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WINCHESTER THURSTON SCHOOL HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameWINCHESTER THURSTON SCHOOL HEALTH AND WELFARE PLAN
Plan identification number 501

WINCHESTER THURSTON SCHOOL HEALTH AND WELFARE PLAN Benefits

401k Plan Type
Plan Features/Benefits

    401k Sponsoring company profile

    WINCHESTER THURSTON SCHOOL has sponsored the creation of one or more 401k plans.

    Company Name:WINCHESTER THURSTON SCHOOL
    Employer identification number (EIN):251030691
    NAIC Classification:611000

    Form 5500 Filing Information

    Submission information for form 5500 for 401k plan WINCHESTER THURSTON SCHOOL HEALTH AND WELFARE PLAN

    Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
    5012020-01-01
    5012019-01-01
    5012018-01-01
    5012017-01-01
    5012016-01-01
    5012015-01-01
    5012014-01-01
    5012013-01-01
    5012012-01-01M. DAVID WOLLAM
    5012011-01-01DAVID WOLLAM
    5012009-01-01DAVID WOLLAM

    Plan Statistics for WINCHESTER THURSTON SCHOOL HEALTH AND WELFARE PLAN

    401k plan membership statisitcs for WINCHESTER THURSTON SCHOOL HEALTH AND WELFARE PLAN

    Measure Date Value
    2020
    Total participants, beginning-of-year2020-01-01179
    Total number of active participants reported on line 7a of the Form 55002020-01-01192
    Number of retired or separated participants receiving benefits2020-01-012
    Number of other retired or separated participants entitled to future benefits2020-01-0120
    Total of all active and inactive participants2020-01-01214
    2019
    Total participants, beginning-of-year2019-01-01179
    Total number of active participants reported on line 7a of the Form 55002019-01-01179
    Total of all active and inactive participants2019-01-01179
    2018
    Total participants, beginning-of-year2018-01-01175
    Total number of active participants reported on line 7a of the Form 55002018-01-01179
    Total of all active and inactive participants2018-01-01179
    2017
    Total participants, beginning-of-year2017-01-01136
    Total number of active participants reported on line 7a of the Form 55002017-01-01175
    Total of all active and inactive participants2017-01-01175
    2016
    Total participants, beginning-of-year2016-01-01139
    Total number of active participants reported on line 7a of the Form 55002016-01-01136
    Total of all active and inactive participants2016-01-01136
    2015
    Total participants, beginning-of-year2015-01-01132
    Total number of active participants reported on line 7a of the Form 55002015-01-01139
    Total of all active and inactive participants2015-01-01139
    2014
    Total participants, beginning-of-year2014-01-01144
    Total number of active participants reported on line 7a of the Form 55002014-01-01132
    Total of all active and inactive participants2014-01-01132
    2013
    Total participants, beginning-of-year2013-01-01141
    Total number of active participants reported on line 7a of the Form 55002013-01-01142
    Number of retired or separated participants receiving benefits2013-01-014
    Number of other retired or separated participants entitled to future benefits2013-01-010
    Total of all active and inactive participants2013-01-01146
    2012
    Total participants, beginning-of-year2012-01-01134
    Total number of active participants reported on line 7a of the Form 55002012-01-01134
    Number of retired or separated participants receiving benefits2012-01-013
    Number of other retired or separated participants entitled to future benefits2012-01-010
    Total of all active and inactive participants2012-01-01137
    2011
    Total participants, beginning-of-year2011-01-01134
    Total number of active participants reported on line 7a of the Form 55002011-01-01130
    Number of retired or separated participants receiving benefits2011-01-012
    Number of other retired or separated participants entitled to future benefits2011-01-010
    Total of all active and inactive participants2011-01-01132
    2009
    Total participants, beginning-of-year2009-01-01138
    Total number of active participants reported on line 7a of the Form 55002009-01-01128
    Number of retired or separated participants receiving benefits2009-01-013
    Number of other retired or separated participants entitled to future benefits2009-01-010
    Total of all active and inactive participants2009-01-01131

