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PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 401k Plan overview

Plan NamePENNSYLVANIA SMALL BUSINESS BENEFITS TRUST
Plan identification number 501

PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover

401k Sponsoring company profile

MANUFACTURER & BUSINESS ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:MANUFACTURER & BUSINESS ASSOCIATION
Employer identification number (EIN):251374544
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012014-06-01
5012014-06-01
5012013-06-01
5012012-06-01STEVEN SHIVAK
5012011-06-01STEVEN SHIVAK
5012009-06-01GERALD DIFRANGO

Plan Statistics for PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST

401k plan membership statisitcs for PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST

Measure Date Value
2014: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2014 401k membership
Total participants, beginning-of-year2014-06-011,799
Total number of active participants reported on line 7a of the Form 55002014-06-010
Number of retired or separated participants receiving benefits2014-06-010
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-010
2013: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2013 401k membership
Total participants, beginning-of-year2013-06-012,066
Total number of active participants reported on line 7a of the Form 55002013-06-011,791
Number of retired or separated participants receiving benefits2013-06-018
Number of other retired or separated participants entitled to future benefits2013-06-010
Total of all active and inactive participants2013-06-011,799
2012: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2012 401k membership
Total participants, beginning-of-year2012-06-012,400
Total number of active participants reported on line 7a of the Form 55002012-06-012,059
Number of retired or separated participants receiving benefits2012-06-017
Number of other retired or separated participants entitled to future benefits2012-06-010
Total of all active and inactive participants2012-06-012,066
2011: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2011 401k membership
Total participants, beginning-of-year2011-06-012,844
Total number of active participants reported on line 7a of the Form 55002011-06-012,400
Total of all active and inactive participants2011-06-012,400
2009: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2009 401k membership
Total participants, beginning-of-year2009-06-013,957
Total number of active participants reported on line 7a of the Form 55002009-06-013,403
Number of retired or separated participants receiving benefits2009-06-014
Total of all active and inactive participants2009-06-013,407

