P AND R ENTERPRISES, INC. has sponsored the creation of one or more 401k plans.
Additional information about P AND R ENTERPRISES, INC.
Submission information for form 5500 for 401k plan P AND R ENTERPRISES, INC. MEDICAL PLAN
401k plan membership statisitcs for P AND R ENTERPRISES, INC. MEDICAL PLAN
| Measure | Date | Value |
|---|
| 2020: P AND R ENTERPRISES, INC. MEDICAL PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-10-01 | 123 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-10-01 | 99 |
| Number of retired or separated participants receiving benefits | 2020-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-10-01 | 0 |
| Total of all active and inactive participants | 2020-10-01 | 99 |
| Number of employers contributing to the scheme | 2020-10-01 | 0 |
| 2019: P AND R ENTERPRISES, INC. MEDICAL PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-10-01 | 134 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-10-01 | 123 |
| Number of retired or separated participants receiving benefits | 2019-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-10-01 | 0 |
| Total of all active and inactive participants | 2019-10-01 | 123 |
| Number of employers contributing to the scheme | 2019-10-01 | 0 |
| 2018: P AND R ENTERPRISES, INC. MEDICAL PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-10-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-10-01 | 134 |
| Number of retired or separated participants receiving benefits | 2018-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-10-01 | 0 |
| Total of all active and inactive participants | 2018-10-01 | 134 |
| Number of employers contributing to the scheme | 2018-10-01 | 0 |
| 2017: P AND R ENTERPRISES, INC. MEDICAL PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-10-01 | 160 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-10-01 | 160 |
| Number of retired or separated participants receiving benefits | 2017-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-10-01 | 0 |
| Total of all active and inactive participants | 2017-10-01 | 160 |
| Number of employers contributing to the scheme | 2017-10-01 | 0 |
| 2016: P AND R ENTERPRISES, INC. MEDICAL PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-10-01 | 163 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-10-01 | 160 |
| Number of retired or separated participants receiving benefits | 2016-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-10-01 | 0 |
| Total of all active and inactive participants | 2016-10-01 | 160 |
| 2015: P AND R ENTERPRISES, INC. MEDICAL PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-10-01 | 150 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-10-01 | 163 |
| Number of retired or separated participants receiving benefits | 2015-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-10-01 | 0 |
| Total of all active and inactive participants | 2015-10-01 | 163 |
| 2014: P AND R ENTERPRISES, INC. MEDICAL PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-10-01 | 152 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-10-01 | 150 |
| Number of retired or separated participants receiving benefits | 2014-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-10-01 | 0 |
| Total of all active and inactive participants | 2014-10-01 | 150 |
| 2013: P AND R ENTERPRISES, INC. MEDICAL PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-10-01 | 214 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-10-01 | 152 |
| Number of retired or separated participants receiving benefits | 2013-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-10-01 | 0 |
| Total of all active and inactive participants | 2013-10-01 | 152 |
| 2012: P AND R ENTERPRISES, INC. MEDICAL PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-10-01 | 158 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-10-01 | 214 |
| Number of retired or separated participants receiving benefits | 2012-10-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-10-01 | 0 |
| Total of all active and inactive participants | 2012-10-01 | 214 |
| Total participants, beginning-of-year | 2012-07-01 | 147 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 158 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-07-01 | 0 |
| Total of all active and inactive participants | 2012-07-01 | 158 |
| Total participants, beginning-of-year | 2012-01-01 | 217 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 72 |
| Total of all active and inactive participants | 2012-01-01 | 72 |
| 2011: P AND R ENTERPRISES, INC. MEDICAL PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 148 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 150 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 0 |
| Total of all active and inactive participants | 2011-07-01 | 150 |
| Total participants, beginning-of-year | 2011-01-01 | 239 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 217 |
| Total of all active and inactive participants | 2011-01-01 | 217 |
| 2010: P AND R ENTERPRISES, INC. MEDICAL PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 155 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 150 |
| Number of retired or separated participants receiving benefits | 2010-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-07-01 | 0 |
| Total of all active and inactive participants | 2010-07-01 | 150 |
| 2009: P AND R ENTERPRISES, INC. MEDICAL PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 153 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 151 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
| Total of all active and inactive participants | 2009-07-01 | 151 |
| Total participants, beginning-of-year | 2009-01-01 | 279 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 275 |
| Total of all active and inactive participants | 2009-01-01 | 275 |
