total plan assets at end of year | 2019-03-31 | $266,616 |
| Total plan assets at beginning of year | 2019-03-31 | $630,758 |
| Value of fidelity bond covering the plan | 2019-03-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2019-03-31 | $132,555 |
| Expenses. Other expenses not covered elsewhere | 2019-03-31 | $331,863 |
| Other income received | 2019-03-31 | $12,102 |
| Net income (gross income less expenses) | 2019-03-31 | $-435,965 |
| Net plan assets at end of year (total assets less liabilities) | 2019-03-31 | $194,793 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-03-31 | $630,758 |
| Total contributions received or receivable from employer(s) | 2019-03-31 | $895,997 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-03-31 | $62,338 |
| 2018 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $71,823 |
| Total plan liabilities at beginning of year | 2018-12-31 | $0 |
| Total income from all sources | 2018-12-31 | $1,040,654 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $1,476,619 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $1,082,418 |
| Total plan assets at end of year | 2018-12-31 | $266,616 |
| Total plan assets at beginning of year | 2018-12-31 | $630,758 |
| Value of fidelity bond covering the plan | 2018-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $132,555 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $331,863 |
| Other income received | 2018-12-31 | $12,102 |
| Net income (gross income less expenses) | 2018-12-31 | $-435,965 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $194,793 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $630,758 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $895,997 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $62,338 |
| Total plan liabilities at end of year | 2018-03-31 | $0 |
| Total plan liabilities at beginning of year | 2018-03-31 | $0 |
| Total income from all sources | 2018-03-31 | $1,080,044 |
| Expenses. Total of all expenses incurred | 2018-03-31 | $1,214,372 |
| Benefits paid (including direct rollovers) | 2018-03-31 | $813,686 |
| Total plan assets at end of year | 2018-03-31 | $630,758 |
| Total plan assets at beginning of year | 2018-03-31 | $765,086 |
| Value of fidelity bond covering the plan | 2018-03-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2018-03-31 | $453,800 |
| Expenses. Other expenses not covered elsewhere | 2018-03-31 | $324,824 |
| Other income received | 2018-03-31 | $6,002 |
| Net income (gross income less expenses) | 2018-03-31 | $-134,328 |
| Net plan assets at end of year (total assets less liabilities) | 2018-03-31 | $630,758 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-03-31 | $765,086 |
| Total contributions received or receivable from employer(s) | 2018-03-31 | $620,242 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-03-31 | $75,862 |
| 2017 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-03-31 | $0 |
| Total plan liabilities at beginning of year | 2017-03-31 | $5,586 |
| Total income from all sources | 2017-03-31 | $1,293,929 |
| Expenses. Total of all expenses incurred | 2017-03-31 | $1,203,173 |
| Benefits paid (including direct rollovers) | 2017-03-31 | $822,584 |
| Total plan assets at end of year | 2017-03-31 | $765,086 |
| Total plan assets at beginning of year | 2017-03-31 | $679,916 |
| Value of fidelity bond covering the plan | 2017-03-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2017-03-31 | $366,807 |
| Expenses. Other expenses not covered elsewhere | 2017-03-31 | $288,579 |
| Noncash contributions received | 2017-03-31 | $1,014 |
| Net income (gross income less expenses) | 2017-03-31 | $90,756 |
| Net plan assets at end of year (total assets less liabilities) | 2017-03-31 | $765,086 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-03-31 | $674,330 |
| Total contributions received or receivable from employer(s) | 2017-03-31 | $926,108 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-03-31 | $92,010 |
| 2016 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-03-31 | $5,586 |
| Total plan liabilities at beginning of year | 2016-03-31 | $0 |
| Total income from all sources | 2016-03-31 | $1,285,847 |
| Expenses. Total of all expenses incurred | 2016-03-31 | $1,234,838 |
| Benefits paid (including direct rollovers) | 2016-03-31 | $900,320 |
| Total plan assets at end of year | 2016-03-31 | $679,916 |
| Total plan assets at beginning of year | 2016-03-31 | $623,321 |
| Value of fidelity bond covering the plan | 2016-03-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2016-03-31 | $337,991 |
| Expenses. Other expenses not covered elsewhere | 2016-03-31 | $243,945 |
| Other income received | 2016-03-31 | $294 |
| Net income (gross income less expenses) | 2016-03-31 | $51,009 |
| Net plan assets at end of year (total assets less liabilities) | 2016-03-31 | $674,330 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-03-31 | $623,321 |
| Total contributions received or receivable from employer(s) | 2016-03-31 | $947,562 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-03-31 | $90,573 |
| 2015 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-03-31 | $387,733 |
| Expenses. Total of all expenses incurred | 2015-03-31 | $280,319 |
| Benefits paid (including direct rollovers) | 2015-03-31 | $258,030 |
| Total plan assets at end of year | 2015-03-31 | $623,321 |
| Total plan assets at beginning of year | 2015-03-31 | $515,907 |
| Value of fidelity bond covering the plan | 2015-03-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2015-03-31 | $58,552 |
| Other income received | 2015-03-31 | $23 |
| Net income (gross income less expenses) | 2015-03-31 | $107,414 |
| Net plan assets at end of year (total assets less liabilities) | 2015-03-31 | $623,321 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-03-31 | $515,907 |
| Total contributions received or receivable from employer(s) | 2015-03-31 | $329,158 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-03-31 | $22,289 |
| 2014 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $1,549,651 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $1,033,744 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $944,351 |
| Total plan assets at end of year | 2014-12-31 | $515,907 |
| Total plan assets at beginning of year | 2014-12-31 | $0 |
| Value of fidelity bond covering the plan | 2014-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $233,784 |