Financial Data on PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST

Measure Date Value
2015 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-05-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-05-31$858,373
Total income from all sources (including contributions)2015-05-31$5,859,032
Total of all expenses incurred2015-05-31$5,933,140
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-05-31$5,548,804
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-05-31$5,858,028
Value of total assets at end of year2015-05-31$0
Value of total assets at beginning of year2015-05-31$932,481
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-05-31$384,336
Total interest from all sources2015-05-31$1,004
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-05-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-05-31$0
Administrative expenses professional fees incurred2015-05-31$28,942
Was this plan covered by a fidelity bond2015-05-31Yes
Value of fidelity bond cover2015-05-31$1,000,000
If this is an individual account plan, was there a blackout period2015-05-31No
Were there any nonexempt tranactions with any party-in-interest2015-05-31No
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-05-31$14,049
Administrative expenses (other) incurred2015-05-31$266,128
Liabilities. Value of operating payables at end of year2015-05-31$0
Liabilities. Value of operating payables at beginning of year2015-05-31$111,319
Total non interest bearing cash at end of year2015-05-31$0
Total non interest bearing cash at beginning of year2015-05-31$102,648
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-05-31No
Value of net income/loss2015-05-31$-74,108
Value of net assets at end of year (total assets less liabilities)2015-05-31$0
Value of net assets at beginning of year (total assets less liabilities)2015-05-31$74,108
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-05-31No
Were any leases to which the plan was party in default or uncollectible2015-05-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-05-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-05-31$815,784
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-05-31$815,784
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-05-31$1,004
Expenses. Payments to insurance carriers foe the provision of benefits2015-05-31$5,548,804
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-05-31No
Was there a failure to transmit to the plan any participant contributions2015-05-31No
Has the plan failed to provide any benefit when due under the plan2015-05-31No
Contributions received in cash from employer2015-05-31$5,858,028
Contract administrator fees2015-05-31$89,266
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-05-31No
Liabilities. Value of benefit claims payable at end of year2015-05-31$0
Liabilities. Value of benefit claims payable at beginning of year2015-05-31$747,054
Did the plan have assets held for investment2015-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-05-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-05-31No
Opinion of an independent qualified public accountant for this plan2015-05-31Unqualified
Accountancy firm name2015-05-31SISTERSON & CO., LLP
Accountancy firm EIN2015-05-31251467156
2014 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-05-31$858,373
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-05-31$1,038,374
Total income from all sources (including contributions)2014-05-31$11,343,307
Total of all expenses incurred2014-05-31$11,472,458
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-05-31$10,884,532
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-05-31$11,337,277
Value of total assets at end of year2014-05-31$932,481
Value of total assets at beginning of year2014-05-31$1,241,633
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-05-31$587,926
Total interest from all sources2014-05-31$2,674
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-05-31No
Administrative expenses professional fees incurred2014-05-31$7,650
Was this plan covered by a fidelity bond2014-05-31Yes
Value of fidelity bond cover2014-05-31$1,000,000
If this is an individual account plan, was there a blackout period2014-05-31No
Were there any nonexempt tranactions with any party-in-interest2014-05-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-05-31$14,049
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-05-31$3,113
Other income not declared elsewhere2014-05-31$3,356
Administrative expenses (other) incurred2014-05-31$380,139
Liabilities. Value of operating payables at end of year2014-05-31$111,319
Liabilities. Value of operating payables at beginning of year2014-05-31$29,880
Total non interest bearing cash at end of year2014-05-31$102,648
Total non interest bearing cash at beginning of year2014-05-31$119,688
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-05-31No
Value of net income/loss2014-05-31$-129,151
Value of net assets at end of year (total assets less liabilities)2014-05-31$74,108
Value of net assets at beginning of year (total assets less liabilities)2014-05-31$203,259
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-05-31No
Were any leases to which the plan was party in default or uncollectible2014-05-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-05-31$815,784
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-05-31$1,118,832
