JOHN SAVOY & SON, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA
401k plan membership statisitcs for JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA
| Measure | Date | Value |
|---|
| 2022: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-06-01 | 96 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-06-01 | 117 |
| 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 | 117 |
| 2021: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-06-01 | 102 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-06-01 | 96 |
| 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 | 96 |
| 2020: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-06-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-06-01 | 102 |
| Number of retired or separated participants receiving benefits | 2020-06-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-06-01 | 0 |
| Total of all active and inactive participants | 2020-06-01 | 102 |
| 2019: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-06-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 122 |
| 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 | 122 |
| 2018: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-06-01 | 157 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 116 |
| 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 | 116 |
| 2017: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 133 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 157 |
| 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 | 157 |
| 2016: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-06-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 133 |
| 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 | 133 |
| 2015: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 105 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 114 |
| Total of all active and inactive participants | 2015-06-01 | 114 |
| 2014: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 105 |
| Total of all active and inactive participants | 2014-06-01 | 105 |
| 2013: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 111 |
| Total of all active and inactive participants | 2013-06-01 | 111 |
| 2012: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 111 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 112 |
| Total of all active and inactive participants | 2012-06-01 | 112 |
| 2011: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-06-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 111 |
| Total of all active and inactive participants | 2011-06-01 | 111 |
| 2010: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-06-01 | 103 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-06-01 | 119 |
| Total of all active and inactive participants | 2010-06-01 | 119 |
| 2009: JOHN SAVOY & SON INC. HEALTH & WELFARE BENEFIT PLA 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 107 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 103 |
| Total of all active and inactive participants | 2009-06-01 | 103 |
| NIPPON LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 81264 ) |
| Policy contract number | LU89 |
| Policy instance | 3 |
| Insurance contract or identification number | LU89 | | Number of Individuals Covered | 102 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $38,972 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $556,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,837 | | Insurance broker organization code? | 3 |
|
| MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
| Policy contract number | 7593-MNL |
| Policy instance | 2 |
| Insurance contract or identification number | 7593-MNL | | Number of Individuals Covered | 117 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $1,709 | | Total amount of fees paid to insurance company | USD $2,065 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,709 | | Amount paid for insurance broker fees | 712 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00575315 |
| Policy instance | 1 |
| Insurance contract or identification number | 00575315 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $4,030 | | Total amount of fees paid to insurance company | USD $1,115 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,357 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,030 | | Amount paid for insurance broker fees | 1115 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00575315 |
| Policy instance | 1 |
| Insurance contract or identification number | 00575315 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $4,150 | | Total amount of fees paid to insurance company | USD $1,717 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $32,614 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,150 | | Amount paid for insurance broker fees | 1717 | | Insurance broker organization code? | 3 |
|
| MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
| Policy contract number | 7593-MNL |
| Policy instance | 2 |
| Insurance contract or identification number | 7593-MNL | | Number of Individuals Covered | 89 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $1,505 | | Total amount of fees paid to insurance company | USD $1,693 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,542 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,505 | | Amount paid for insurance broker fees | 627 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 022217300 |
| Policy instance | 3 |
| Insurance contract or identification number | 022217300 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $608 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $608 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 022217800 |
| Policy instance | 4 |
| Insurance contract or identification number | 022217800 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $17,730 | | Welfare Benefit Premiums Paid to Carrier | USD $538,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,730 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 02217900 |
| Policy instance | 5 |
| Insurance contract or identification number | 02217900 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $178 | | Welfare Benefit Premiums Paid to Carrier | USD $4,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $178 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 022217901 |
| Policy instance | 6 |
| Insurance contract or identification number | 022217901 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00575315 |
| Policy instance | 1 |
| Insurance contract or identification number | 00575315 | | Number of Individuals Covered | 85 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $4,017 | | Total amount of fees paid to insurance company | USD $1,293 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $33,562 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,017 | | Amount paid for insurance broker fees | 1293 | | Insurance broker organization code? | 3 |
|
| MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
| Policy contract number | 7593-MNL |
| Policy instance | 2 |
| Insurance contract or identification number | 7593-MNL | | Number of Individuals Covered | 100 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $1,658 | | Total amount of fees paid to insurance company | USD $1,752 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,658 | | Amount paid for insurance broker fees | 615 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 022217300 |
| Policy instance | 3 |
| Insurance contract or identification number | 022217300 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $608 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,953 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $608 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 022217800 |
| Policy instance | 4 |
| Insurance contract or identification number | 022217800 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $19,191 | | Welfare Benefit Premiums Paid to Carrier | USD $692,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,191 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 02217900 |
| Policy instance | 5 |
| Insurance contract or identification number | 02217900 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $463 | | Welfare Benefit Premiums Paid to Carrier | USD $16,607 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $463 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 934904 |
| Policy instance | 6 |
| Insurance contract or identification number | 934904 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,152 | | Welfare Benefit Premiums Paid to Carrier | USD $11,521 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,152 | | Insurance broker organization code? | 3 |
|
| GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 ) |
| Policy contract number | 10117781 |
| Policy instance | 3 |
| Insurance contract or identification number | 10117781 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $28,756 | | Total amount of fees paid to insurance company | USD $2,704 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $599,625 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,756 | | Amount paid for insurance broker fees | 2704 |
|
| MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
| Policy contract number | 7593-MNL |
| Policy instance | 2 |
| Insurance contract or identification number | 7593-MNL | | Number of Individuals Covered | 115 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $1,741 | | Total amount of fees paid to insurance company | USD $1,959 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,511 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,741 | | Amount paid for insurance broker fees | 726 | | Additional information about fees paid to insurance broker | OVERRIDES | | Insurance broker organization code? | 3 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5456148 |
| Policy instance | 1 |
| Insurance contract or identification number | 5456148 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $3,082 | | Total amount of fees paid to insurance company | USD $924 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $31,033 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,082 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 924 |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5456148 |
| Policy instance | 1 |
| Insurance contract or identification number | 5456148 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $2,404 | | Total amount of fees paid to insurance company | USD $959 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,758 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,796 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 959 |
|
| MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
| Policy contract number | 7593-MNL |
| Policy instance | 2 |
| Insurance contract or identification number | 7593-MNL | | Number of Individuals Covered | 119 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $1,536 | | Total amount of fees paid to insurance company | USD $1,726 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $877 | | Amount paid for insurance broker fees | 365 | | Additional information about fees paid to insurance broker | TPA FEES | | Insurance broker organization code? | 5 |
|
| GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 ) |
| Policy contract number | 10117781 |
| Policy instance | 3 |
| Insurance contract or identification number | 10117781 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $31,408 | | Total amount of fees paid to insurance company | USD $26 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $531,494 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,408 | | Amount paid for insurance broker fees | 26 |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 117781 |
| Policy instance | 3 |
| Insurance contract or identification number | 117781 | | Number of Individuals Covered | 145 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $815,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
| Policy contract number | 7593-MNL |
| Policy instance | 2 |
| Insurance contract or identification number | 7593-MNL | | Number of Individuals Covered | 121 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Total amount of commissions paid to insurance broker | USD $1,587 | | Total amount of fees paid to insurance company | USD $1,786 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1124 | | Additional information about fees paid to insurance broker | TPA FEES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $952 | | Insurance broker name | KISTLER TIFFANY BENEFITS CO |
|
| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | 5456148 |
| Policy instance | 1 |
| Insurance contract or identification number | 5456148 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,296 | | Total amount of fees paid to insurance company | USD $689 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,296 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 689 | | Insurance broker name | ERC OF NEW YORK DBA EMERSON REID LL |
|
| MADISON NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65781 ) |
| Policy contract number | 7593-MNL |
| Policy instance | 1 |
| Insurance contract or identification number | 7593-MNL | | Number of Individuals Covered | 114 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Total amount of commissions paid to insurance broker | USD $1,528 | | Total amount of fees paid to insurance company | USD $1,720 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1083 | | Additional information about fees paid to insurance broker | TPA FEES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $917 | | Insurance broker name | KISTLER TIFFANY BENEFITS CO |
|
| BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 ) |
| Policy contract number | 204688 |
| Policy instance | 2 |
| Insurance contract or identification number | 204688 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | 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 $800,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 ) |
| Policy contract number | 501242 |
| Policy instance | 3 |
| Insurance contract or identification number | 501242 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | 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 $5,688 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BALTIMORE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61212 ) |
| Policy contract number | 7593-BLI |
| Policy instance | 1 |
| Insurance contract or identification number | 7593-BLI | | Number of Individuals Covered | 105 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $1,377 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,474 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $826 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIAM O. DAGGETT JR. |
|
| GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 ) |
| Policy contract number | 1166450002 |
| Policy instance | 3 |
| Insurance contract or identification number | 1166450002 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 116645 |
| Policy instance | 2 |
| Insurance contract or identification number | 116645 | | Number of Individuals Covered | 157 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $631,811 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BALTIMORE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61212 ) |
| Policy contract number | 7593-BLI |
| Policy instance | 1 |
| Insurance contract or identification number | 7593-BLI | | Number of Individuals Covered | 111 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Total amount of commissions paid to insurance broker | USD $1,475 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,287 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $885 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIAM O. DAGGETT JR. |
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| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 116645 |
| Policy instance | 2 |
| Insurance contract or identification number | 116645 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $569,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 ) |
| Policy contract number | 1166450002 |
| Policy instance | 3 |
| Insurance contract or identification number | 1166450002 | | Number of Individuals Covered | 5 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 113851 |
| Policy instance | 2 |
| Insurance contract or identification number | 113851 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $659,749 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BALTIMORE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61212 ) |
| Policy contract number | 7593-BLI |
| Policy instance | 1 |
| Insurance contract or identification number | 7593-BLI | | Number of Individuals Covered | 112 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Total amount of commissions paid to insurance broker | USD $1,485 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,369 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $891 | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIAM O. DAGGETT JR. |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 113851 |
| Policy instance | 2 |
| Insurance contract or identification number | 113851 | | Number of Individuals Covered | 127 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $674,874 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BALTIMORE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61212 ) |
| Policy contract number | 7593-BLI |
| Policy instance | 1 |
| Insurance contract or identification number | 7593-BLI | | Number of Individuals Covered | 111 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $1,583 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,189 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BALTIMORE LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61212 ) |
| Policy contract number | LO 7593 |
| Policy instance | 2 |
| Insurance contract or identification number | LO 7593 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $1,637 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 ) |
| Policy contract number | 055086 |
| Policy instance | 1 |
| Insurance contract or identification number | 055086 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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