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THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameTHE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN
Plan identification number 502

THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

THE IVYMOUNT SCHOOL, INC. has sponsored the creation of one or more 401k plans.

Company Name:THE IVYMOUNT SCHOOL, INC.
Employer identification number (EIN):521195527
NAIC Classification:611000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-07-01LEE-NADINE OPPENHEIM2023-01-27
5022020-07-01
5022019-07-01
5022018-07-01
5022017-07-01LEE-NADINE OPPENHEIM
5022016-07-01LEE-NADINE OPPENHEIM
5022015-07-01LEE-NADINE OPPENHEIM
5022014-07-01LEE-NADINE OPPENHEIM
5022013-07-01LEE-NADINE OPPENHEIM
5022012-07-01LEE-NADINE OPPENHEIM
5022011-07-01LEE-NADINE OPPENHEIM
5022009-09-01LEE-NADINE OPPENHEIM
5022007-09-01LEE-NADINE OPPENHEIM
5022006-09-01LEE-NADINE OPPENHEIM
5022005-09-01LEE-NADINE OPPENHEIM

Plan Statistics for THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN

401k plan membership statisitcs for THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN

Measure Date Value
2021: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01129
Total number of active participants reported on line 7a of the Form 55002021-07-01132
Number of retired or separated participants receiving benefits2021-07-011
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01133
Number of employers contributing to the scheme2021-07-010
2020: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01106
Total number of active participants reported on line 7a of the Form 55002020-07-01118
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-0111
Total of all active and inactive participants2020-07-01129
2019: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01124
Total number of active participants reported on line 7a of the Form 55002019-07-01106
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-018
Total of all active and inactive participants2019-07-01114
2018: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01115
Total number of active participants reported on line 7a of the Form 55002018-07-01100
Number of retired or separated participants receiving benefits2018-07-013
Number of other retired or separated participants entitled to future benefits2018-07-0117
Total of all active and inactive participants2018-07-01120
2017: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01122
Total number of active participants reported on line 7a of the Form 55002017-07-01100
Number of retired or separated participants receiving benefits2017-07-017
Number of other retired or separated participants entitled to future benefits2017-07-0114
Total of all active and inactive participants2017-07-01121
2016: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01138
Total number of active participants reported on line 7a of the Form 55002016-07-01119
Number of retired or separated participants receiving benefits2016-07-011
Number of other retired or separated participants entitled to future benefits2016-07-0114
Total of all active and inactive participants2016-07-01134
2015: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01138
Total number of active participants reported on line 7a of the Form 55002015-07-01123
Number of retired or separated participants receiving benefits2015-07-018
Number of other retired or separated participants entitled to future benefits2015-07-0115
Total of all active and inactive participants2015-07-01146
2014: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01139
Total number of active participants reported on line 7a of the Form 55002014-07-01134
Number of retired or separated participants receiving benefits2014-07-013
Number of other retired or separated participants entitled to future benefits2014-07-0130
Total of all active and inactive participants2014-07-01167
2013: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01127
Total number of active participants reported on line 7a of the Form 55002013-07-01136
Number of retired or separated participants receiving benefits2013-07-011
Number of other retired or separated participants entitled to future benefits2013-07-0122
Total of all active and inactive participants2013-07-01159
2012: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01146
Total number of active participants reported on line 7a of the Form 55002012-07-01124
Number of retired or separated participants receiving benefits2012-07-011
Number of other retired or separated participants entitled to future benefits2012-07-019
Total of all active and inactive participants2012-07-01134
2011: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01122
Total number of active participants reported on line 7a of the Form 55002011-07-01146
Number of retired or separated participants receiving benefits2011-07-015
Number of other retired or separated participants entitled to future benefits2011-07-0127
Total of all active and inactive participants2011-07-01178
2009: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-01149
Total number of active participants reported on line 7a of the Form 55002009-09-01121
Number of retired or separated participants receiving benefits2009-09-014
Number of other retired or separated participants entitled to future benefits2009-09-010
Total of all active and inactive participants2009-09-01125
2007: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2007 401k membership
Total participants, beginning-of-year2007-09-01141
Total number of active participants reported on line 7a of the Form 55002007-09-01162
Number of retired or separated participants receiving benefits2007-09-013
Number of other retired or separated participants entitled to future benefits2007-09-010
Total of all active and inactive participants2007-09-01165
2006: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2006 401k membership
Total participants, beginning-of-year2006-09-01105
Total number of active participants reported on line 7a of the Form 55002006-09-01155
Number of retired or separated participants receiving benefits2006-09-012
Number of other retired or separated participants entitled to future benefits2006-09-010
Total of all active and inactive participants2006-09-01157
2005: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2005 401k membership
Total participants, beginning-of-year2005-09-01147
Total number of active participants reported on line 7a of the Form 55002005-09-01147
Number of retired or separated participants receiving benefits2005-09-015
Number of other retired or separated participants entitled to future benefits2005-09-010
Total of all active and inactive participants2005-09-01152