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-05-31$1,118,832
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-05-31$2,674
Expenses. Payments to insurance carriers foe the provision of benefits2014-05-31$10,884,532
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-05-31No
Was there a failure to transmit to the plan any participant contributions2014-05-31No
Has the plan failed to provide any benefit when due under the plan2014-05-31No
Contributions received in cash from employer2014-05-31$11,337,277
Contract administrator fees2014-05-31$200,137
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-05-31No
Liabilities. Value of benefit claims payable at end of year2014-05-31$747,054
Liabilities. Value of benefit claims payable at beginning of year2014-05-31$1,008,494
Did the plan have assets held for investment2014-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-05-31No
Opinion of an independent qualified public accountant for this plan2014-05-31Unqualified
Accountancy firm name2014-05-31SISTERSON & CO., LLP
Accountancy firm EIN2014-05-31251467156
2013 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-05-31$1,038,374
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-05-31$1,168,868
Total income from all sources (including contributions)2013-05-31$13,442,421
Total of all expenses incurred2013-05-31$13,349,804
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-05-31$12,668,374
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-05-31$13,439,268
Value of total assets at end of year2013-05-31$1,241,633
Value of total assets at beginning of year2013-05-31$1,279,510
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-05-31$681,430
Total interest from all sources2013-05-31$3,153
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-05-31No
Administrative expenses professional fees incurred2013-05-31$11,831
Was this plan covered by a fidelity bond2013-05-31Yes
Value of fidelity bond cover2013-05-31$1,000,000
If this is an individual account plan, was there a blackout period2013-05-31No
Were there any nonexempt tranactions with any party-in-interest2013-05-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-05-31$3,113
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-05-31$340
Administrative expenses (other) incurred2013-05-31$606,716
Liabilities. Value of operating payables at end of year2013-05-31$29,880
Liabilities. Value of operating payables at beginning of year2013-05-31$25,522
Total non interest bearing cash at end of year2013-05-31$119,688
Total non interest bearing cash at beginning of year2013-05-31$143,959
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-05-31No
Value of net income/loss2013-05-31$92,617
Value of net assets at end of year (total assets less liabilities)2013-05-31$203,259
Value of net assets at beginning of year (total assets less liabilities)2013-05-31$110,642
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-05-31No
Were any leases to which the plan was party in default or uncollectible2013-05-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-05-31$1,118,832
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-05-31$1,135,211
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-05-31$1,135,211
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-05-31$3,153
Expenses. Payments to insurance carriers foe the provision of benefits2013-05-31$12,668,374
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-05-31No
Was there a failure to transmit to the plan any participant contributions2013-05-31No
Has the plan failed to provide any benefit when due under the plan2013-05-31No
Contributions received in cash from employer2013-05-31$13,439,268
Contract administrator fees2013-05-31$62,883
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-05-31No
Liabilities. Value of benefit claims payable at end of year2013-05-31$1,008,494
Liabilities. Value of benefit claims payable at beginning of year2013-05-31$1,143,346
Did the plan have assets held for investment2013-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-05-31No
Opinion of an independent qualified public accountant for this plan2013-05-31Unqualified
Accountancy firm name2013-05-31SISTERSON & CO., LLP
Accountancy firm EIN2013-05-31251467156
2012 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-05-31$1,168,868
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-05-31$1,437,640
Total income from all sources (including contributions)2012-05-31$16,120,125
Total of all expenses incurred2012-05-31$16,052,810
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-05-31$15,344,372
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-05-31$16,115,930
Value of total assets at end of year2012-05-31$1,279,510
Value of total assets at beginning of year2012-05-31$1,480,967
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-05-31$708,438
Total interest from all sources2012-05-31$4,195
Total dividends received (eg from common stock, registered investment company shares)2012-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-05-31No
Administrative expenses professional fees incurred2012-05-31$11,829
Was this plan covered by a fidelity bond2012-05-31Yes
Value of fidelity bond cover2012-05-31$1,000,000
If this is an individual account plan, was there a blackout period2012-05-31No