| 2008: P AND R ENTERPRISES, INC. MEDICAL PLAN 2008 401k membership |
|---|
| Total participants, beginning-of-year | 2008-07-01 | 159 |
| Total number of active participants reported on line 7a of the Form 5500 | 2008-07-01 | 160 |
| Number of retired or separated participants receiving benefits | 2008-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2008-07-01 | 0 |
| Total of all active and inactive participants | 2008-07-01 | 160 |
| 2007: P AND R ENTERPRISES, INC. MEDICAL PLAN 2007 401k membership |
|---|
| Total participants, beginning-of-year | 2007-07-01 | 175 |
| Total number of active participants reported on line 7a of the Form 5500 | 2007-07-01 | 161 |
| Number of retired or separated participants receiving benefits | 2007-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2007-07-01 | 0 |
| Total of all active and inactive participants | 2007-07-01 | 161 |
| 2006: P AND R ENTERPRISES, INC. MEDICAL PLAN 2006 401k membership |
|---|
| Total participants, beginning-of-year | 2006-07-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2006-07-01 | 161 |
| Number of retired or separated participants receiving benefits | 2006-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2006-07-01 | 0 |
| Total of all active and inactive participants | 2006-07-01 | 161 |
| 2005: P AND R ENTERPRISES, INC. MEDICAL PLAN 2005 401k membership |
|---|
| Total participants, beginning-of-year | 2005-07-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2005-07-01 | 110 |
| Number of retired or separated participants receiving benefits | 2005-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2005-07-01 | 0 |
| Total of all active and inactive participants | 2005-07-01 | 110 |
| 2004: P AND R ENTERPRISES, INC. MEDICAL PLAN 2004 401k membership |
|---|
| Total participants, beginning-of-year | 2004-07-01 | 126 |
| Total number of active participants reported on line 7a of the Form 5500 | 2004-07-01 | 110 |
| Number of retired or separated participants receiving benefits | 2004-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2004-07-01 | 0 |
| Total of all active and inactive participants | 2004-07-01 | 110 |
| 2003: P AND R ENTERPRISES, INC. MEDICAL PLAN 2003 401k membership |
|---|
| Total participants, beginning-of-year | 2003-07-01 | 142 |
| Total number of active participants reported on line 7a of the Form 5500 | 2003-07-01 | 133 |
| Number of retired or separated participants receiving benefits | 2003-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2003-07-01 | 0 |
| Total of all active and inactive participants | 2003-07-01 | 133 |
| 2002: P AND R ENTERPRISES, INC. MEDICAL PLAN 2002 401k membership |
|---|
| Total participants, beginning-of-year | 2002-07-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2002-07-01 | 134 |
| Number of retired or separated participants receiving benefits | 2002-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2002-07-01 | 0 |
| Total of all active and inactive participants | 2002-07-01 | 134 |
| Measure | Date | Value |
|---|
| 2012 : P AND R ENTERPRISES, INC. MEDICAL PLAN 2012 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2012-12-31 | $0 |
| Total transfer of assets to this plan | 2012-12-31 | $375,186 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $66,145 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $90,256 |
| Total income from all sources (including contributions) | 2012-12-31 | $569,644 |
| Total loss/gain on sale of assets | 2012-12-31 | $0 |
| Total of all expenses incurred | 2012-12-31 | $862,437 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $642,623 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $569,184 |
| Value of total assets at end of year | 2012-12-31 | $359,978 |
| Value of total assets at beginning of year | 2012-12-31 | $301,696 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $219,814 |
| Total interest from all sources | 2012-12-31 | $460 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $7,388 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $50,000 |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $1,847 |
| Administrative expenses (other) incurred | 2012-12-31 | $115,007 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $7,145 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $40,256 |
| Total non interest bearing cash at end of year | 2012-12-31 | $318,660 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $130,928 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-292,793 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $293,833 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $211,440 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $126,000 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $126,000 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $460 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $100,422 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $567,337 |
| Employer contributions (assets) at end of year | 2012-12-31 | $41,318 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $44,768 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $542,201 |
| Contract administrator fees | 2012-12-31 | $97,419 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $59,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $50,000 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | INEICH & COMPANY, LLP |
| Accountancy firm EIN | 2012-12-31 | 562552172 |
| 2011 : P AND R ENTERPRISES, INC. MEDICAL PLAN 2011 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2011-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $90,256 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $75,586 |
| Total income from all sources (including contributions) | 2011-12-31 | $633,923 |