    Form 5500 Responses

    2020
    2020-01-01Type of plan entitySingle employer plan
    2020-01-01Submission has been amendedNo
    2020-01-01This submission is the final filingNo
    2020-01-01This return/report is a short plan year return/report (less than 12 months)No
    2020-01-01Plan is a collectively bargained planNo
    2020-01-01Plan funding arrangement – InsuranceYes
    2020-01-01Plan funding arrangement – General assets of the sponsorYes
    2020-01-01Plan benefit arrangement – InsuranceYes
    2020-01-01Plan benefit arrangement – General assets of the sponsorYes
    2019
    2019-01-01Type of plan entitySingle employer plan
    2019-01-01Submission has been amendedNo
    2019-01-01This submission is the final filingNo
    2019-01-01This return/report is a short plan year return/report (less than 12 months)No
    2019-01-01Plan is a collectively bargained planNo
    2019-01-01Plan funding arrangement – InsuranceYes
    2019-01-01Plan funding arrangement – General assets of the sponsorYes
    2019-01-01Plan benefit arrangement – InsuranceYes
    2019-01-01Plan benefit arrangement – General assets of the sponsorYes
    2018
    2018-01-01Type of plan entitySingle employer plan
    2018-01-01Plan funding arrangement – InsuranceYes
    2018-01-01Plan funding arrangement – General assets of the sponsorYes
    2018-01-01Plan benefit arrangement – InsuranceYes
    2018-01-01Plan benefit arrangement – General assets of the sponsorYes
    2017
    2017-01-01Type of plan entitySingle employer plan
    2017-01-01Plan funding arrangement – InsuranceYes
    2017-01-01Plan funding arrangement – General assets of the sponsorYes
    2017-01-01Plan benefit arrangement – InsuranceYes
    2017-01-01Plan benefit arrangement – General assets of the sponsorYes
    2016
    2016-01-01Type of plan entitySingle employer plan
    2016-01-01Plan funding arrangement – InsuranceYes
    2016-01-01Plan funding arrangement – General assets of the sponsorYes
    2016-01-01Plan benefit arrangement – InsuranceYes
    2016-01-01Plan benefit arrangement – General assets of the sponsorYes
    2015
    2015-01-01Type of plan entitySingle employer plan
    2015-01-01Plan funding arrangement – InsuranceYes
    2015-01-01Plan funding arrangement – General assets of the sponsorYes
    2015-01-01Plan benefit arrangement – InsuranceYes
    2015-01-01Plan benefit arrangement – General assets of the sponsorYes
    2014
    2014-01-01Type of plan entitySingle employer plan
    2014-01-01Plan funding arrangement – InsuranceYes
    2014-01-01Plan funding arrangement – General assets of the sponsorYes
    2014-01-01Plan benefit arrangement – InsuranceYes
    2014-01-01Plan benefit arrangement – General assets of the sponsorYes
    2013
    2013-01-01Type of plan entitySingle employer plan
    2013-01-01Plan funding arrangement – InsuranceYes
    2013-01-01Plan funding arrangement – General assets of the sponsorYes
    2013-01-01Plan benefit arrangement – InsuranceYes
    2013-01-01Plan benefit arrangement – General assets of the sponsorYes
    2012
    2012-01-01Type of plan entitySingle employer plan
    2012-01-01Plan funding arrangement – InsuranceYes
    2012-01-01Plan funding arrangement – General assets of the sponsorYes
    2012-01-01Plan benefit arrangement – InsuranceYes
    2012-01-01Plan benefit arrangement – General assets of the sponsorYes
    2011
    2011-01-01Type of plan entitySingle 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 planNo
    2011-01-01Plan funding arrangement – InsuranceYes
    2011-01-01Plan funding arrangement – General assets of the sponsorYes
    2011-01-01Plan benefit arrangement – InsuranceYes
    2011-01-01Plan benefit arrangement – General assets of the sponsorYes
    2009
    2009-01-01Type of plan entitySingle 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 planNo
    2009-01-01Plan funding arrangement – InsuranceYes
    2009-01-01Plan funding arrangement – General assets of the sponsorYes
    2009-01-01Plan benefit arrangement – InsuranceYes
    2009-01-01Plan benefit arrangement – General assets of the sponsorYes