| Other income received | 2014-12-31 | $33 |
| Net income (gross income less expenses) | 2014-12-31 | $515,907 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $515,907 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $1,315,834 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $89,393 |
| 2022: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2022 form 5500 responses |
|---|
| 2022-04-01 | Type of plan entity | Single employer plan |
| 2022-04-01 | Submission has been amended | No |
| 2022-04-01 | This submission is the final filing | No |
| 2022-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-04-01 | Plan is a collectively bargained plan | No |
| 2022-04-01 | Plan funding arrangement – Insurance | Yes |
| 2022-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2021 form 5500 responses |
|---|
| 2021-04-01 | Type of plan entity | Single employer plan |
| 2021-04-01 | Submission has been amended | No |
| 2021-04-01 | This submission is the final filing | No |
| 2021-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-04-01 | Plan is a collectively bargained plan | No |
| 2021-04-01 | Plan funding arrangement – Trust | Yes |
| 2021-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-04-01 | Plan benefit arrangement - Trust | Yes |
| 2021-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2020 form 5500 responses |
|---|
| 2020-04-01 | Type of plan entity | Single employer plan |
| 2020-04-01 | Submission has been amended | No |
| 2020-04-01 | This submission is the final filing | No |
| 2020-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-04-01 | Plan is a collectively bargained plan | No |
| 2020-04-01 | Plan funding arrangement – Trust | Yes |
| 2020-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-04-01 | Plan benefit arrangement - Trust | Yes |
| 2020-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2019 form 5500 responses |
|---|
| 2019-04-01 | Type of plan entity | Single employer plan |
| 2019-04-01 | Submission has been amended | No |
| 2019-04-01 | This submission is the final filing | No |
| 2019-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-04-01 | Plan is a collectively bargained plan | No |
| 2019-04-01 | Plan funding arrangement – Trust | Yes |
| 2019-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-04-01 | Plan benefit arrangement - Trust | Yes |
| 2019-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2018 form 5500 responses |
|---|
| 2018-04-01 | Type of plan entity | Single employer plan |
| 2018-04-01 | Submission has been amended | No |
| 2018-04-01 | This submission is the final filing | No |
| 2018-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-04-01 | Plan is a collectively bargained plan | No |
| 2018-04-01 | Plan funding arrangement – Trust | Yes |
| 2018-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-04-01 | Plan benefit arrangement - Trust | Yes |
| 2018-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2017 form 5500 responses |
|---|
| 2017-04-01 | Type of plan entity | Single employer plan |
| 2017-04-01 | Submission has been amended | No |
| 2017-04-01 | This submission is the final filing | No |
| 2017-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-04-01 | Plan is a collectively bargained plan | No |
| 2017-04-01 | Plan funding arrangement – Trust | Yes |
| 2017-04-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-04-01 | Plan benefit arrangement - Trust | Yes |
| 2017-04-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2016 form 5500 responses |
|---|
| 2016-04-01 | Type of plan entity | Single employer plan |
| 2016-04-01 | Submission has been amended | No |
| 2016-04-01 | This submission is the final filing | No |
| 2016-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-04-01 | Plan is a collectively bargained plan | No |
| 2016-04-01 | Plan funding arrangement – Insurance | Yes |
| 2016-04-01 | Plan funding arrangement – Trust | Yes |
| 2016-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-04-01 | Plan benefit arrangement - Trust | Yes |
| 2015: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2015 form 5500 responses |
|---|
| 2015-04-01 | Type of plan entity | Single employer plan |
| 2015-04-01 | Submission has been amended | No |
| 2015-04-01 | This submission is the final filing | No |
| 2015-04-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-04-01 | Plan is a collectively bargained plan | No |
| 2015-04-01 | Plan funding arrangement – Insurance | Yes |
| 2015-04-01 | Plan funding arrangement – Trust | Yes |
| 2015-04-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-04-01 | Plan benefit arrangement - Trust | Yes |
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Multi-employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 168424 |
| Policy instance | 1 |
| Insurance contract or identification number | 168424 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2022-04-01 | | Insurance policy end date | 2023-03-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $528,172 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 168424 |
| Policy instance | 1 |
| Insurance contract or identification number | 168424 | | Number of Individuals Covered | 185 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $8,936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 16619 |
| Policy instance | 2 |
| Insurance contract or identification number | 16619 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2015-04-01 | | Insurance policy end date | 2016-03-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $54,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 168424 |
| Policy instance | 1 |
| Insurance contract or identification number | 168424 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-03-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $35,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 168424 |
| Policy instance | 1 |
| Insurance contract or identification number | 168424 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $131,434 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 79354000,4001 |
| Policy instance | 1 |