| Total loss/gain on sale of assets | 2011-12-31 | $0 |
| Total of all expenses incurred | 2011-12-31 | $998,925 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $735,971 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $630,798 |
| Value of total assets at end of year | 2011-12-31 | $301,696 |
| Value of total assets at beginning of year | 2011-12-31 | $652,028 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $262,954 |
| Total interest from all sources | 2011-12-31 | $3,125 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $6,963 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $300,000 |
| If this is an individual account plan, was there a blackout period | 2011-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $1,642 |
| Administrative expenses (other) incurred | 2011-12-31 | $150,162 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $40,256 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $35,586 |
| Total non interest bearing cash at end of year | 2011-12-31 | $130,928 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $30,195 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $-365,002 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $211,440 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $576,442 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $126,000 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $574,358 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $574,358 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $3,125 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $115,431 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $629,156 |
| Employer contributions (assets) at end of year | 2011-12-31 | $44,768 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $47,475 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $620,540 |
| Contract administrator fees | 2011-12-31 | $105,829 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $50,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $40,000 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | INEICH & COMPANY, LLP |
| Accountancy firm EIN | 2011-12-31 | 562552172 |
| 2010 : P AND R ENTERPRISES, INC. MEDICAL PLAN 2010 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $75,586 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $75,033 |
| Total income from all sources (including contributions) | 2010-12-31 | $769,770 |
| Total loss/gain on sale of assets | 2010-12-31 | $0 |
| Total of all expenses incurred | 2010-12-31 | $1,034,092 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $737,668 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $745,121 |
| Value of total assets at end of year | 2010-12-31 | $652,028 |
| Value of total assets at beginning of year | 2010-12-31 | $915,797 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $296,424 |
| Total interest from all sources | 2010-12-31 | $6,379 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Administrative expenses professional fees incurred | 2010-12-31 | $6,861 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $300,000 |
| If this is an individual account plan, was there a blackout period | 2010-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Other income not declared elsewhere | 2010-12-31 | $18,270 |
| Administrative expenses (other) incurred | 2010-12-31 | $163,450 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $35,586 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $45,033 |
| Total non interest bearing cash at end of year | 2010-12-31 | $30,195 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $23,133 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-264,322 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $576,442 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $840,764 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $574,358 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $833,565 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $833,565 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $6,379 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $140,929 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $745,121 |
| Employer contributions (assets) at end of year | 2010-12-31 | $47,475 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $59,099 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $596,739 |
| Contract administrator fees | 2010-12-31 | $126,113 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2010-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $40,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $30,000 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | INEICH & COMPANY, LLP |
| Accountancy firm EIN | 2010-12-31 | 562552172 |
| 2020: P AND R ENTERPRISES, INC. MEDICAL PLAN 2020 form 5500 responses |
|---|
| 2020-10-01 | Type of plan entity | Single employer plan |
| 2020-10-01 | Plan funding arrangement – Insurance | Yes |
| 2020-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2019: P AND R ENTERPRISES, INC. MEDICAL PLAN 2019 form 5500 responses |
|---|
| 2019-10-01 | Type of plan entity | Single employer plan |
| 2019-10-01 | Plan funding arrangement – Insurance | Yes |
| 2019-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2018: P AND R ENTERPRISES, INC. MEDICAL PLAN 2018 form 5500 responses |
|---|
| 2018-10-01 | Type of plan entity | Single employer plan |
| 2018-10-01 | Plan funding arrangement – Insurance | Yes |
| 2018-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: P AND R ENTERPRISES, INC. MEDICAL PLAN 2017 form 5500 responses |
|---|
| 2017-10-01 | Type of plan entity | Single employer plan |
| 2017-10-01 | Plan funding arrangement – Insurance | Yes |
| 2017-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: P AND R ENTERPRISES, INC. MEDICAL PLAN 2016 form 5500 responses |