    Insurance Providers Used on plan

    UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NC2
    Policy instance 1
    Insurance contract or identification number021056NC2
    Number of Individuals Covered0
    Insurance policy start date2019-09-01
    Insurance policy end date2020-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number932564
    Policy instance 2
    Insurance contract or identification number932564
    Number of Individuals Covered147
    Insurance policy start date2019-09-01
    Insurance policy end date2020-08-31
    Total amount of commissions paid to insurance brokerUSD $6,535
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D, VOL LIFE/AD&D
    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 $32,413
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,535
    Insurance broker organization code?3
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NN3
    Policy instance 8
    Insurance contract or identification number021056NN3
    Number of Individuals Covered113
    Insurance policy start date2019-09-01
    Insurance policy end date2020-08-31
    Total amount of commissions paid to insurance brokerUSD $3,397
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    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 $35,613
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,249
    Insurance broker organization code?3
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NC3
    Policy instance 3
    Insurance contract or identification number021056NC3
    Number of Individuals Covered0
    Insurance policy start date2019-09-01
    Insurance policy end date2020-08-31
    Total amount of commissions paid to insurance brokerUSD $16
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    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 $530
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $16
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056303
    Policy instance 4
    Insurance contract or identification number021056303
    Number of Individuals Covered62
    Insurance policy start date2019-09-01
    Insurance policy end date2020-08-31
    Total amount of commissions paid to insurance brokerUSD $11,108
    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 $378,416
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,430
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056302
    Policy instance 5
    Insurance contract or identification number021056302
    Number of Individuals Covered136
    Insurance policy start date2019-09-01
    Insurance policy end date2020-08-31
    Total amount of commissions paid to insurance brokerUSD $25,458
    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 $851,548
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $17,073
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056902
    Policy instance 6
    Insurance contract or identification number021056902
    Number of Individuals Covered2
    Insurance policy start date2019-09-01
    Insurance policy end date2020-08-31
    Total amount of commissions paid to insurance brokerUSD $67
    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 $3,540
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $67
    Insurance broker organization code?3
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NN2
    Policy instance 7
    Insurance contract or identification number021056NN2
    Number of Individuals Covered99
    Insurance policy start date2019-09-01
    Insurance policy end date2020-08-31
    Total amount of commissions paid to insurance brokerUSD $3,613
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    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 $38,647
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,423
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056903
    Policy instance 9
    Insurance contract or identification number021056903
    Number of Individuals Covered0
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $30
    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 $501
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $30
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056902
    Policy instance 8
    Insurance contract or identification number021056902
    Number of Individuals Covered0
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    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 $-560
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056303
    Policy instance 7
    Insurance contract or identification number021056303
    Number of Individuals Covered51
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $9,724
    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 $327,073
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $9,724
    Insurance broker organization code?3
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NN3
    Policy instance 6
    Insurance contract or identification number021056NN3
    Number of Individuals Covered112
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $3,467
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    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 $36,813
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,467
    Insurance broker organization code?3
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NC3
    Policy instance 4
    Insurance contract or identification number021056NC3
    Number of Individuals Covered0
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    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 $-130
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NC2
    Policy instance 3
    Insurance contract or identification number021056NC2
    Number of Individuals Covered1
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $3
    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 BenefitNo
    Dental Insurance Welfare BenefitYes
    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
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3
    Insurance broker organization code?3
    SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
    Policy contract number932564
    Policy instance 1
    Insurance contract or identification number932564
    Number of Individuals Covered148
    Insurance policy start date2019-07-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $575
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D, VOL LIFE/AD&D
    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 $5,285
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $575
    Insurance broker organization code?3
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NN2
    Policy instance 5