Were there any nonexempt tranactions with any party-in-interest2012-05-31No
Assets. Other investments not covered elsewhere at end of year2012-05-31$340
Assets. Other investments not covered elsewhere at beginning of year2012-05-31$1,265
Administrative expenses (other) incurred2012-05-31$631,582
Liabilities. Value of operating payables at end of year2012-05-31$25,522
Total non interest bearing cash at end of year2012-05-31$143,959
Total non interest bearing cash at beginning of year2012-05-31$117,919
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Value of net income/loss2012-05-31$67,315
Value of net assets at end of year (total assets less liabilities)2012-05-31$110,642
Value of net assets at beginning of year (total assets less liabilities)2012-05-31$43,327
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-05-31No
Were any leases to which the plan was party in default or uncollectible2012-05-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-05-31$1,135,211
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-05-31$1,361,783
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-05-31$1,361,783
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-05-31$4,195
Expenses. Payments to insurance carriers foe the provision of benefits2012-05-31$15,344,372
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-05-31No
Was there a failure to transmit to the plan any participant contributions2012-05-31No
Has the plan failed to provide any benefit when due under the plan2012-05-31No
Contributions received in cash from employer2012-05-31$16,115,930
Income. Dividends from common stock2012-05-31$0
Contract administrator fees2012-05-31$65,027
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-05-31No
Liabilities. Value of benefit claims payable at end of year2012-05-31$1,143,346
Liabilities. Value of benefit claims payable at beginning of year2012-05-31$1,437,640
Did the plan have assets held for investment2012-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-05-31No
Opinion of an independent qualified public accountant for this plan2012-05-31Unqualified
Accountancy firm name2012-05-31SISTERSON & CO LLP
Accountancy firm EIN2012-05-31251467156
2011 : PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$1,437,640
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$1,753,077
Total income from all sources (including contributions)2011-05-31$19,447,143
Total of all expenses incurred2011-05-31$19,678,860
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-05-31$18,670,476
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-05-31$19,440,358
Value of total assets at end of year2011-05-31$1,480,967
Value of total assets at beginning of year2011-05-31$2,028,121
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-05-31$1,008,384
Total interest from all sources2011-05-31$6,783
Total dividends received (eg from common stock, registered investment company shares)2011-05-31$2
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-05-31No
Administrative expenses professional fees incurred2011-05-31$7,959
Was this plan covered by a fidelity bond2011-05-31Yes
Value of fidelity bond cover2011-05-31$500,000
If this is an individual account plan, was there a blackout period2011-05-31No
Were there any nonexempt tranactions with any party-in-interest2011-05-31No
Assets. Other investments not covered elsewhere at end of year2011-05-31$1,265
Assets. Other investments not covered elsewhere at beginning of year2011-05-31$1,702
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-05-31$10,000
Administrative expenses (other) incurred2011-05-31$879,010
Total non interest bearing cash at end of year2011-05-31$117,919
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Value of net income/loss2011-05-31$-231,717
Value of net assets at end of year (total assets less liabilities)2011-05-31$43,327
Value of net assets at beginning of year (total assets less liabilities)2011-05-31$275,044
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-05-31No
Were any leases to which the plan was party in default or uncollectible2011-05-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-05-31$1,361,783
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-05-31$2,016,419
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-05-31$2,016,419
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-05-31$6,783
Expenses. Payments to insurance carriers foe the provision of benefits2011-05-31$18,670,476
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-05-31No
Was there a failure to transmit to the plan any participant contributions2011-05-31No
Has the plan failed to provide any benefit when due under the plan2011-05-31No
Contributions received in cash from employer2011-05-31$19,440,358
Income. Dividends from common stock2011-05-31$2
Contract administrator fees2011-05-31$121,415
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-05-31No
Liabilities. Value of benefit claims payable at end of year2011-05-31$1,437,640
Liabilities. Value of benefit claims payable at beginning of year2011-05-31$1,753,077
Did the plan have assets held for investment2011-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-05-31No
Opinion of an independent qualified public accountant for this plan2011-05-31Unqualified
Accountancy firm name2011-05-31SISTERSON & CO LLP
Accountancy firm EIN2011-05-31251467156