|---|
| 2016-10-01 | Type of plan entity | Single employer plan |
| 2016-10-01 | Submission has been amended | No |
| 2016-10-01 | This submission is the final filing | No |
| 2016-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-10-01 | Plan is a collectively bargained plan | No |
| 2016-10-01 | Plan funding arrangement – Insurance | Yes |
| 2016-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: P AND R ENTERPRISES, INC. MEDICAL PLAN 2015 form 5500 responses |
|---|
| 2015-10-01 | Type of plan entity | Single employer plan |
| 2015-10-01 | Submission has been amended | No |
| 2015-10-01 | This submission is the final filing | No |
| 2015-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-10-01 | Plan is a collectively bargained plan | No |
| 2015-10-01 | Plan funding arrangement – Insurance | Yes |
| 2015-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: P AND R ENTERPRISES, INC. MEDICAL PLAN 2014 form 5500 responses |
|---|
| 2014-10-01 | Type of plan entity | Single employer plan |
| 2014-10-01 | Submission has been amended | No |
| 2014-10-01 | This submission is the final filing | No |
| 2014-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-10-01 | Plan is a collectively bargained plan | No |
| 2014-10-01 | Plan funding arrangement – Insurance | Yes |
| 2014-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: P AND R ENTERPRISES, INC. MEDICAL PLAN 2013 form 5500 responses |
|---|
| 2013-10-01 | Type of plan entity | Single employer plan |
| 2013-10-01 | Submission has been amended | No |
| 2013-10-01 | This submission is the final filing | No |
| 2013-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-10-01 | Plan is a collectively bargained plan | No |
| 2013-10-01 | Plan funding arrangement – Insurance | Yes |
| 2013-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: P AND R ENTERPRISES, INC. MEDICAL PLAN 2012 form 5500 responses |
|---|
| 2012-10-01 | Type of plan entity | Single employer plan |
| 2012-10-01 | Submission has been amended | No |
| 2012-10-01 | This submission is the final filing | No |
| 2012-10-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-10-01 | Plan is a collectively bargained plan | No |
| 2012-10-01 | Plan funding arrangement – Insurance | Yes |
| 2012-10-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 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 – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: P AND R ENTERPRISES, INC. MEDICAL PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 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 – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: P AND R ENTERPRISES, INC. MEDICAL PLAN 2010 form 5500 responses |
|---|
| 2010-07-01 | Type of plan entity | Single employer plan |
| 2010-07-01 | Submission has been amended | No |
| 2010-07-01 | This submission is the final filing | No |
| 2010-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-07-01 | Plan is a collectively bargained plan | No |
| 2010-07-01 | Plan funding arrangement – Insurance | Yes |
| 2010-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: P AND R ENTERPRISES, INC. MEDICAL PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Submission has been amended | No |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| 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 – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| 2008: P AND R ENTERPRISES, INC. MEDICAL PLAN 2008 form 5500 responses |
|---|
| 2008-07-01 | Type of plan entity | Single employer plan |
| 2008-07-01 | Submission has been amended | No |
| 2008-07-01 | This submission is the final filing | No |
| 2008-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-07-01 | Plan is a collectively bargained plan | No |
| 2008-07-01 | Plan funding arrangement – Insurance | Yes |
| 2008-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2007: P AND R ENTERPRISES, INC. MEDICAL PLAN 2007 form 5500 responses |
|---|
| 2007-07-01 | Type of plan entity | Single employer plan |
| 2007-07-01 | Submission has been amended | No |
| 2007-07-01 | This submission is the final filing | No |
| 2007-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2007-07-01 | Plan is a collectively bargained plan | No |
| 2007-07-01 | Plan funding arrangement – Insurance | Yes |
| 2007-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2006: P AND R ENTERPRISES, INC. MEDICAL PLAN 2006 form 5500 responses |
|---|
| 2006-07-01 | Type of plan entity | Single employer plan |
| 2006-07-01 | Submission has been amended | No |
| 2006-07-01 | This submission is the final filing | No |
| 2006-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2006-07-01 | Plan is a collectively bargained plan | No |
| 2006-07-01 | Plan funding arrangement – Insurance | Yes |
| 2006-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2005: P AND R ENTERPRISES, INC. MEDICAL PLAN 2005 form 5500 responses |
|---|
| 2005-07-01 | Type of plan entity | Single employer plan |
| 2005-07-01 | Submission has been amended | No |
| 2005-07-01 | This submission is the final filing | No |
| 2005-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2005-07-01 | Plan is a collectively bargained plan | No |
| 2005-07-01 | Plan funding arrangement – Insurance | Yes |
| 2005-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2004: P AND R ENTERPRISES, INC. MEDICAL PLAN 2004 form 5500 responses |
|---|
| 2004-07-01 | Type of plan entity | Single employer plan |
| 2004-07-01 | Submission has been amended | No |
| 2004-07-01 | This submission is the final filing | No |
| 2004-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2004-07-01 | Plan is a collectively bargained plan | No |
| 2004-07-01 | Plan funding arrangement – Insurance | Yes |