    Insurance contract or identification number021056NN2
    Number of Individuals Covered91
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $3,038
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitYes
    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 $32,259
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,038
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number02156302
    Policy instance 10
    Insurance contract or identification number02156302
    Number of Individuals Covered142
    Insurance policy start date2018-09-01
    Insurance policy end date2019-08-31
    Total amount of commissions paid to insurance brokerUSD $24,538
    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 $830,734
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $24,538
    Insurance broker organization code?3
    UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
    Policy contract numberG4037352-557
    Policy instance 2
    Insurance contract or identification numberG4037352-557
    Number of Individuals Covered145
    Insurance policy start date2018-09-01
    Insurance policy end date2019-06-30
    Total amount of commissions paid to insurance brokerUSD $5,675
    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 BenefitNo
    Dental Insurance Welfare BenefitNo
    Vision Insurance Welfare BenefitNo
    Life Insurance Welfare BenefitYes
    Temporary Disability Insurance Welfare BenefitNo
    Long Term Disability Insurance Welfare BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedAD&D, VOL & DEP LIFE AND ADD
    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 $25,797
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,675
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056903
    Policy instance 5
    Insurance contract or identification number021056903
    Number of Individuals Covered0
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $501
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NC2
    Policy instance 6
    Insurance contract or identification number021056NC2
    Number of Individuals Covered5
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $87
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,104
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $72
    Insurance broker organization code?3
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NC3
    Policy instance 7
    Insurance contract or identification number021056NC3
    Number of Individuals Covered2
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $112
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,234
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $80
    Insurance broker organization code?3
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NN2
    Policy instance 8
    Insurance contract or identification number021056NN2
    Number of Individuals Covered90
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $3,019
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $34,507
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,237
    Insurance broker organization code?3
    UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
    Policy contract numberG4037352-557
    Policy instance 1
    Insurance contract or identification numberG4037352-557
    Number of Individuals Covered146
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $6,791
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D, DEP LIFE, VOL LIFE, VOL AD&D
    Welfare Benefit Premiums Paid to CarrierUSD $30,868
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,791
    Insurance broker organization code?3
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NN3
    Policy instance 9
    Insurance contract or identification number021056NN3
    Number of Individuals Covered107
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $3,021
    Total amount of fees paid to insurance companyUSD $0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $34,886
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,277
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056902
    Policy instance 4
    Insurance contract or identification number021056902
    Number of Individuals Covered1
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $33
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,658
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $33
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056303
    Policy instance 3
    Insurance contract or identification number021056303
    Number of Individuals Covered47
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $5,348
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $287,005
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,348
    Insurance broker organization code?3
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056302
    Policy instance 2
    Insurance contract or identification number021056302
    Number of Individuals Covered131
    Insurance policy start date2017-09-01
    Insurance policy end date2018-08-31
    Total amount of commissions paid to insurance brokerUSD $15,837
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $854,601
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $15,837
    Insurance broker organization code?3
    UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
    Policy contract number908772
    Policy instance 2
    Insurance contract or identification number908772
    Number of Individuals Covered175
    Insurance policy start date2016-09-01
    Insurance policy end date2017-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $30,364
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $982,643
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $0
    Amount paid for insurance broker fees30364
    Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY BENEFITS LLC
    UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
    Policy contract numberG4037352-557
    Policy instance 1
    Insurance contract or identification numberG4037352-557
    Number of Individuals Covered139
    Insurance policy start date2016-09-01
    Insurance policy end date2017-08-31
    Total amount of commissions paid to insurance brokerUSD $6,461
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D, DEP LIFE, VOL LIFE, VOL AD&D
    Welfare Benefit Premiums Paid to CarrierUSD $29,367
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,461
    Insurance broker organization code?3
    Insurance broker nameISM INSURANCE, INC.
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NN0
    Policy instance 5
    Insurance contract or identification number021056NN0
    Number of Individuals Covered79
    Insurance policy start date2016-09-01