Form 5500 Responses for PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST

2014: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2014 form 5500 responses
2014-06-01Type of plan entityMulitple employer plan
2014-06-01Submission has been amendedYes
2014-06-01This submission is the final filingYes
2014-06-01Plan funding arrangement – TrustYes
2014-06-01Plan benefit arrangement – InsuranceYes
2013: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2013 form 5500 responses
2013-06-01Type of plan entityMulitple employer plan
2013-06-01Submission has been amendedYes
2013-06-01Plan funding arrangement – TrustYes
2013-06-01Plan benefit arrangement – InsuranceYes
2012: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2012 form 5500 responses
2012-06-01Type of plan entityMulitple employer plan
2012-06-01Plan funding arrangement – TrustYes
2012-06-01Plan benefit arrangement – InsuranceYes
2011: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2011 form 5500 responses
2011-06-01Type of plan entityMulitple employer plan
2011-06-01Plan funding arrangement – TrustYes
2011-06-01Plan benefit arrangement – InsuranceYes
2009: PENNSYLVANIA SMALL BUSINESS BENEFITS TRUST 2009 form 5500 responses
2009-06-01Type of plan entityMulitple employer plan
2009-06-01This submission is the final filingNo
2009-06-01Plan funding arrangement – TrustYes
2009-06-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number259168 + SUBS
Policy instance 3
Insurance contract or identification number259168 + SUBS
Number of Individuals Covered709
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number510
Policy instance 4
Insurance contract or identification number510
Number of Individuals Covered80
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $416
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $416
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number0176244
Policy instance 1
Insurance contract or identification number0176244
Number of Individuals Covered217
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $3,241
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 $39,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,241
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 )
Policy contract number1068456
Policy instance 5
Insurance contract or identification number1068456
Number of Individuals Covered15
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 $124,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFHM908799
Policy instance 6
Insurance contract or identification numberFHM908799
Number of Individuals Covered281
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $387
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
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $38,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $387
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number260087,88,89
Policy instance 9
Insurance contract or identification number260087,88,89
Number of Individuals Covered1739
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $44,424
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,424
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414661
Policy instance 7
Insurance contract or identification number00414661
Number of Individuals Covered46
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $2,094
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
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,686
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,053
Insurance broker organization code?3
Insurance broker nameLIFETIME FINANCIAL GROWTH, LLC
HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 )
Policy contract number05831000
Policy instance 8
Insurance contract or identification number05831000
Number of Individuals Covered9619
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $578,388
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
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,974,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $131,851
Insurance broker organization code?3
Insurance broker nameHANZEL & HILL, INC.
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00506002
Policy instance 2
Insurance contract or identification number00506002
Number of Individuals Covered0
Insurance policy start date2014-06-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
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
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 numberSMB-001 TO 005
Policy instance 10
Insurance contract or identification numberSMB-001 TO 005
Number of Individuals Covered590
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 $40,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 )
Policy contract number01332315
Policy instance 11
Insurance contract or identification number01332315
Number of Individuals Covered26
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $473
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $30,541
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $192
Insurance broker organization code?3
Insurance broker nameHANZEL & HILL, INC.
HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 )
Policy contract number01228604
Policy instance 12
Insurance contract or identification number01228604
Number of Individuals Covered28
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $1,886
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $43,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,279
Insurance broker organization code?3
Insurance broker nameARMS INSURANCE GROUP, INC.
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberSMB-001 TO 005
Policy instance 10
Insurance contract or identification numberSMB-001 TO 005
Number of Individuals Covered997
Insurance policy start date2013-06-01
Insurance policy end date2014-05-30
Total amount of commissions paid to insurance brokerUSD $0
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 $43,358
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: 26921 )
Policy contract number260087,88,89
Policy instance 9
Insurance contract or identification number260087,88,89
Number of Individuals Covered1835
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $40,298
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $40,298
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number1068456
Policy instance 8
Insurance contract or identification number1068456
Number of Individuals Covered13587
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $798,328
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
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $33,015,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $207,775
Insurance broker organization code?3
Insurance broker nameBROOKVILLE INSURANCE AGENCY, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414661
Policy instance 7
Insurance contract or identification number00414661
Number of Individuals Covered49
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $2,421
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
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,374
Insurance broker organization code?3
Insurance broker nameLIFETIME FINANCIAL GROWTH, LLC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFHM908799
Policy instance 6
Insurance contract or identification numberFHM908799
Number of Individuals Covered446
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $56,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number510
Policy instance 4
Insurance contract or identification number510
Number of Individuals Covered97
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $433
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $433
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number259168 + SUBS
Policy instance 3
Insurance contract or identification number259168 + SUBS
Number of Individuals Covered778
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 )
Policy contract number00506002
Policy instance 2
Insurance contract or identification number00506002
Number of Individuals Covered163
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number0176244
Policy instance 1
Insurance contract or identification number0176244
Number of Individuals Covered211
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $3,126
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 $40,921
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,126
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 )
Policy contract number1068456
Policy instance 5
Insurance contract or identification number1068456
Number of Individuals Covered27
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 $257,656
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFHM908799
Policy instance 8
Insurance contract or identification numberFHM908799
Number of Individuals Covered481
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $58,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number0176244
Policy instance 1
Insurance contract or identification number0176244
Number of Individuals Covered221
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $3,064
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 $40,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,064
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 )
Policy contract number00506002
Policy instance 2
Insurance contract or identification number00506002
Number of Individuals Covered257
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number510
Policy instance 4
Insurance contract or identification number510
Number of Individuals Covered86
