MUNCY HOMES, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN
401k plan membership statisitcs for MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN
| Measure | Date | Value |
|---|
| 2022: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-06-01 | 319 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 316 |
| Number of retired or separated participants receiving benefits | 2022-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-06-01 | 0 |
| Total of all active and inactive participants | 2022-06-01 | 316 |
| 2021: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-06-01 | 252 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 319 |
| Number of retired or separated participants receiving benefits | 2021-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-06-01 | 0 |
| Total of all active and inactive participants | 2021-06-01 | 319 |
| 2019: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-06-01 | 433 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 383 |
| Number of retired or separated participants receiving benefits | 2019-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-06-01 | 0 |
| Total of all active and inactive participants | 2019-06-01 | 383 |
| 2018: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-06-01 | 430 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 414 |
| Number of retired or separated participants receiving benefits | 2018-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-06-01 | 0 |
| Total of all active and inactive participants | 2018-06-01 | 414 |
| 2017: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-06-01 | 0 |
| Total of all active and inactive participants | 2017-06-01 | 0 |
| 2016: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-06-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 0 |
| Number of retired or separated participants receiving benefits | 2016-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-06-01 | 0 |
| Total of all active and inactive participants | 2016-06-01 | 0 |
| 2015: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 556 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 0 |
| Number of retired or separated participants receiving benefits | 2015-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-06-01 | 0 |
| Total of all active and inactive participants | 2015-06-01 | 0 |
| 2014: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 591 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 556 |
| Number of retired or separated participants receiving benefits | 2014-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-06-01 | 0 |
| Total of all active and inactive participants | 2014-06-01 | 556 |
| 2013: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 574 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 591 |
| Number of retired or separated participants receiving benefits | 2013-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-06-01 | 0 |
| Total of all active and inactive participants | 2013-06-01 | 591 |
| 2012: MUNCY HOMES INC & AFFILIATES GROUP HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 503 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 574 |
| Number of retired or separated participants receiving benefits | 2012-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-06-01 | 0 |
| Total of all active and inactive participants | 2012-06-01 | 574 |
| INDECS CORPORATION BENEFIT ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 166 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 5 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 452617 |
| Policy instance | 4 |
| Insurance contract or identification number | 452617 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| STEELWORKERS HEALTH & WELFARE FUND (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 54741 |
| Policy instance | 3 |
| Insurance contract or identification number | 54741 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | 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 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | N86055 |
| Policy instance | 2 |
| Insurance contract or identification number | N86055 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| CORESOURCE (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | UN0000 |
| Policy instance | 1 |
| Insurance contract or identification number | UN0000 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $25,039 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,039 |
|
| CORESOURCE (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | UN0000 |
| Policy instance | 1 |
| Insurance contract or identification number | UN0000 | | Number of Individuals Covered | 154 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $23,039 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,039 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | N86055 |
| Policy instance | 2 |
| Insurance contract or identification number | N86055 | | Number of Individuals Covered | 174 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $4,182 | | Total amount of fees paid to insurance company | USD $1,414 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability 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 $4,182 | | Amount paid for insurance broker fees | 1414 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| STEELWORKERS HEALTH & WELFARE FUND (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 54741 |
| Policy instance | 3 |
| Insurance contract or identification number | 54741 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | 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 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 452617 |
| Policy instance | 4 |
| Insurance contract or identification number | 452617 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $9,527 | | Total amount of fees paid to insurance company | USD $4,800 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability 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 $9,527 | | Amount paid for insurance broker fees | 4800 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| INDECS CORPORATION BENEFIT ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 166 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 5 |
|
| CORESOURCE (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | UN0000 |
