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PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 401k Plan overview

Plan NamePMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND
Plan identification number 501

PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Vision
  • Temporary disability (accident and sickness)
  • Collectively bargained welfare benefit arrangement under Code section 419A(f)(5).

401k Sponsoring company profile

PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND has sponsored the creation of one or more 401k plans.

Company Name:PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND
Employer identification number (EIN):236472304
NAIC Classification:488300
NAIC Description: Support Activities for Water Transportation

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-01-01
5012018-01-01
5012017-01-01PATRICK DOLAN PATRICK DOLAN2018-10-10
5012016-01-01PATRICK DOLAN
5012015-01-01 PATRICK DOLAN2016-10-03
5012014-01-01
5012013-01-01GARY THACKER PATRICK DOLAN2014-10-10
5012012-01-01GARY THACKER PATRICK DOLAN2013-08-29
5012011-01-01GARY THACKER PATRICK DOLAN2012-10-11
5012010-01-01GARY THACKER PATRICK DOLAN2011-10-14
5012009-01-01GARY THACKER PATRICK DOLAN2010-10-13

Plan Statistics for PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND

401k plan membership statisitcs for PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND

Measure Date Value
2019: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2019 401k membership
Total participants, beginning-of-year2019-01-0126
Total number of active participants reported on line 7a of the Form 55002019-01-010
Total of all active and inactive participants2019-01-010
Number of employers contributing to the scheme2019-01-011
2018: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2018 401k membership
Total participants, beginning-of-year2018-01-0117
Total number of active participants reported on line 7a of the Form 55002018-01-0126
Total of all active and inactive participants2018-01-0126
Number of employers contributing to the scheme2018-01-011
2017: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2017 401k membership
Total participants, beginning-of-year2017-01-0120
Total number of active participants reported on line 7a of the Form 55002017-01-0117
Total of all active and inactive participants2017-01-0117
Number of employers contributing to the scheme2017-01-011
2016: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2016 401k membership
Total participants, beginning-of-year2016-01-0123
Total number of active participants reported on line 7a of the Form 55002016-01-0120
Total of all active and inactive participants2016-01-0120
Number of employers contributing to the scheme2016-01-011
2015: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2015 401k membership
Total participants, beginning-of-year2015-01-0124
Total number of active participants reported on line 7a of the Form 55002015-01-0123
Total of all active and inactive participants2015-01-0123
2014: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2014 401k membership
Total participants, beginning-of-year2014-01-0121
Total number of active participants reported on line 7a of the Form 55002014-01-0124
Total of all active and inactive participants2014-01-0124
2013: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2013 401k membership
Total participants, beginning-of-year2013-01-0110
Total number of active participants reported on line 7a of the Form 55002013-01-0121
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0121
2012: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2012 401k membership
Total participants, beginning-of-year2012-01-0111
Total number of active participants reported on line 7a of the Form 55002012-01-0110
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-0110
2011: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2011 401k membership
Total participants, beginning-of-year2011-01-0114
Total number of active participants reported on line 7a of the Form 55002011-01-0111
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0111
2010: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2010 401k membership
Total participants, beginning-of-year2010-01-0130
Total number of active participants reported on line 7a of the Form 55002010-01-0114
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-0114
2009: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2009 401k membership
Total participants, beginning-of-year2009-01-0125
Total number of active participants reported on line 7a of the Form 55002009-01-0130
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-0130

