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CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 401k Plan overview

Plan NameCONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN
Plan identification number 501

CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

CONSUMER SUPPORT SERVICES, INC. has sponsored the creation of one or more 401k plans.

Company Name:CONSUMER SUPPORT SERVICES, INC.
Employer identification number (EIN):311378304
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about CONSUMER SUPPORT SERVICES, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1993-05-03
Company Identification Number: 844404
Legal Registered Office Address: 2040 CHEERY VALLEY RD
-
NEWARK
United States of America (USA)
43055

More information about CONSUMER SUPPORT SERVICES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01LISA MOORE RANDALL C NIPPS2018-07-26
5012016-01-01LISA MOORE RANDALL C NIPPS2017-07-12
5012015-01-01LISA MOORE RANDALL C NIPPS2016-08-31
5012014-01-01LISA MOORE RANDALL C NIPPS2015-06-29
5012013-01-01LISA MOORE RANDALL C NIPPS2015-01-21
5012012-01-01LISA MOORE RANDALL C NIPPS2013-07-29
5012011-01-01LISA MOORE RANDALL C NIPPS2012-08-03
5012010-01-01LISA MOORE RANDALL C NIPPS2011-07-26

Plan Statistics for CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN

401k plan membership statisitcs for CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN

Measure Date Value
2022: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01400
Total number of active participants reported on line 7a of the Form 55002022-01-01377
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01377
2021: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01448
Total number of active participants reported on line 7a of the Form 55002021-01-01400
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01400
2020: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01480
Total number of active participants reported on line 7a of the Form 55002020-01-01448
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01448
2019: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01531
Total number of active participants reported on line 7a of the Form 55002019-01-01480
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01480
2018: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01476
Total number of active participants reported on line 7a of the Form 55002018-01-01531
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01531
2017: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-010
Total number of active participants reported on line 7a of the Form 55002017-01-01476
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01476
2016: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01288
Total number of active participants reported on line 7a of the Form 55002016-01-01411
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01411
2015: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01260
Total number of active participants reported on line 7a of the Form 55002015-01-01288
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01288
2014: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01215
Total number of active participants reported on line 7a of the Form 55002014-01-01260
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01260
2013: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01116
Total number of active participants reported on line 7a of the Form 55002013-01-01215
Total of all active and inactive participants2013-01-01215
2012: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01116
Total number of active participants reported on line 7a of the Form 55002012-01-01116
Total of all active and inactive participants2012-01-01116
2011: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01342
Total number of active participants reported on line 7a of the Form 55002011-01-01116
Total of all active and inactive participants2011-01-01116
2010: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-01333
Total number of active participants reported on line 7a of the Form 55002010-01-01342
Total of all active and inactive participants2010-01-01342