    Insurance policy end date2017-08-31
    Total amount of commissions paid to insurance brokerUSD $2,474
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $28,365
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $2,474
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NN1
    Policy instance 6
    Insurance contract or identification number021056NN1
    Number of Individuals Covered121
    Insurance policy start date2016-09-01
    Insurance policy end date2017-08-31
    Total amount of commissions paid to insurance brokerUSD $3,372
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $39,478
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,372
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NC0
    Policy instance 3
    Insurance contract or identification number021056NC0
    Number of Individuals Covered0
    Insurance policy start date2016-09-01
    Insurance policy end date2017-08-31
    Total amount of commissions paid to insurance brokerUSD $28
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $147
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $28
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY BENEFITS LLC
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056NC1
    Policy instance 4
    Insurance contract or identification number021056NC1
    Number of Individuals Covered6
    Insurance policy start date2016-09-01
    Insurance policy end date2017-08-31
    Total amount of commissions paid to insurance brokerUSD $136
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,880
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $136
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056900
    Policy instance 7
    Insurance contract or identification number021056900
    Number of Individuals Covered1
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $179
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $8,928
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $179
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056301
    Policy instance 6
    Insurance contract or identification number021056301
    Number of Individuals Covered36
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $4,242
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $192,759
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,242
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056300
    Policy instance 5
    Insurance contract or identification number021056300
    Number of Individuals Covered136
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $15,600
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $713,735
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $15,600
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056CA0
    Policy instance 4
    Insurance contract or identification number021056CA0
    Number of Individuals Covered7
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $113
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $2,315
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $113
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056AA1
    Policy instance 3
    Insurance contract or identification number021056AA1
    Number of Individuals Covered79
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $-4,180
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $26,035
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $-4,180
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056AA0
    Policy instance 2
    Insurance contract or identification number021056AA0
    Number of Individuals Covered122
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $-1,437
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $35,063
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $-1,437
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
    Policy contract numberG4037352-557
    Policy instance 1
    Insurance contract or identification numberG4037352-557
    Number of Individuals Covered135
    Insurance policy start date2015-09-01
    Insurance policy end date2016-08-31
    Total amount of commissions paid to insurance brokerUSD $6,391
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D, DEP LIFE, VOL LIFE, VOL AD&D
    Welfare Benefit Premiums Paid to CarrierUSD $29,049
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,391
    Insurance broker organization code?3
    Insurance broker nameISM INSURANCE, INC.
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056AA1
    Policy instance 3
    Insurance contract or identification number021056AA1
    Number of Individuals Covered89
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $7,707
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $30,916
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $7,707
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
    Policy contract numberG4037352-557
    Policy instance 1
    Insurance contract or identification numberG4037352-557
    Number of Individuals Covered139
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $6,784
    Total amount of fees paid to insurance companyUSD $0
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D, DEP LIFE, VOL LIFE, VOL AD&D
    Welfare Benefit Premiums Paid to CarrierUSD $30,837
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,784
    Insurance broker organization code?3
    Insurance broker nameISM INSURANCE, INC.
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056AA0
    Policy instance 2
    Insurance contract or identification number021056AA0
    Number of Individuals Covered112
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $6,090
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $38,623
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees6090
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056CA0
    Policy instance 4
    Insurance contract or identification number021056CA0
    Number of Individuals Covered5
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $126
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $586
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $126
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH BENEFITS (National Association of Insurance Commissioners NAIC id number: 11018 )
    Policy contract number021056CA1
    Policy instance 5
    Insurance contract or identification number021056CA1
    Number of Individuals Covered0
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Dental Insurance Welfare BenefitYes
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $494
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056300
    Policy instance 6
    Insurance contract or identification number021056300
    Number of Individuals Covered139