Financial Data on PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND

Measure Date Value
2019 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2019 401k financial data
Total plan liabilities at end of year2019-08-09$0
Total plan liabilities at beginning of year2019-08-09$9,758
Total income from all sources2019-08-09$3,709
Expenses. Total of all expenses incurred2019-08-09$28,343
Benefits paid (including direct rollovers)2019-08-09$4,475
Total plan assets at end of year2019-08-09$0
Total plan assets at beginning of year2019-08-09$34,392
Value of fidelity bond covering the plan2019-08-09$200,000
Expenses. Other expenses not covered elsewhere2019-08-09$6,481
Other income received2019-08-09$483
Net income (gross income less expenses)2019-08-09$-24,634
Net plan assets at end of year (total assets less liabilities)2019-08-09$0
Net plan assets at beginning of year (total assets less liabilities)2019-08-09$24,634
Total contributions received or receivable from employer(s)2019-08-09$3,226
Expenses. Administrative service providers (salaries,fees and commissions)2019-08-09$17,387
2018 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2018 401k financial data
Total plan liabilities at end of year2018-12-31$9,758
Total plan liabilities at beginning of year2018-12-31$6,668
Total income from all sources2018-12-31$36,005
Expenses. Total of all expenses incurred2018-12-31$84,696
Benefits paid (including direct rollovers)2018-12-31$54,808
Total plan assets at end of year2018-12-31$34,392
Total plan assets at beginning of year2018-12-31$79,993
Value of fidelity bond covering the plan2018-12-31$200,000
Expenses. Other expenses not covered elsewhere2018-12-31$7,348
Other income received2018-12-31$180
Net income (gross income less expenses)2018-12-31$-48,691
Net plan assets at end of year (total assets less liabilities)2018-12-31$24,634
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$73,325
Total contributions received or receivable from employer(s)2018-12-31$35,825
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$22,540
2017 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2017 401k financial data
Total plan liabilities at end of year2017-12-31$6,668
Total plan liabilities at beginning of year2017-12-31$5,050
Total income from all sources2017-12-31$40,268
Expenses. Total of all expenses incurred2017-12-31$72,036
Benefits paid (including direct rollovers)2017-12-31$46,276
Total plan assets at end of year2017-12-31$79,993
Total plan assets at beginning of year2017-12-31$110,143
Value of fidelity bond covering the plan2017-12-31$200,000
Expenses. Other expenses not covered elsewhere2017-12-31$25,760
Other income received2017-12-31$277
Net income (gross income less expenses)2017-12-31$-31,768
Net plan assets at end of year (total assets less liabilities)2017-12-31$73,325
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$105,093
Total contributions received or receivable from employer(s)2017-12-31$39,991
2016 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2016 401k financial data
Total plan liabilities at end of year2016-12-31$5,050
Total plan liabilities at beginning of year2016-12-31$6,540
Total income from all sources2016-12-31$45,011
Expenses. Total of all expenses incurred2016-12-31$66,898
Benefits paid (including direct rollovers)2016-12-31$42,981
Total plan assets at end of year2016-12-31$110,143
Total plan assets at beginning of year2016-12-31$133,520
Value of fidelity bond covering the plan2016-12-31$200,000
Expenses. Other expenses not covered elsewhere2016-12-31$23,917
Other income received2016-12-31$710
Net income (gross income less expenses)2016-12-31$-21,887
Net plan assets at end of year (total assets less liabilities)2016-12-31$105,093
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$126,980
Total contributions received or receivable from employer(s)2016-12-31$44,301
2015 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2015 401k financial data
Total plan liabilities at end of year2015-12-31$6,540
Total plan liabilities at beginning of year2015-12-31$4,992
Total income from all sources2015-12-31$56,730
Expenses. Total of all expenses incurred2015-12-31$67,565
Benefits paid (including direct rollovers)2015-12-31$43,221
Total plan assets at end of year2015-12-31$133,520
Total plan assets at beginning of year2015-12-31$142,807
Value of fidelity bond covering the plan2015-12-31$200,000
Expenses. Other expenses not covered elsewhere2015-12-31$24,344
Other income received2015-12-31$1,884
Net income (gross income less expenses)2015-12-31$-10,835
Net plan assets at end of year (total assets less liabilities)2015-12-31$126,980