Form 5500 Responses for CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN

2022: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: CONSUMER SUPPORT SERVICES, INC. EE BENEFIT PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number953614
Policy instance 6
Insurance contract or identification number953614
Number of Individuals Covered153
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Welfare Benefit Premiums Paid to CarrierUSD $315,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number217-00-00-47-00
Policy instance 5
Insurance contract or identification number217-00-00-47-00
Number of Individuals Covered144
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Welfare Benefit Premiums Paid to CarrierUSD $304,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number07X2784
Policy instance 4
Insurance contract or identification number07X2784
Number of Individuals Covered10
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $5,402
Welfare Benefit Premiums Paid to CarrierUSD $320,175
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,380
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberM0001274
Policy instance 3
Insurance contract or identification numberM0001274
Number of Individuals Covered28
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $10,229
Welfare Benefit Premiums Paid to CarrierUSD $3,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,999
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9570
Policy instance 2
Insurance contract or identification number9570
Number of Individuals Covered194
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $52,846
Welfare Benefit Premiums Paid to CarrierUSD $352,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $52,846
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number16049
Policy instance 1
Insurance contract or identification number16049
Number of Individuals Covered377
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $135,269
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $85,737
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?5
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number16049
Policy instance 1
Insurance contract or identification number16049
Number of Individuals Covered144
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $132,813
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $82,693
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?5
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9570
Policy instance 2
Insurance contract or identification number9570
Number of Individuals Covered203
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $61,934
Welfare Benefit Premiums Paid to CarrierUSD $412,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,934
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberM0001274
Policy instance 3
Insurance contract or identification numberM0001274
Number of Individuals Covered37
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $15,165
Welfare Benefit Premiums Paid to CarrierUSD $42,165
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,259
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number07X2784
Policy instance 4
Insurance contract or identification number07X2784
Number of Individuals Covered16
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $7,400
Welfare Benefit Premiums Paid to CarrierUSD $389,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,000
Insurance broker organization code?3
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number217-00-00-47-00
Policy instance 5
Insurance contract or identification number217-00-00-47-00
Number of Individuals Covered144
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Welfare Benefit Premiums Paid to CarrierUSD $594,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number241332
Policy instance 6
Insurance contract or identification number241332
Number of Individuals Covered159
Insurance policy start date2020-01-01
Insurance policy end date2020-06-30
Welfare Benefit Premiums Paid to CarrierUSD $446,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ATLANTIC SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 27154 )
Policy contract number217-00-00-47-00
Policy instance 5
Insurance contract or identification number217-00-00-47-00
Number of Individuals Covered152
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Welfare Benefit Premiums Paid to CarrierUSD $292,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number07X2784
Policy instance 4
Insurance contract or identification number07X2784
Number of Individuals Covered17
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $7,215
Welfare Benefit Premiums Paid to CarrierUSD $311,761
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,850
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberM0001274
Policy instance 3
Insurance contract or identification numberM0001274
Number of Individuals Covered50
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,859
Welfare Benefit Premiums Paid to CarrierUSD $28,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,859
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9570
Policy instance 2
Insurance contract or identification number9570
Number of Individuals Covered239
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $62,650
Welfare Benefit Premiums Paid to CarrierUSD $417,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $62,650
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number16049
Policy instance 1
Insurance contract or identification number16049
Number of Individuals Covered152
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $131,807
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $79,615
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?5
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number07X2784
Policy instance 4
Insurance contract or identification number07X2784
Number of Individuals Covered16
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $8,103
Welfare Benefit Premiums Paid to CarrierUSD $304,495
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $6,598
Insurance broker organization code?3
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberM0001274
Policy instance 3
Insurance contract or identification numberM0001274
Number of Individuals Covered90
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Welfare Benefit Premiums Paid to CarrierUSD $7,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9570
Policy instance 2
Insurance contract or identification number9570
Number of Individuals Covered209
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $53,791
Welfare Benefit Premiums Paid to CarrierUSD $358,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $53,791
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract number16049
Policy instance 1
Insurance contract or identification number16049
Number of Individuals Covered165
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $136,014
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $229,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $80,770
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?5
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number10313
Policy instance 1
Insurance contract or identification number10313
Number of Individuals Covered165
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $89,507
Welfare Benefit Premiums Paid to CarrierUSD $543,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $61,727
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?5
Insurance broker nameSTAEBLER GROUP
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9570
Policy instance 2
Insurance contract or identification number9570
Number of Individuals Covered164
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $56,278
Welfare Benefit Premiums Paid to CarrierUSD $375,189
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,278
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameINTEGRATED EMPLOYEE BENEFITS SOLUTI
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberM0001274
Policy instance 3
Insurance contract or identification numberM0001274
Number of Individuals Covered126
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $35,398
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,857
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameRGI, LLC
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number07X2784
Policy instance 4
Insurance contract or identification number07X2784
Number of Individuals Covered19
Insurance policy start date2017-10-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,758
Welfare Benefit Premiums Paid to CarrierUSD $83,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,324
Insurance broker organization code?3
Insurance broker nameROGERS BENEFIT GROUP
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number64123
Policy instance 5
Insurance contract or identification number64123
Number of Individuals Covered21
Insurance policy start date2017-01-01
Insurance policy end date2017-09-30
Total amount of commissions paid to insurance brokerUSD $8,296
Welfare Benefit Premiums Paid to CarrierUSD $241,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,612
Insurance broker organization code?3
Insurance broker nameROGERS BENEFIT GROUP
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9570
Policy instance 3
Insurance contract or identification number9570
Number of Individuals Covered165
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $39,565
Welfare Benefit Premiums Paid to CarrierUSD $263,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $39,565
Insurance broker organization code?3
Insurance broker nameINTEGRATED EMPLOYEE BENEFITS SOLUTI
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number10313
Policy instance 2
Insurance contract or identification number10313
Number of Individuals Covered123
Insurance policy start date2015-07-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $27,305
Welfare Benefit Premiums Paid to CarrierUSD $154,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $9,102
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?5
Insurance broker nameSTAEBLER GROUP
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10313
Policy instance 1
Insurance contract or identification number10313
Number of Individuals Covered123
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $38,835
Welfare Benefit Premiums Paid to CarrierUSD $132,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,534
Insurance broker organization code?3
Insurance broker nameMEDICAL BENEFITS ADMINISTRATORS
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10313
Policy instance 1
Insurance contract or identification number10313
Number of Individuals Covered122
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $42,909
Welfare Benefit Premiums Paid to CarrierUSD $243,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,606
Insurance broker organization code?3
Insurance broker nameMEDICAL BENEFITS ADMINISTRATORS
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number9570
Policy instance 2
Insurance contract or identification number9570
Number of Individuals Covered138
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $35,310
Welfare Benefit Premiums Paid to CarrierUSD $235,399
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,310
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameINTEGRATED EMPLOYEE BENEFIT SOLUTIO
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number97975
Policy instance 2
Insurance contract or identification number97975
Number of Individuals Covered100
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $32,853
Welfare Benefit Premiums Paid to CarrierUSD $219,021
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $32,853
Additional information about fees paid to insurance brokerCOMMISSIONS
Insurance broker organization code?3
Insurance broker nameINTEGRATED EMPLOYEE BENEFIT SOLUTIO
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10313
Policy instance 1
Insurance contract or identification number10313
Number of Individuals Covered115
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $30,541
Welfare Benefit Premiums Paid to CarrierUSD $173,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,361
Insurance broker nameMEDICAL BENEFITS ADMINISTRATORS
HCC LIFE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number10313
Policy instance 1
Insurance contract or identification number10313
Number of Individuals Covered116
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $23,760
Welfare Benefit Premiums Paid to CarrierUSD $134,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,920
Insurance broker nameMEDICAL BENEFITS ADMINISTRATORS

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