COMMUNITY SYSTEMS, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan COMMUNITY SYSTEMS, INC HEALTH PLAN - VA
| Measure | Date | Value |
|---|
| 2022: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 174 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 209 |
| Number of retired or separated participants receiving benefits | 2022-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2022-01-01 | 0 |
| Total of all active and inactive participants | 2022-01-01 | 209 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 194 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 174 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 24 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 198 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 181 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 173 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 10 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 183 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 141 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 153 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 6 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 159 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 131 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 130 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 16 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 146 |
| 2017: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 119 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 127 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 20 |
| 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 | 147 |
| 2015: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-11-01 | 114 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-11-01 | 99 |
| Total of all active and inactive participants | 2015-11-01 | 99 |
| Total participants | 2015-11-01 | 99 |
| 2014: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-11-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-11-01 | 196 |
| Total of all active and inactive participants | 2014-11-01 | 196 |
| Total participants | 2014-11-01 | 196 |
| 2013: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-11-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-11-01 | 159 |
| Total of all active and inactive participants | 2013-11-01 | 159 |
| Total participants | 2013-11-01 | 159 |
| 2012: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-11-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-11-01 | 136 |
| Number of retired or separated participants receiving benefits | 2012-11-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-11-01 | 0 |
| Total of all active and inactive participants | 2012-11-01 | 136 |
| 2011: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-11-01 | 153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-11-01 | 139 |
| Number of retired or separated participants receiving benefits | 2011-11-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2011-11-01 | 0 |
| Total of all active and inactive participants | 2011-11-01 | 142 |
| 2010: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-11-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-11-01 | 153 |
| Total of all active and inactive participants | 2010-11-01 | 153 |
| Total participants | 2010-11-01 | 153 |
| 2009: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-11-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-11-01 | 155 |
| Total of all active and inactive participants | 2009-11-01 | 155 |
| Total participants | 2009-11-01 | 155 |
| 2008: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-11-01 | 135 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-11-01 | 150 |
| Total of all active and inactive participants | 2008-11-01 | 150 |
| Total participants | 2008-11-01 | 150 |
| 2007: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-11-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-11-01 | 135 |
| Total of all active and inactive participants | 2007-11-01 | 135 |
| Total participants | 2007-11-01 | 135 |
| 2006: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-11-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-11-01 | 132 |
| Total of all active and inactive participants | 2006-11-01 | 132 |
| Total participants | 2006-11-01 | 132 |
| 2005: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-11-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-11-01 | 117 |
| Total of all active and inactive participants | 2005-11-01 | 117 |
| Total participants | 2005-11-01 | 117 |
| 2022: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 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 – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | First time form 5500 has been submitted | Yes |
| 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 – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2015 form 5500 responses |
|---|
| 2015-11-01 | Type of plan entity | Single employer plan |
| 2015-11-01 | Submission has been amended | No |
| 2015-11-01 | This submission is the final filing | No |
| 2015-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-11-01 | Plan is a collectively bargained plan | No |
| 2015-11-01 | Plan funding arrangement – Insurance | Yes |
| 2015-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2014 form 5500 responses |
|---|
| 2014-11-01 | Type of plan entity | Single employer plan |
| 2014-11-01 | Submission has been amended | No |
| 2014-11-01 | This submission is the final filing | No |
| 2014-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-11-01 | Plan is a collectively bargained plan | No |
| 2014-11-01 | Plan funding arrangement – Insurance | Yes |
| 2014-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2013 form 5500 responses |
|---|
| 2013-11-01 | Type of plan entity | Single employer plan |
| 2013-11-01 | Submission has been amended | No |
| 2013-11-01 | This submission is the final filing | No |
| 2013-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-11-01 | Plan is a collectively bargained plan | No |
| 2013-11-01 | Plan funding arrangement – Insurance | Yes |