| Policy instance | 1 |
| Insurance contract or identification number | UN0000 | | Number of Individuals Covered | 287 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $18,879 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $188,793 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,879 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | N86055 |
| Policy instance | 2 |
| Insurance contract or identification number | N86055 | | Number of Individuals Covered | 168 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $2,606 | | Total amount of fees paid to insurance company | USD $1,176 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,855 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,606 | | Amount paid for insurance broker fees | 1176 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| STEELWORKERS HEALTH & WELFARE FUND (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 54741 |
| Policy instance | 3 |
| Insurance contract or identification number | 54741 | | Number of Individuals Covered | 224 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $150,917 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 452617 |
| Policy instance | 4 |
| Insurance contract or identification number | 452617 | | Number of Individuals Covered | 260 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $5,767 | | Total amount of fees paid to insurance company | USD $3,600 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,007 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,767 | | Amount paid for insurance broker fees | 3600 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 |
|
| INDECS CORPORATION BENEFIT ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 234 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $309,231 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $267,103 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $149,585 | | Insurance broker organization code? | 5 |
|
| INDECS CORPORATION BENEFIT ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 225 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $284,497 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $178,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $125,246 | | Insurance broker organization code? | 5 | | Insurance broker name | MULTIPLAN |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 452617 |
| Policy instance | 4 |
| Insurance contract or identification number | 452617 | | Number of Individuals Covered | 244 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $5,492 | | Total amount of fees paid to insurance company | USD $4,587 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,780 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,492 | | Amount paid for insurance broker fees | 4587 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES LLC |
|
| STEELWORKERS HEALTH & WELFARE FUND (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 54741 |
| Policy instance | 3 |
| Insurance contract or identification number | 54741 | | Number of Individuals Covered | 245 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $136,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | N86055 |
| Policy instance | 2 |
| Insurance contract or identification number | N86055 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $2,135 | | Total amount of fees paid to insurance company | USD $790 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $53,473 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,135 | | Amount paid for insurance broker fees | 790 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | JOYCE HAGGERTY BELL INSURANCE |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | 0210075-SL |
| Policy instance | 1 |
| Insurance contract or identification number | 0210075-SL | | Number of Individuals Covered | 151 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $20,043 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $205,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,758 | | Insurance broker name | HARTMAN EMPLOYEE BENEFITS INC |
|
| INDECS CORPORATION BENEFIT ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 52429 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 282 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of fees paid to insurance company | USD $207,088 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $203,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 98735 | | Insurance broker organization code? | 5 | | Insurance broker name | HEALTHCARECSTRAGETIS |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 452617 |
| Policy instance | 4 |
| Insurance contract or identification number | 452617 | | Number of Individuals Covered | 282 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $6,549 | | Total amount of fees paid to insurance company | USD $4,700 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,383 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,549 | | Amount paid for insurance broker fees | 4700 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | HARTMAN EMPLOYEE BENEFITS |
|
| STEELWORKERS HEALTH & WELFARE FUND (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 54741 |
| Policy instance | 3 |
| Insurance contract or identification number | 54741 | | Number of Individuals Covered | 282 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $163,873 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | N86055 |
| Policy instance | 2 |
| Insurance contract or identification number | N86055 | | Number of Individuals Covered | 141 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $2,158 | | Total amount of fees paid to insurance company | USD $805 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,826 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,158 | | Amount paid for insurance broker fees | 805 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | JOYCE HAGGERTY BELL INSURANCE |
|
| HEALTHAMERICA OF PENNSYLVANIA, INC (National Association of Insurance Commissioners NAIC id number: 95060 ) |
| Policy contract number | 1805610000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1805610000 | | Number of Individuals Covered | 257 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $15,192 | | Total amount of fees paid to insurance company | USD $53,696 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $140,361 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,192 | | Amount paid for insurance broker fees | 3358 | | Insurance broker organization code? | 4 | | Insurance broker name | HEALTH AMERICA OF PA |