| 2004-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2003: P AND R ENTERPRISES, INC. MEDICAL PLAN 2003 form 5500 responses |
|---|
| 2003-07-01 | Type of plan entity | Single employer plan |
| 2003-07-01 | Submission has been amended | No |
| 2003-07-01 | This submission is the final filing | No |
| 2003-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2003-07-01 | Plan is a collectively bargained plan | No |
| 2003-07-01 | Plan funding arrangement – Insurance | Yes |
| 2003-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2002: P AND R ENTERPRISES, INC. MEDICAL PLAN 2002 form 5500 responses |
|---|
| 2002-07-01 | Type of plan entity | Single employer plan |
| 2002-07-01 | First time form 5500 has been submitted | Yes |
| 2002-07-01 | Submission has been amended | No |
| 2002-07-01 | This submission is the final filing | No |
| 2002-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2002-07-01 | Plan is a collectively bargained plan | No |
| 2002-07-01 | Plan funding arrangement – Insurance | Yes |
| 2002-07-01 | Plan benefit arrangement – Insurance | Yes |
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 1R9M |
| Policy instance | 1 |
| Insurance contract or identification number | 1R9M | | Number of Individuals Covered | 153 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $839 | | Total amount of fees paid to insurance company | USD $38,454 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $913,640 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $839 | | Amount paid for insurance broker fees | 26573 | | Additional information about fees paid to insurance broker | PRODUCER SERVICE FEE | | Insurance broker organization code? | 3 |
|
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 1R9M |
| Policy instance | 1 |
| Insurance contract or identification number | 1R9M | | Number of Individuals Covered | 177 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $1,153 | | Total amount of fees paid to insurance company | USD $59,120 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $951,850 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,153 | | Amount paid for insurance broker fees | 41522 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS PRODUCER SERVICE FEE | | Insurance broker organization code? | 3 |
|
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 1R9M |
| Policy instance | 1 |
| Insurance contract or identification number | 1R9M | | Number of Individuals Covered | 191 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $28,547 | | Total amount of fees paid to insurance company | USD $20,853 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $951,563 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,547 | | Amount paid for insurance broker fees | 7845 | | Additional information about fees paid to insurance broker | PRODUCER SERVICES FEE | | Insurance broker organization code? | 3 |
|
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 1R9M |
| Policy instance | 1 |
| Insurance contract or identification number | 1R9M | | Number of Individuals Covered | 208 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $37,112 | | Total amount of fees paid to insurance company | USD $15,867 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,175,139 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 1R9M |
| Policy instance | 1 |
| Insurance contract or identification number | 1R9M | | Number of Individuals Covered | 234 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $39,848 | | Total amount of fees paid to insurance company | USD $32,076 | | 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 $1,307,624 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $39,848 | | Amount paid for insurance broker fees | 14137 | | Additional information about fees paid to insurance broker | MEDICAL CONTRACTS X PCPM DENTAL CONTRACTS X PCPM NON-MONETARY INCENTIVE | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY & ASSOC. INSURANCE GROUP |
|
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 1R9M |
| Policy instance | 1 |
| Insurance contract or identification number | 1R9M | | Number of Individuals Covered | 226 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $34,885 | | Total amount of fees paid to insurance company | USD $62 | | 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 $1,162,831 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,885 | | Amount paid for insurance broker fees | 62 | | Additional information about fees paid to insurance broker | NON-MONETARY INCENTIVE | | Insurance broker organization code? | 3 | | Insurance broker name | USI INSURANCE SERVICES, LLC |
|
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | 1R9M |
| Policy instance | 1 |
| Insurance contract or identification number | 1R9M | | Number of Individuals Covered | 152 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $29,117 | | Total amount of fees paid to insurance company | USD $31,531 | | 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 | No | | 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 $970,573 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,117 | | Amount paid for insurance broker fees | 18937 | | Additional information about fees paid to insurance broker | NEW BUSINESS BONUS MEDICAL BONUS NON-MONETARY INCENTIVE | | Insurance broker organization code? | 3 | | Insurance broker name | KELLY AND ASSOCIATES INS. GROUP |
|
| KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 ) |
| Policy contract number | 22167 |
| Policy instance | 1 |
