PIETRAGALLO, GORDON, ALFANO, BOSICK & RASPANTI has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM
401k plan membership statisitcs for PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM
| Measure | Date | Value |
|---|
| 2022: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 122 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 120 |
| Total of all active and inactive participants | 2022-01-01 | 120 |
| 2021: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 122 |
| Total of all active and inactive participants | 2021-01-01 | 122 |
| 2020: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 116 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 125 |
| Total of all active and inactive participants | 2020-01-01 | 125 |
| 2019: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 116 |
| Total of all active and inactive participants | 2019-01-01 | 116 |
| 2018: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 164 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 125 |
| Total of all active and inactive participants | 2018-01-01 | 125 |
| 2017: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 164 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 164 |
| 2016: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 172 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 188 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 188 |
| 2015: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 125 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 172 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 172 |
| 2014: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 130 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 125 |
| Total of all active and inactive participants | 2014-01-01 | 125 |
| 2013: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 145 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 130 |
| Total of all active and inactive participants | 2013-01-01 | 130 |
| 2012: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 145 |
| Total of all active and inactive participants | 2012-01-01 | 145 |
| 2011: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 148 |
| Total of all active and inactive participants | 2011-01-01 | 148 |
| 2010: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 155 |
| Total of all active and inactive participants | 2010-01-01 | 155 |
| 2009: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 153 |
| Total of all active and inactive participants | 2009-01-01 | 153 |
| Total participants | 2009-01-01 | 0 |
| 2022: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | Yes |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | No |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | No |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | No |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: PIETRAGALLO GORDON ALFANO BOSICK & RASPANTI SECTION 125 CAFETERIA PLAN AND PREMIUM CONVERSION PROGRAM 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 0001228981 |
| Policy instance | 1 |
| Insurance contract or identification number | 0001228981 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $121,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1098016 |
| Policy instance | 3 |
| Insurance contract or identification number | 1098016 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $2,124 | | Total amount of fees paid to insurance company | USD $750 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,478 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,093 | | Amount paid for insurance broker fees | 750 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 2 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $3,499 | | Total amount of fees paid to insurance company | USD $1,091 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,458 | | Amount paid for insurance broker fees | 620 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 19201-VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | 19201-VARIOUS | | Number of Individuals Covered | 66 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $12,831 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPO PRODUCT | | Welfare Benefit Premiums Paid to Carrier | USD $474,134 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,831 | | Insurance broker organization code? | 3 |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 128981 |
| Policy instance | 5 |
| Insurance contract or identification number | 128981 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-09-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $89,781 | | 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 number | 048303 |
| Policy instance | 6 |
| Insurance contract or identification number | 048303 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $420 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $420 | | Insurance broker organization code? | 3 |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 7 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 96 | | Insurance policy start date | 2021-09-01 | | Insurance policy end date | 2022-08-31 | | Total amount of commissions paid to insurance broker | USD $19,297 | | Total amount of fees paid to insurance company | USD $4,604 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,397 | | Amount paid for insurance broker fees | 2116 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 128981 |
| Policy instance | 5 |
| Insurance contract or identification number | 128981 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-09-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $107,271 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 048303 |
| Policy instance | 6 |
| Insurance contract or identification number | 048303 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 7 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $15,078 | | Total amount of fees paid to insurance company | USD $3,598 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,561 | | Amount paid for insurance broker fees | 1653 | | Additional information about fees paid to insurance broker | OTHER | | Insurance broker organization code? | 3 |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 2 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $3,033 | | Total amount of fees paid to insurance company | USD $948 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,264 | | Amount paid for insurance broker fees | 538 | | Additional information about fees paid to insurance broker | OTHER | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 0001228981 |
| Policy instance | 1 |
| Insurance contract or identification number | 0001228981 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-09-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1098016 |
| Policy instance | 3 |
| Insurance contract or identification number | 1098016 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $4,108 | | Total amount of fees paid to insurance company | USD $374 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,175 | | Commission paid to Insurance Broker | USD $1,103 | | Amount paid for insurance broker fees | 374 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 19201-VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | 19201-VARIOUS | | Number of Individuals Covered | 68 | | Insurance policy start date | 2020-09-01 | | Insurance policy end date | 2021-08-31 | | Total amount of commissions paid to insurance broker | USD $12,642 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPO PRODUCT | | Welfare Benefit Premiums Paid to Carrier | USD $403,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,642 | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 0001228981 |
| Policy instance | 1 |
| Insurance contract or identification number | 0001228981 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 2 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $3,197 | | Total amount of fees paid to insurance company | USD $999 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,332 | | Amount paid for insurance broker fees | 566 | | Additional information about fees paid to insurance broker | OTHER | | Insurance broker organization code? | 3 |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1098016 |
| Policy instance | 3 |
| Insurance contract or identification number | 1098016 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $4,859 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,120 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 19201-VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | 19201-VARIOUS | | Number of Individuals Covered | 67 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $12,600 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPO PRODUCT | | Welfare Benefit Premiums Paid to Carrier | USD $456,486 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,600 | | Insurance broker organization code? | 3 |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 128981 |
| Policy instance | 5 |
| Insurance contract or identification number | 128981 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-09-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $102,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 7 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $16,709 | | Total amount of fees paid to insurance company | USD $3,987 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,271 | | Amount paid for insurance broker fees | 1832 | | Additional information about fees paid to insurance broker | OTHER | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 048303 |