|
| HEALTHAMERICA OF PENNSYLVANIA, INC (National Association of Insurance Commissioners NAIC id number: 95060 ) |
| Policy contract number | 1805610000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1805610000 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $12,653 | | Welfare Benefit Premiums Paid to Carrier | USD $147,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,653 | | Insurance broker name | HEB HARTMAN EMPLOYEE BENEFITS INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | N86055 |
| Policy instance | 2 |
| Insurance contract or identification number | N86055 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $2,031 | | Total amount of fees paid to insurance company | USD $721 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $39,669 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,031 | | Amount paid for insurance broker fees | 721 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | JOYCE HAGGERTY BELL INSURANCE |
|
| STEELWORKERS HEALTH & WELFARE FUND (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 54741 |
| Policy instance | 3 |
| Insurance contract or identification number | 54741 | | Number of Individuals Covered | 392 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $189,987 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 452617 |
| Policy instance | 4 |
| Insurance contract or identification number | 452617 | | Number of Individuals Covered | 392 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $8,635 | | Total amount of fees paid to insurance company | USD $4,669 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $50,839 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,635 | | Amount paid for insurance broker fees | 4669 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker organization code? | 3 | | Insurance broker name | HARTMAN EMPLOYEE BENEFITS |
|
| TRISTAR BENEFIT ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: 52412 ) |
| Policy contract number | 50030 |
| Policy instance | 5 |
| Insurance contract or identification number | 50030 | | Number of Individuals Covered | 337 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of fees paid to insurance company | USD $229,832 | | Welfare Benefit Premiums Paid to Carrier | USD $224,863 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 118556 | | Insurance broker organization code? | 5 | | Insurance broker name | ENVISION RX |
|
| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 1805613000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1805613000 | | Number of Individuals Covered | 490 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $14,212 | | Welfare Benefit Premiums Paid to Carrier | USD $337,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,212 | | Insurance broker name | THE HARTMAN EMPLOYEE BENEFITS INC |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | N86055 |
| Policy instance | 2 |
| Insurance contract or identification number | N86055 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $2,031 | | Total amount of fees paid to insurance company | USD $721 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,110 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,031 | | Amount paid for insurance broker fees | 721 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker name | JOYCE HAGGERTY BELL INSURANCE |
|
| STEELWORKERS HEALTH & WELFARE FUND (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 54741 |
| Policy instance | 3 |
| Insurance contract or identification number | 54741 | | Number of Individuals Covered | 376 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $200,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 452617 |
| Policy instance | 4 |
| Insurance contract or identification number | 452617 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $7,449 | | Total amount of fees paid to insurance company | USD $4,373 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $150,798 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,375 | | Amount paid for insurance broker fees | 4373 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker name | INDEPENDENCE PLANNING GRP LLC |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 452617 |
| Policy instance | 4 |
| Insurance contract or identification number | 452617 | | Number of Individuals Covered | 410 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $6,996 | | Total amount of fees paid to insurance company | USD $4,303 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,057 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,996 | | Amount paid for insurance broker fees | 4303 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker name | HARTMAN EMPLOYEE BENEFITS |
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| STEELWORKERS HEALTH & WELFARE FUND (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 54741 |
| Policy instance | 3 |
| Insurance contract or identification number | 54741 | | Number of Individuals Covered | 395 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $219,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | N86055 |
| Policy instance | 2 |
| Insurance contract or identification number | N86055 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $1,951 | | Total amount of fees paid to insurance company | USD $667 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,951 | | Amount paid for insurance broker fees | 667 | | Additional information about fees paid to insurance broker | SERVICE FEE | | Insurance broker name | JOYCE HAGGERTY BELL INSURANCE |
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| CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 ) |
| Policy contract number | 1805613000 |
| Policy instance | 1 |
| Insurance contract or identification number | 1805613000 | | Number of Individuals Covered | 518 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $15,159 | | Welfare Benefit Premiums Paid to Carrier | USD $337,848 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,159 | | Insurance broker name | THE HARTMAN EMPLOYEE BENEFITS INC |
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