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $15,800
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $856,281
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $15,800
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056301
    Policy instance 7
    Insurance contract or identification number021056301
    Number of Individuals Covered38
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $4,528
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $245,696
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $4,528
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056901
    Policy instance 9
    Insurance contract or identification number021056901
    Number of Individuals Covered0
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $0
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $0
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
    Policy contract number021056900
    Policy instance 8
    Insurance contract or identification number021056900
    Number of Individuals Covered0
    Insurance policy start date2014-09-01
    Insurance policy end date2015-08-31
    Total amount of commissions paid to insurance brokerUSD $183
    Total amount of fees paid to insurance companyUSD $0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $9,125
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $183
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY
    HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
    Policy contract numberISH-010,C10
    Policy instance 4
    Insurance contract or identification numberISH-010,C10
    Number of Individuals Covered209
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $140
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $7,015
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $140
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC
    HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
    Policy contract number01087903
    Policy instance 3
    Insurance contract or identification number01087903
    Number of Individuals Covered192
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $16,000
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $1,156,056
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $16,000
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC
    UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
    Policy contract numberG4037352-557
    Policy instance 1
    Insurance contract or identification numberG4037352-557
    Number of Individuals Covered132
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $6,797
    Total amount of fees paid to insurance companyUSD $919
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D, DEP LIFE, VOL LIFE, VOL AD&D
    Welfare Benefit Premiums Paid to CarrierUSD $30,897
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $6,797
    Amount paid for insurance broker fees919
    Additional information about fees paid to insurance brokerPRODUCER BONUS PAYMENT
    Insurance broker organization code?3
    Insurance broker nameISM INSURANCE, INC.
    UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )
    Policy contract number858309 - 858310
    Policy instance 2
    Insurance contract or identification number858309 - 858310
    Number of Individuals Covered210
    Insurance policy start date2013-09-01
    Insurance policy end date2014-08-31
    Total amount of commissions paid to insurance brokerUSD $1,171
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $58,787
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,171
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC
    UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )
    Policy contract number858309, 858310
    Policy instance 1
    Insurance contract or identification number858309, 858310
    Number of Individuals Covered212
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $1,145
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $57,075
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $1,145
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC.
    UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
    Policy contract numberG4037352-557
    Policy instance 2
    Insurance contract or identification numberG4037352-557
    Number of Individuals Covered134
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $5,412
    Total amount of fees paid to insurance companyUSD $1,801
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D, DEP LIFE, VOL LIFE, VOL AD&D
    Welfare Benefit Premiums Paid to CarrierUSD $30,068
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,412
    Amount paid for insurance broker fees1801
    Additional information about fees paid to insurance brokerPRODUCER BONUS PAYMENT
    Insurance broker organization code?3
    Insurance broker nameISM INSURANCE INC.
    HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
    Policy contract numberISH-010
    Policy instance 3
    Insurance contract or identification numberISH-010
    Number of Individuals Covered211
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $202
    Total amount of fees paid to insurance companyUSD $454
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $10,080
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees454
    Additional information about fees paid to insurance brokerINSURANCE, UNDERWRITING, PREMIUM TAXES
    Insurance broker organization code?3
    Commission paid to Insurance BrokerUSD $202
    Insurance broker nameAON RISK SERVICES CENTRAL, INC.
    HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
    Policy contract number14048
    Policy instance 4
    Insurance contract or identification number14048
    Number of Individuals Covered180
    Insurance policy start date2012-09-01
    Insurance policy end date2013-08-31
    Total amount of commissions paid to insurance brokerUSD $15,700
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $901,006
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $15,700
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC.
    HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
    Policy contract numberISH-010
    Policy instance 3
    Insurance contract or identification numberISH-010
    Number of Individuals Covered202
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $189
    Total amount of fees paid to insurance companyUSD $425
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Vision Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $9,442
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Amount paid for insurance broker fees425
    Additional information about fees paid to insurance brokerINSURANCE, UNDERWRITING, PREMIUM TAXES