Form 5500 Responses for THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN

2021: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2019: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2018: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2009: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-09-01Type of plan entitySingle employer plan
2009-09-01Submission has been amendedNo
2009-09-01This submission is the final filingNo
2009-09-01This return/report is a short plan year return/report (less than 12 months)No
2009-09-01Plan is a collectively bargained planNo
2009-09-01Plan funding arrangement – InsuranceYes
2009-09-01Plan benefit arrangement – InsuranceYes
2007: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2007 form 5500 responses
2007-09-01Type of plan entitySingle employer plan
2007-09-01Submission has been amendedNo
2007-09-01This submission is the final filingNo
2007-09-01This return/report is a short plan year return/report (less than 12 months)No
2007-09-01Plan is a collectively bargained planNo
2007-09-01Plan funding arrangement – InsuranceYes
2007-09-01Plan benefit arrangement – InsuranceYes
2006: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2006 form 5500 responses
2006-09-01Type of plan entitySingle employer plan
2006-09-01Submission has been amendedNo
2006-09-01This submission is the final filingNo
2006-09-01This return/report is a short plan year return/report (less than 12 months)No
2006-09-01Plan is a collectively bargained planNo
2006-09-01Plan funding arrangement – InsuranceYes
2006-09-01Plan benefit arrangement – InsuranceYes
2005: THE IVYMOUNT SCHOOL HEALTH AND WELFARE PLAN 2005 form 5500 responses
2005-09-01Type of plan entitySingle employer plan
2005-09-01First time form 5500 has been submittedYes
2005-09-01Submission has been amendedNo
2005-09-01This submission is the final filingNo
2005-09-01This return/report is a short plan year return/report (less than 12 months)No
2005-09-01Plan is a collectively bargained planNo
2005-09-01Plan funding arrangement – InsuranceYes
2005-09-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number23810
Policy instance 1
Insurance contract or identification number23810
Number of Individuals Covered132
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $40,740
Total amount of fees paid to insurance companyUSD $850
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $694,475
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,668
Amount paid for insurance broker fees848
Additional information about fees paid to insurance brokerANNUAL BOB
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number23810
Policy instance 1
Insurance contract or identification number23810
Number of Individuals Covered141
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $47,259
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $735,292
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,822
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number23810
Policy instance 1
Insurance contract or identification number23810
Number of Individuals Covered142
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $50,790
Total amount of fees paid to insurance companyUSD $7,249
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $625,205
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,260
Amount paid for insurance broker fees7249
Additional information about fees paid to insurance brokerBONUS, NON-MONETARY COMPENSATION
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number23810
Policy instance 1
Insurance contract or identification number23810
Number of Individuals Covered151
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $57,301
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $673,515
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $36,399
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number23810
Policy instance 1
Insurance contract or identification number23810
Number of Individuals Covered158
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $48,748
Total amount of fees paid to insurance companyUSD $2,600
Are there contracts with allocated funds for individual policies?0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $710,688
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $24,430
Amount paid for insurance broker fees2600
Additional information about fees paid to insurance brokerANNUAL BOB BONUS
Insurance broker organization code?3
Insurance broker nameEMP. BEN. CORP. OF AMERICA
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number23810
Policy instance 1
Insurance contract or identification number23810
Number of Individuals Covered182
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $63,837
Total amount of fees paid to insurance companyUSD $10,519
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $746,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $37,617
Amount paid for insurance broker fees10519
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameEMP. BEN. CORP. OF AMERICA
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number17JZ*
Policy instance 1
Insurance contract or identification number17JZ*
Number of Individuals Covered172