| 2013-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2012 form 5500 responses |
|---|
| 2012-11-01 | Type of plan entity | Single employer plan |
| 2012-11-01 | Submission has been amended | No |
| 2012-11-01 | This submission is the final filing | No |
| 2012-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-11-01 | Plan is a collectively bargained plan | No |
| 2012-11-01 | Plan funding arrangement – Insurance | Yes |
| 2012-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2011 form 5500 responses |
|---|
| 2011-11-01 | Type of plan entity | Single employer plan |
| 2011-11-01 | Submission has been amended | No |
| 2011-11-01 | This submission is the final filing | No |
| 2011-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-11-01 | Plan is a collectively bargained plan | No |
| 2011-11-01 | Plan funding arrangement – Insurance | Yes |
| 2011-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2010: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2010 form 5500 responses |
|---|
| 2010-11-01 | Type of plan entity | Single employer plan |
| 2010-11-01 | Submission has been amended | No |
| 2010-11-01 | This submission is the final filing | No |
| 2010-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-11-01 | Plan is a collectively bargained plan | No |
| 2010-11-01 | Plan funding arrangement – Insurance | Yes |
| 2010-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2009 form 5500 responses |
|---|
| 2009-11-01 | Type of plan entity | Single employer plan |
| 2009-11-01 | Submission has been amended | No |
| 2009-11-01 | This submission is the final filing | No |
| 2009-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-11-01 | Plan is a collectively bargained plan | No |
| 2009-11-01 | Plan funding arrangement – Insurance | Yes |
| 2009-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2008: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2008 form 5500 responses |
|---|
| 2008-11-01 | Type of plan entity | Single employer plan |
| 2008-11-01 | Submission has been amended | No |
| 2008-11-01 | This submission is the final filing | No |
| 2008-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-11-01 | Plan is a collectively bargained plan | No |
| 2008-11-01 | Plan funding arrangement – Insurance | Yes |
| 2008-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2007 form 5500 responses |
|---|
| 2007-11-01 | Type of plan entity | Single employer plan |
| 2007-11-01 | Submission has been amended | No |
| 2007-11-01 | This submission is the final filing | No |
| 2007-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-11-01 | Plan is a collectively bargained plan | No |
| 2007-11-01 | Plan funding arrangement – Insurance | Yes |
| 2007-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2006 form 5500 responses |
|---|
| 2006-11-01 | Type of plan entity | Single employer plan |
| 2006-11-01 | Submission has been amended | No |
| 2006-11-01 | This submission is the final filing | No |
| 2006-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-11-01 | Plan is a collectively bargained plan | No |
| 2006-11-01 | Plan funding arrangement – Insurance | Yes |
| 2006-11-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: COMMUNITY SYSTEMS, INC HEALTH PLAN - VA 2005 form 5500 responses |
|---|
| 2005-11-01 | Type of plan entity | Single employer plan |
| 2005-11-01 | First time form 5500 has been submitted | Yes |
| 2005-11-01 | Submission has been amended | No |
| 2005-11-01 | This submission is the final filing | No |
| 2005-11-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-11-01 | Plan is a collectively bargained plan | No |
| 2005-11-01 | Plan funding arrangement – Insurance | Yes |
| 2005-11-01 | Plan benefit arrangement – Insurance | Yes |
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 185 | | Insurance policy start date | 2015-11-01 | | Insurance policy end date | 2016-10-31 | | Total amount of commissions paid to insurance broker | USD $46,440 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $791,808 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $46,440 | | Insurance broker name | THE FERMAN GROUP LLC |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2014-11-02 | | Insurance policy end date | 2015-10-31 | | Total amount of commissions paid to insurance broker | USD $63,447 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $904,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,070 | | Insurance broker name | GROUP BENEFIT SERVICES INC |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $59,563 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $884,608 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $26,645 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP BENEFIT SERVICES, INC (GBS) |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $44,850 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $688,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,900 | | Insurance broker organization code? | 3 | | Insurance broker name | GROUP BENEFIT SERVICES, INC. |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $7,809 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $794,177 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 153 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $734,090 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2008-11-01 | | Insurance policy end date | 2009-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $622,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2007-11-01 | | Insurance policy end date | 2008-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $552,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2006-11-01 | | Insurance policy end date | 2007-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $461,036 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 1985 |
| Policy instance | 1 |
| Insurance contract or identification number | 1985 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2005-11-01 | | Insurance policy end date | 2006-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $332,605 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