| Insurance contract or identification number | 22167 | | Number of Individuals Covered | 214 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $25,595 | | Total amount of fees paid to insurance company | USD $1,470 | | 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 | No | | 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 $775,365 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,595 | | Amount paid for insurance broker fees | 1470 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | ELLEN GOLDEN |
|
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $7,859 | | Total amount of fees paid to insurance company | USD $1,074 | | 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 | No | | 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 $261,966 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,859 | | Amount paid for insurance broker fees | 60 | | Additional information about fees paid to insurance broker | NON-MONETARY INCENTIVE AMOUNT | | Insurance broker organization code? | 3 | | Insurance broker name | MATHER AND STROHL ADMINISTRATION |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | GER-P06-127R |
| Policy instance | 1 |
| Insurance contract or identification number | GER-P06-127R | | Number of Individuals Covered | 208 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Dental Insurance Welfare Benefit | No | | 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 | | Other welfare benefits provided | EXCESS LOSS | | 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 $62,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL645582 |
| Policy instance | 2 |
| Insurance contract or identification number | GL645582 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $513 | | Total amount of fees paid to insurance company | USD $5,235 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | 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 $24,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 5235 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE & OTHER SERVICES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $513 | | Insurance broker name | FCE BENEFIT ADMINISTRATORS, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR645776 |
| Policy instance | 3 |
| Insurance contract or identification number | VAR645776 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $94 | | Total amount of fees paid to insurance company | USD $951 | | 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 | No | | Dental Insurance Welfare Benefit | No | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | 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 $4,421 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 951 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE & OTHER SERVICES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $94 | | Insurance broker name | FCE BENEFIT ADMINISTRATORS, INC. |
|
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $26,026 | | Total amount of fees paid to insurance company | USD $4,338 | | 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 | No | | 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 $867,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | GER-P06-127R |
| Policy instance | 1 |
| Insurance contract or identification number | GER-P06-127R | | Number of Individuals Covered | 252 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Dental Insurance Welfare Benefit | No | | 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 | | Other welfare benefits provided | EXCESS LOSS | | 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 $76,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL645582 |
| Policy instance | 2 |
| Insurance contract or identification number | GL645582 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $592 | | Total amount of fees paid to insurance company | USD $5,520 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | 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 $25,674 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VAR645776 |
| Policy instance | 3 |
| Insurance contract or identification number | VAR645776 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $110 | | Total amount of fees paid to insurance company | USD $1,011 | | 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 | No | | Dental Insurance Welfare Benefit | No | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | 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 $4,704 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $31,671 | | Total amount of fees paid to insurance company | USD $2,871 | | 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 | No | | 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 $1,055,705 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL645582/VAR645 |
| Policy instance | 2 |
| Insurance contract or identification number | GL645582/VAR645 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $729 | | Total amount of fees paid to insurance company | USD $7,550 | | 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 | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | 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 $35,114 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7550 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE & OTHER SERVICES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $729 | | Insurance broker name | FCE BENEFIT ADMINISTRATORS, INC. |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | GER-P06-127R |
| Policy instance | 1 |