| Insurance contract or identification number | 79354000,4001 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $13,711 | | Total amount of fees paid to insurance company | USD $810 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $501,426 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,550 | | Amount paid for insurance broker fees | 810 | | Additional information about fees paid to insurance broker | OTHER BROKER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE PROTECTOR GROUP INSURANCE |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05722942 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05722942 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,504 | | Total amount of fees paid to insurance company | USD $15 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,504 | | Amount paid for insurance broker fees | 15 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF PENNSYLVANIA INC. |
|
| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CLI-70644 |
| Policy instance | 4 |
| Insurance contract or identification number | CLI-70644 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $203,628 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | NONE | | Insurance broker organization code? | 3 | | Insurance broker name | THE COVENANT SERVICES GROUP |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 45600800,801 |
| Policy instance | 3 |
| Insurance contract or identification number | 45600800,801 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,360 | | Total amount of fees paid to insurance company | USD $78 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 Carrier | USD $111,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,100 | | Amount paid for insurance broker fees | 78 | | Additional information about fees paid to insurance broker | OTHER BROKER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | THE PROTECTOR GROUP INSURANCE |
|
| ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 ) |
| Policy contract number | 98-47-835 |
| Policy instance | 1 |
| Insurance contract or identification number | 98-47-835 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $225,587 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 79354000 |
| Policy instance | 4 |
| Insurance contract or identification number | 79354000 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $15,655 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $503,341 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,655 | | Insurance broker name | THE PROTECTOR GROUP |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 45600800 |
| Policy instance | 3 |
| Insurance contract or identification number | 45600800 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,434 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,434 | | Insurance broker name | THE PROTECTOR GROUP INSURANCE |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 46-002903 |
| Policy instance | 5 |
| Insurance contract or identification number | 46-002903 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $16 | | Welfare Benefit Premiums Paid to Carrier | USD $129,280 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | 4488899 |
| Policy instance | 4 |
| Insurance contract or identification number | 4488899 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,805 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $84,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | 4488899 |
| Policy instance | 3 |
| Insurance contract or identification number | 4488899 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $15,014 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $447,329 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 655767 |
| Policy instance | 2 |
| Insurance contract or identification number | 655767 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $728,376 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05722942 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05722942 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,822 | | Total amount of fees paid to insurance company | USD $29 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,142 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 ) |
| Policy contract number | 9982336 |
| Policy instance | 6 |
| Insurance contract or identification number | 9982336 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-01-31 | | Total amount of commissions paid to insurance broker | USD $1,722 | | Welfare Benefit Premiums Paid to Carrier | USD $61,938 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,722 | | Insurance broker name | THE PROTECTOR GROUP |
|
| FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 ) |
| Policy contract number | 4488899 |
| Policy instance | 5 |
| Insurance contract or identification number | 4488899 | | Number of Individuals Covered | 68 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-01-31 | | Total amount of commissions paid to insurance broker | USD $13,407 | | Welfare Benefit Premiums Paid to Carrier | USD $363,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,407 | | Insurance broker name | THE PROTECTOR GROUP |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 4933240 |
| Policy instance | 4 |
| Insurance contract or identification number | 4933240 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,821 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,821 | | Insurance broker name | PROTECTOR GROUP INS AGCY CORP |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 655767 |
| Policy instance | 3 |
| Insurance contract or identification number | 655767 | | Number of Individuals Covered | 109 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $668,597 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 46-002903 |
| Policy instance | 2 |
| Insurance contract or identification number | 46-002903 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $32 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $129,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 32 | | Additional information about fees paid to insurance broker | AARP MEMBERSHIP FEES | | Insurance broker organization code? | 3 | | Insurance broker name | AARP HEALTH CARE OPTIONS |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05722942 |
| Policy instance | 1 |
| Insurance contract or identification number | TM05722942 | | Number of Individuals Covered | 111 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,692 | | Total amount of fees paid to insurance company | USD $19 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,470 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,692 | | Amount paid for insurance broker fees | 19 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS OF PENNSYLVANIA |
|