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$137,815
Total contributions received or receivable from employer(s)2015-12-31$54,846
2014 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2014 401k financial data
Total plan liabilities at end of year2014-12-31$4,992
Total plan liabilities at beginning of year2014-12-31$5,313
Total income from all sources2014-12-31$42,582
Expenses. Total of all expenses incurred2014-12-31$89,387
Benefits paid (including direct rollovers)2014-12-31$63,818
Total plan assets at end of year2014-12-31$142,807
Total plan assets at beginning of year2014-12-31$189,933
Value of fidelity bond covering the plan2014-12-31$200,000
Expenses. Other expenses not covered elsewhere2014-12-31$25,569
Other income received2014-12-31$1,603
Net income (gross income less expenses)2014-12-31$-46,805
Net plan assets at end of year (total assets less liabilities)2014-12-31$137,815
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$184,620
Total contributions received or receivable from employer(s)2014-12-31$40,979
2013 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2013 401k financial data
Total plan liabilities at end of year2013-12-31$5,313
Total plan liabilities at beginning of year2013-12-31$4,896
Total income from all sources2013-12-31$46,277
Expenses. Total of all expenses incurred2013-12-31$120,667
Benefits paid (including direct rollovers)2013-12-31$95,821
Total plan assets at end of year2013-12-31$189,933
Total plan assets at beginning of year2013-12-31$263,906
Value of fidelity bond covering the plan2013-12-31$200,000
Expenses. Other expenses not covered elsewhere2013-12-31$24,846
Other income received2013-12-31$-108
Net income (gross income less expenses)2013-12-31$-74,390
Net plan assets at end of year (total assets less liabilities)2013-12-31$184,620
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$259,010
Total contributions received or receivable from employer(s)2013-12-31$46,385
2012 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2012 401k financial data
Total plan liabilities at end of year2012-12-31$4,896
Total plan liabilities at beginning of year2012-12-31$5,258
Total income from all sources2012-12-31$47,903
Expenses. Total of all expenses incurred2012-12-31$124,139
Benefits paid (including direct rollovers)2012-12-31$97,119
Total plan assets at end of year2012-12-31$263,906
Total plan assets at beginning of year2012-12-31$340,504
Value of fidelity bond covering the plan2012-12-31$200,000
Expenses. Other expenses not covered elsewhere2012-12-31$27,020
Other income received2012-12-31$2,073
Net income (gross income less expenses)2012-12-31$-76,236
Net plan assets at end of year (total assets less liabilities)2012-12-31$259,010
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$335,246
Total contributions received or receivable from employer(s)2012-12-31$45,830
2011 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2011 401k financial data
Total plan liabilities at end of year2011-12-31$5,258
Total plan liabilities at beginning of year2011-12-31$4,767
Total income from all sources2011-12-31$55,994
Expenses. Total of all expenses incurred2011-12-31$142,025
Benefits paid (including direct rollovers)2011-12-31$118,921
Total plan assets at end of year2011-12-31$340,504
Total plan assets at beginning of year2011-12-31$426,044
Value of fidelity bond covering the plan2011-12-31$200,000
Expenses. Other expenses not covered elsewhere2011-12-31$23,104
Other income received2011-12-31$8,535
Net income (gross income less expenses)2011-12-31$-86,031
Net plan assets at end of year (total assets less liabilities)2011-12-31$335,246
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$421,277
Total contributions received or receivable from employer(s)2011-12-31$47,459
2010 : PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2010 401k financial data
Total plan liabilities at end of year2010-12-31$4,767
Total plan liabilities at beginning of year2010-12-31$5,926
Total income from all sources2010-12-31$20,331
Expenses. Total of all expenses incurred2010-12-31$114,776
Benefits paid (including direct rollovers)2010-12-31$88,731
Total plan assets at end of year2010-12-31$426,044
Total plan assets at beginning of year2010-12-31$521,648
Value of fidelity bond covering the plan2010-12-31$200,000
Expenses. Other expenses not covered elsewhere2010-12-31$26,045
Other income received2010-12-31$13,694
Net income (gross income less expenses)2010-12-31$-94,445
Net plan assets at end of year (total assets less liabilities)2010-12-31$421,277
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$515,722
Total contributions received or receivable from employer(s)2010-12-31$6,637