| Policy instance | 6 |
| Insurance contract or identification number | 048303 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2019-09-01 | | Insurance policy end date | 2020-08-31 | | Total amount of commissions paid to insurance broker | USD $399 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $399 | | Insurance broker organization code? | 3 |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 8 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $13,271 | | Total amount of fees paid to insurance company | USD $3,167 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,775 | | Amount paid for insurance broker fees | 1455 | | Additional information about fees paid to insurance broker | OTHER | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 048303 |
| Policy instance | 7 |
| Insurance contract or identification number | 048303 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $55 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05919955 |
| Policy instance | 6 |
| Insurance contract or identification number | TM05919955 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $288 | | Total amount of fees paid to insurance company | USD $54 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $108 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 54 | | Additional information about fees paid to insurance broker | SUPPLEMENTAL COMPENSATION |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 128981 |
| Policy instance | 5 |
| Insurance contract or identification number | 128981 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $101,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 ) |
| Policy contract number | 1098016 |
| Policy instance | 3 |
| Insurance contract or identification number | 1098016 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $3,580 | | Total amount of fees paid to insurance company | USD $1,349 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $34,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,390 | | Amount paid for insurance broker fees | 1349 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 2 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $2,878 | | Total amount of fees paid to insurance company | USD $873 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,199 | | Amount paid for insurance broker fees | 485 | | Additional information about fees paid to insurance broker | OTHER | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 0001228981 |
| Policy instance | 1 |
| Insurance contract or identification number | 0001228981 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-09-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,730 | | 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 number | 19201-VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | 19201-VARIOUS | | Number of Individuals Covered | 73 | | Insurance policy start date | 2018-09-01 | | Insurance policy end date | 2019-08-31 | | Total amount of commissions paid to insurance broker | USD $19,273 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPO PRODUCT | | Welfare Benefit Premiums Paid to Carrier | USD $480,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $19,273 | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 155183 |
| Policy instance | 3 |
| Insurance contract or identification number | 155183 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $1,042 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $521 | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 0001228981 |
| Policy instance | 1 |
| Insurance contract or identification number | 0001228981 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-09-01 | | Total amount of commissions paid to insurance broker | USD $3,726 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $66,325 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,726 | | Insurance broker organization code? | 3 |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 2 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $12,999 | | Total amount of fees paid to insurance company | USD $3,080 | | Long Term Disability Insurance Welfare Benefit | Yes | | Commission paid to Insurance Broker | USD $5,489 | | Amount paid for insurance broker fees | 1347 | | Additional information about fees paid to insurance broker | OTHER | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 19201-VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | 19201-VARIOUS | | Number of Individuals Covered | 80 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $17,898 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPO PRODUCT | | Welfare Benefit Premiums Paid to Carrier | USD $472,660 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,898 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05919955 |
| Policy instance | 6 |
| Insurance contract or identification number | TM05919955 | | Number of Individuals Covered | 125 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $4,434 | | Total amount of fees paid to insurance company | USD $522 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $45,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,359 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 522 | | Additional information about fees paid to insurance broker | NON-MONETARY AND SUPPLEMENTAL COMEPENSATION |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 128981 |
| Policy instance | 5 |
| Insurance contract or identification number | 128981 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-09-01 | | Total amount of commissions paid to insurance broker | USD $6,256 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $87,569 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,256 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 05539992 |
| Policy instance | 7 |
| Insurance contract or identification number | 05539992 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 8 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2017-09-01 | | Insurance policy end date | 2018-08-31 | | Total amount of commissions paid to insurance broker | USD $2,570 | | Total amount of fees paid to insurance company | USD $633 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,071 | | Amount paid for insurance broker fees | 279 | | Additional information about fees paid to insurance broker | OTHER | | Insurance broker organization code? | 3 |
|
| STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 155183 |
| Policy instance | 3 |
| Insurance contract or identification number | 155183 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $2,180 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,090 | | Insurance broker organization code? | 3 | | Insurance broker name | IAN GORDON |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 19201-VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | 19201-VARIOUS | | Number of Individuals Covered | 89 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $24,051 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EPO PRODUCT | | Welfare Benefit Premiums Paid to Carrier | USD $591,842 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,051 | | Insurance broker organization code? | 3 | | Insurance broker name | LIBERTY INSURANCE SERVICES |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 128981 |
| Policy instance | 5 |
| Insurance contract or identification number | 128981 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-09-01 | | Total amount of commissions paid to insurance broker | USD $6,440 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $93,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,440 | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID DBA CBDI |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 05539992 |
| Policy instance | 7 |
| Insurance contract or identification number | 05539992 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05919955 |
| Policy instance | 6 |
| Insurance contract or identification number | TM05919955 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $2,649 | | Total amount of fees paid to insurance company | USD $102 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,649 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 60 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker name | WILLIS OF PENNSYLVANIA, INC |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 0001228981 |
| Policy instance | 1 |
| Insurance contract or identification number | 0001228981 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-09-01 | | Total amount of commissions paid to insurance broker | USD $4,416 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,161 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,416 | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON REID DBA CBDI |
|
| NORTHWESTERN MUTUAL (National Association of Insurance Commissioners NAIC id number: 67091 ) |
| Policy contract number | 664495 |
| Policy instance | 2 |
| Insurance contract or identification number | 664495 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2016-09-01 | | Insurance policy end date | 2017-08-31 | | Total amount of commissions paid to insurance broker | USD $14,896 | | Total amount of fees paid to insurance company | USD $3,212 | | Long Term Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,230 | | Amount paid for insurance broker fees | 1439 | | Additional information about fees paid to insurance broker | OTHER COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | STRIANO FNCL GROUP, LLC |
|