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $45,356
Total amount of fees paid to insurance companyUSD $34,975
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $907,119
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $45,356
Amount paid for insurance broker fees16478
Additional information about fees paid to insurance brokerMEDICAL CONTRACTS X PCPM NON MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameEBCA
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number*17JZ
Policy instance 1
Insurance contract or identification number*17JZ
Number of Individuals Covered150
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $25,880
Total amount of fees paid to insurance companyUSD $29,213
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $739,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,880
Amount paid for insurance broker fees14282
Additional information about fees paid to insurance brokerMEDICAL CONTRACTS X PCPM NON MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameEBCA
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number*17JZ
Policy instance 1
Insurance contract or identification number*17JZ
Number of Individuals Covered137
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $21,985
Total amount of fees paid to insurance companyUSD $18,082
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $585,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $21,985
Amount paid for insurance broker fees5240
Additional information about fees paid to insurance brokerMEDICAL CONTRACTS X PCPM NON MONETARY INCENTIVE
Insurance broker organization code?3
Insurance broker nameEBCA
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number*17JZ
Policy instance 1
Insurance contract or identification number*17JZ
Number of Individuals Covered151
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $33,672
Total amount of fees paid to insurance companyUSD $20,800
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $962,052
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*17JZ
Policy instance 1
Insurance contract or identification number*17JZ
Number of Individuals Covered144
Insurance policy start date2010-09-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $20,991
Total amount of fees paid to insurance companyUSD $59
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $524,773
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 number6310
Policy instance 1
Insurance contract or identification number6310
Number of Individuals Covered192
Insurance policy start date2008-09-01
Insurance policy end date2009-08-31
Total amount of commissions paid to insurance brokerUSD $43,575
Total amount of fees paid to insurance companyUSD $105
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOINT-OF-SERVICE
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 CarrierUSD $682,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,073
Amount paid for insurance broker fees105
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameWILLIS OF MARYLAND
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number6310
Policy instance 1
Insurance contract or identification number6310
Number of Individuals Covered181
Insurance policy start date2007-09-01
Insurance policy end date2008-08-31
Total amount of commissions paid to insurance brokerUSD $29,431
Total amount of fees paid to insurance companyUSD $69
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOINT-OF-SERVICE
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 CarrierUSD $577,234
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $27,384
Amount paid for insurance broker fees69
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameHRH OF DC
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number6310
Policy instance 1
Insurance contract or identification number6310
Number of Individuals Covered177
Insurance policy start date2006-09-01
Insurance policy end date2007-08-31
Total amount of commissions paid to insurance brokerUSD $31,285
Total amount of fees paid to insurance companyUSD $261
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOINT-OF-SERVICE
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 CarrierUSD $521,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,285
Amount paid for insurance broker fees261
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMPLOYEE BENEFITS CORP.
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number6310
Policy instance 1
Insurance contract or identification number6310
Number of Individuals Covered173
Insurance policy start date2005-09-01
Insurance policy end date2006-08-31
Total amount of commissions paid to insurance brokerUSD $25,463
Total amount of fees paid to insurance companyUSD $2,760
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOINT-OF-SERVICE
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 CarrierUSD $511,887
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,463
Insurance broker organization code?3
Amount paid for insurance broker fees2760
Additional information about fees paid to insurance brokerBONUS COMPENSATION
Insurance broker nameHRH OF DC

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