| Insurance contract or identification number | GER-P06-127R | | Number of Individuals Covered | 262 | | Insurance policy start date | 2009-05-01 | | Insurance policy end date | 2010-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | 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 | No | | Dental Insurance Welfare Benefit | No | | 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 | | Other welfare benefits provided | EXCESS LOSS | | 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 $93,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GROUP HOSPITALIZATION MEDICAL SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $41,506 | | Total amount of fees paid to insurance company | USD $64 | | 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 | No | | 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 $1,037,641 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $41,506 | | Amount paid for insurance broker fees | 64 | | Additional information about fees paid to insurance broker | NON-MONETARY INCENTIVE AMOUNT | | Insurance broker organization code? | 3 | | Insurance broker name | ELLEN GOLDEN, CLU CHFC |
|
| GROUP HOSPITALIZATION MEDICAL SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 160 | | Insurance policy start date | 2008-07-01 | | Insurance policy end date | 2009-06-30 | | Total amount of commissions paid to insurance broker | USD $32,443 | | Total amount of fees paid to insurance company | USD $2,014 | | 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 | No | | 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 $811,068 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,443 | | Amount paid for insurance broker fees | 2014 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS NON-MONETARY INCENTIVE AMOUNT | | Insurance broker organization code? | 3 | | Insurance broker name | ELLEN GOLDEN, CLU |
|
| GROUP HOSPITALIZATION MEDICAL SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2007-07-01 | | Insurance policy end date | 2008-06-30 | | Total amount of commissions paid to insurance broker | USD $30,736 | | Total amount of fees paid to insurance company | USD $6,633 | | 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 | No | | 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 $768,401 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,736 | | Amount paid for insurance broker fees | 1913 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS NON-MONETARY INCENTIVE AMOUNT | | Insurance broker organization code? | 3 | | Insurance broker name | BENEFITMALL |
|
| GROUP HOSPITALIZATION MEDICAL SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 161 | | Insurance policy start date | 2006-07-01 | | Insurance policy end date | 2007-06-30 | | Total amount of commissions paid to insurance broker | USD $36,755 | | Total amount of fees paid to insurance company | USD $2,271 | | 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 | No | | 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 $918,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,755 | | Amount paid for insurance broker fees | 2271 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS NON-MONETARY INCENTIVE AMOUNT | | Insurance broker organization code? | 3 | | Insurance broker name | ELLEN GOLDEN |
|
| GROUP HOSPITALIZATION MEDICAL SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2005-07-01 | | Insurance policy end date | 2006-06-30 | | Total amount of commissions paid to insurance broker | USD $25,286 | | Total amount of fees paid to insurance company | USD $4,298 | | 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 | No | | 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 $632,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,286 | | Amount paid for insurance broker fees | 4298 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS NON-MONETARY INCENTIVE AMOUNT | | Insurance broker organization code? | 3 | | Insurance broker name | ELLEN GOLDEN |
|
| GROUP HOSPITALIZATION MEDICAL SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2004-07-01 | | Insurance policy end date | 2005-06-30 | | Total amount of commissions paid to insurance broker | USD $32,047 | | Total amount of fees paid to insurance company | USD $4,877 | | 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 | No | | 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 $640,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,047 | | Amount paid for insurance broker fees | 4877 | | Additional information about fees paid to insurance broker | PERSISTENCY BONUS NON-MONETARY INCENTIVE AMOUNT | | Insurance broker organization code? | 3 | | Insurance broker name | ELLEN GOLDEN |
|
| GROUP HOSPITALIZATION MEDICAL SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2003-07-01 | | Insurance policy end date | 2004-06-30 | | Total amount of commissions paid to insurance broker | USD $31,051 | | Total amount of fees paid to insurance company | USD $55 | | 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 | No | | 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 $621,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $31,051 | | Amount paid for insurance broker fees | 55 | | Additional information about fees paid to insurance broker | NON-MONETARY INCENTIVE AMOUNT | | Insurance broker organization code? | 3 | | Insurance broker name | ELLEN GOLDEN |
|
| GROUP HOSPITALIZATION MEDICAL SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 53007 ) |
| Policy contract number | UN21 |
| Policy instance | 1 |
| Insurance contract or identification number | UN21 | | Number of Individuals Covered | 134 | | Insurance policy start date | 2002-07-01 | | Insurance policy end date | 2003-06-30 | | Total amount of commissions paid to insurance broker | USD $28,073 | | Total amount of fees paid to insurance company | USD $52 | | 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 | No | | 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 $561,458 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,073 | | Amount paid for insurance broker fees | 52 | | Additional information about fees paid to insurance broker | NON-MONETARY INCENTIVE AMOUNT | | Insurance broker organization code? | 3 | | Insurance broker name | ELLEN GOLDEN |
|