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $423
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $423
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number259168 + SUBS
Policy instance 3
Insurance contract or identification number259168 + SUBS
Number of Individuals Covered788
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 )
Policy contract number1068456
Policy instance 5
Insurance contract or identification number1068456
Number of Individuals Covered34
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 $472,676
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 number1068456
Policy instance 6
Insurance contract or identification number1068456
Number of Individuals Covered1345
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $911,582
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
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $39,978,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $235,330
Insurance broker organization code?3
Insurance broker nameFRINGE BENEFIT SERVICES, INC.
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number00414661
Policy instance 7
Insurance contract or identification number00414661
Number of Individuals Covered60
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $2,253
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
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,209
Insurance broker organization code?3
Insurance broker nameLIFETIME FINANCIAL GROWTH, LLC
UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number260087,88,89
Policy instance 9
Insurance contract or identification number260087,88,89
Number of Individuals Covered2009
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $46,218
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $46,218
Insurance broker organization code?3
Insurance broker nameSMC INSURANCE AGENCY, INC.
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberSMB-001 TO 005
Policy instance 10
Insurance contract or identification numberSMB-001 TO 005
Number of Individuals Covered1094
Insurance policy start date2012-06-01
Insurance policy end date2013-05-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,990
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 $44,221
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 fees1990
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameHM LIFE INSURANCE COMPANY
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01068456
Policy instance 5
Insurance contract or identification number01068456
Number of Individuals Covered1207
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 $62,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number510
Policy instance 4
Insurance contract or identification number510
Number of Individuals Covered77
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $372
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberSMB-001 TO 005
Policy instance 13
Insurance contract or identification numberSMB-001 TO 005
Number of Individuals Covered1030
Insurance policy start date2011-06-01
Insurance policy end date2012-05-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $2,050
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 $45,554
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: 26921 )
Policy contract number260087, 88,89
Policy instance 3
Insurance contract or identification number260087, 88,89
Number of Individuals Covered2393
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $54,127
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract numberACCT 0176244
Policy instance 1
Insurance contract or identification numberACCT 0176244
Number of Individuals Covered227
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $3,210
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 $40,047
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 number01068456
Policy instance 6
Insurance contract or identification number01068456
Number of Individuals Covered1400
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Welfare Benefit Premiums Paid to CarrierUSD $1,441,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 )
Policy contract number01068456
Policy instance 7
Insurance contract or identification number01068456
Number of Individuals Covered67
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Welfare Benefit Premiums Paid to CarrierUSD $678,228
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 number01068456
Policy instance 8
Insurance contract or identification number01068456
Number of Individuals Covered0
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Other welfare benefits providedBLUE RX
Welfare Benefit Premiums Paid to CarrierUSD $11,355
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 number01068456
Policy instance 9
Insurance contract or identification number01068456
Number of Individuals Covered1579
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Other welfare benefits providedMEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $9,329,986
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract numberGP11/GP497
Policy instance 10
Insurance contract or identification numberGP11/GP497
Number of Individuals Covered65
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $2,766
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
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFHM908799
Policy instance 11
Insurance contract or identification numberFHM908799
Number of Individuals Covered1994
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Other welfare benefits providedADD DEPSP LIFSUP STD LIFE ADDSUP
Welfare Benefit Premiums Paid to CarrierUSD $64,993
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: 26921 )
Policy contract number0058485
Policy instance 12
Insurance contract or identification number0058485
Number of Individuals Covered845
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 )
Policy contract number00506002
Policy instance 2
Insurance contract or identification number00506002
Number of Individuals Covered601
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFHM908799
Policy instance 11
Insurance contract or identification numberFHM908799
Number of Individuals Covered845
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $1,093
Total amount of fees paid to insurance companyUSD $68
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedADD DEPSP LIFSUP STD LIFE ADDSUP
Welfare Benefit Premiums Paid to CarrierUSD $93,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number251239-ALL SUBS
Policy instance 1
Insurance contract or identification number251239-ALL SUBS
Number of Individuals Covered262
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $3,410
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 $45,524
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 )
Policy contract number00506002
Policy instance 2
Insurance contract or identification number00506002
Number of Individuals Covered771
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
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: 26921 )
Policy contract number260087, 88,89
Policy instance 3
Insurance contract or identification number260087, 88,89
Number of Individuals Covered2408
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $63,366
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number510
Policy instance 4
Insurance contract or identification number510
Number of Individuals Covered73
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $338
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
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 number01068456
Policy instance 5
Insurance contract or identification number01068456
Number of Individuals Covered1315
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
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 $65,682
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 number01068456
Policy instance 6
Insurance contract or identification number01068456
Number of Individuals Covered1618
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Welfare Benefit Premiums Paid to CarrierUSD $1,814,546
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 )
Policy contract number01068456
Policy instance 7
Insurance contract or identification number01068456
Number of Individuals Covered87
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Welfare Benefit Premiums Paid to CarrierUSD $981,666
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 number01068456
Policy instance 8
Insurance contract or identification number01068456
Number of Individuals Covered17
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Other welfare benefits providedBLUE RX
Welfare Benefit Premiums Paid to CarrierUSD $22,508
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 number01068456
Policy instance 9
Insurance contract or identification number01068456
Number of Individuals Covered1859
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
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
Other welfare benefits providedMEDICAL
Welfare Benefit Premiums Paid to CarrierUSD $10,977,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract numberGP11/GP497
Policy instance 10
Insurance contract or identification numberGP11/GP497
Number of Individuals Covered64
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $2,979
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
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,861
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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