    Insurance broker organization code?3
    Commission paid to Insurance BrokerUSD $189
    Insurance broker nameAON RISK SERVICES CENTRAL, INC.
    HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
    Policy contract number14048
    Policy instance 4
    Insurance contract or identification number14048
    Number of Individuals Covered174
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $14,765
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Health Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $838,713
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $14,765
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC.
    UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )
    Policy contract number858309, 858310
    Policy instance 1
    Insurance contract or identification number858309, 858310
    Number of Individuals Covered201
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $997
    Total amount of fees paid to insurance companyUSD $0
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Dental Insurance Welfare BenefitYes
    Welfare Benefit Premiums Paid to CarrierUSD $54,520
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $997
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC.
    UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 )
    Policy contract numberG4037352-557
    Policy instance 2
    Insurance contract or identification numberG4037352-557
    Number of Individuals Covered128
    Insurance policy start date2011-09-01
    Insurance policy end date2012-08-31
    Total amount of commissions paid to insurance brokerUSD $5,570
    Total amount of fees paid to insurance companyUSD $1,730
    Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
    Contracts With Unallocated Funds Deposit Administration0
    Life Insurance Welfare BenefitYes
    Long Term Disability Insurance Welfare BenefitYes
    Other welfare benefits providedAD&D, DEP LIFE, VOL LIFE, VOL AD&D
    Welfare Benefit Premiums Paid to CarrierUSD $28,689
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $5,570
    Amount paid for insurance broker fees1730
    Additional information about fees paid to insurance brokerPRODUCER BONUS PAYMENT
    Insurance broker organization code?3
    Insurance broker nameISM INSURANCE INC.
    UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )
    Policy contract number858309,310
    Policy instance 1
    Insurance contract or identification number858309,310
    Number of Individuals Covered186
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $1,113
    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 BenefitYes
    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 $51,445
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
    Policy contract number20194
    Policy instance 2
    Insurance contract or identification number20194
    Number of Individuals Covered143
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $325
    Total amount of fees paid to insurance companyUSD $2,888
    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 BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY LIFE, AD&D
    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 $22,460
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
    Policy contract numberISH-010
    Policy instance 3
    Insurance contract or identification numberISH-010
    Number of Individuals Covered192
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $120
    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 BenefitYes
    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 $5,995
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
    Policy contract number14048
    Policy instance 4
    Insurance contract or identification number14048
    Number of Individuals Covered153
    Insurance policy start date2010-09-01
    Insurance policy end date2011-08-31
    Total amount of commissions paid to insurance brokerUSD $14,988
    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 $792,996
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 )
    Policy contract number858309,310
    Policy instance 1
    Insurance contract or identification number858309,310
    Number of Individuals Covered179
    Insurance policy start date2009-09-01
    Insurance policy end date2010-08-31
    Total amount of commissions paid to insurance brokerUSD $944
    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 BenefitYes
    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 $51,360
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $944
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC.
    PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
    Policy contract number20194
    Policy instance 2
    Insurance contract or identification number20194
    Number of Individuals Covered128
    Insurance policy start date2009-09-01
    Insurance policy end date2010-08-31
    Total amount of commissions paid to insurance brokerUSD $3,153
    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 BenefitYes
    Unemployment Insurance Welfare BenefitNo
    Other welfare benefits providedVOLUNTARY LIFE, AD&D
    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 $21,089
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $3,153
    Insurance broker organization code?3
    Insurance broker nameSIMPSON MCCRADY BENEFITS LLC
    HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
    Policy contract numberISH-010
    Policy instance 3
    Insurance contract or identification numberISH-010
    Number of Individuals Covered189
    Insurance policy start date2009-09-01
    Insurance policy end date2010-08-31
    Total amount of commissions paid to insurance brokerUSD $177
    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 BenefitYes
    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 $8,835
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $177
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC.
    HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
    Policy contract number14048
    Policy instance 4
    Insurance contract or identification number14048
    Number of Individuals Covered150
    Insurance policy start date2009-09-01
    Insurance policy end date2010-08-31
    Total amount of commissions paid to insurance brokerUSD $14,538
    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 $737,096
    Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
    Commission paid to Insurance BrokerUSD $14,538
    Insurance broker organization code?3
    Insurance broker nameAON RISK SERVICES CENTRAL, INC.

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