Form 5500 Responses for PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND

2019: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2019 form 5500 responses
2019-01-01Type of plan entityMulti-employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingYes
2019-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2018 form 5500 responses
2018-01-01Type of plan entityMulti-employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2017 form 5500 responses
2017-01-01Type of plan entityMulti-employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2016 form 5500 responses
2016-01-01Type of plan entityMulti-employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2015 form 5500 responses
2015-01-01Type of plan entityMulti-employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2014 form 5500 responses
2014-01-01Type of plan entityMulti-employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2013 form 5500 responses
2013-01-01Type of plan entityMulti-employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2012 form 5500 responses
2012-01-01Type of plan entityMulti-employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2011 form 5500 responses
2011-01-01Type of plan entityMulti-employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2010 form 5500 responses
2010-01-01Type of plan entityMulti-employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: PMTA SECURITY OFFICERS POLICE AND GUARDS WELFARE FUND 2009 form 5500 responses
2009-01-01Type of plan entityMulti-employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number327487
Policy instance 1
Insurance contract or identification number327487
Number of Individuals Covered0
Insurance policy start date2019-01-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $134
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $134
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG16330
Policy instance 2
Insurance contract or identification numberMG16330
Number of Individuals Covered5
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $585
Total amount of fees paid to insurance companyUSD $536
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,340
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $585
Insurance broker organization code?3
Amount paid for insurance broker fees536
Additional information about fees paid to insurance brokerCOMPENSATION
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number327487
Policy instance 1
Insurance contract or identification number327487
Number of Individuals Covered5
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,500
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $52,468
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,500
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG16330
Policy instance 2
Insurance contract or identification numberMG16330
Number of Individuals Covered8
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $585
Total amount of fees paid to insurance companyUSD $536
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $585
Insurance broker organization code?3
Amount paid for insurance broker fees536
Additional information about fees paid to insurance brokerCOMPENSATION
Insurance broker nameTHE AMERIHEALTH AGENCY, INC.
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number327487
Policy instance 1
Insurance contract or identification number327487
Number of Individuals Covered6
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $1,500
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $44,144
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,500
Insurance broker organization code?3
Insurance broker nameRICHARD GABRIEL ASSOCIATES, INC.
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG16330
Policy instance 1
Insurance contract or identification numberMG16330
Number of Individuals Covered12
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $558
Total amount of fees paid to insurance companyUSD $512
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $558
Insurance broker organization code?3
Amount paid for insurance broker fees512
Additional information about fees paid to insurance brokerCOMPENSATION
Insurance broker nameTHE AMERIHEALTH AGENCY, INC.
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number327487
Policy instance 2
Insurance contract or identification number327487
Number of Individuals Covered5
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,275
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,275
Insurance broker organization code?3
Insurance broker nameRICHARD GABRIEL ASSOCIATES, INC.
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG16330
Policy instance 1
Insurance contract or identification numberMG16330
Number of Individuals Covered15
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,297
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,928
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $677
Insurance broker organization code?3
Additional information about fees paid to insurance brokerCOMPENSATION
Insurance broker nameTHE AMERIHEALTH AGENCY, INC.
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number327487
Policy instance 2
Insurance contract or identification number327487
Number of Individuals Covered10
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $2,000
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $62,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,000
Insurance broker organization code?3
Insurance broker nameRICHARD GABRIEL ASSOCIATES, INC.
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG16330
Policy instance 1
Insurance contract or identification numberMG16330
Number of Individuals Covered14
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $653
Total amount of fees paid to insurance companyUSD $599
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $653
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMISSION
Insurance broker organization code?3
Insurance broker nameTHE AMERIHEALTH AGENCY, INC.
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number327487
Policy instance 2
Insurance contract or identification number327487
Number of Individuals Covered10
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,525
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $91,450
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,525
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameRICHARD GABRIEL ASSOCIATES, INC.
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number327487
Policy instance 1
Insurance contract or identification number327487
Number of Individuals Covered13
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $6,295
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $96,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,295
Insurance broker organization code?3
Insurance broker nameRICHARD GABRIEL ASSOCIATES, INC.
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG16330
Policy instance 2
Insurance contract or identification numberMG16330
Number of Individuals Covered16
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $669
Total amount of fees paid to insurance companyUSD $613
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $669
Insurance broker organization code?3
Amount paid for insurance broker fees613
Additional information about fees paid to insurance brokerCOMPENSATION
Insurance broker nameTHE AMERIHEALTH AGENCY, INC.
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number327487
Policy instance 2
Insurance contract or identification number327487
Number of Individuals Covered32
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $3,200
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $111,291
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG16330
Policy instance 1
Insurance contract or identification numberMG16330
Number of Individuals Covered20
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $855
Total amount of fees paid to insurance companyUSD $784
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG16330
Policy instance 2
Insurance contract or identification numberMG16330
Number of Individuals Covered20
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,654
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number327487
Policy instance 1
Insurance contract or identification number327487
Number of Individuals Covered15
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,534
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $85,145
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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