ROOF SERVICES CORPORATION has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN
401k plan membership statisitcs for ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN
| Measure | Date | Value |
|---|
| 2018: ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-03-01 | 171 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-03-01 | 0 |
| Number of retired or separated participants receiving benefits | 2018-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-03-01 | 0 |
| Total of all active and inactive participants | 2018-03-01 | 0 |
| 2017: ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-03-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-03-01 | 0 |
| Number of retired or separated participants receiving benefits | 2017-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-03-01 | 0 |
| Total of all active and inactive participants | 2017-03-01 | 0 |
| 2016: ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-03-01 | 177 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-03-01 | 161 |
| Number of retired or separated participants receiving benefits | 2016-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-03-01 | 0 |
| Total of all active and inactive participants | 2016-03-01 | 161 |
| 2015: ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-03-01 | 188 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-03-01 | 177 |
| Number of retired or separated participants receiving benefits | 2015-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-03-01 | 0 |
| Total of all active and inactive participants | 2015-03-01 | 177 |
| 2014: ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-03-01 | 140 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-03-01 | 188 |
| Number of retired or separated participants receiving benefits | 2014-03-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-03-01 | 0 |
| Total of all active and inactive participants | 2014-03-01 | 188 |
| 2013: ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-03-01 | 229 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-03-01 | 140 |
| Total of all active and inactive participants | 2013-03-01 | 140 |
| 2012: ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-03-01 | 226 |
| Total of all active and inactive participants | 2012-03-01 | 0 |
| 2011: ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-03-01 | 262 |
| Total of all active and inactive participants | 2011-03-01 | 0 |
| 2009: ROOF SERVICES J.G.M. CORPORATION PREMIUM CONVERSION PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-03-01 | 137 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-03-01 | 281 |
| Number of retired or separated participants receiving benefits | 2009-03-01 | 6 |
| Total of all active and inactive participants | 2009-03-01 | 287 |
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2996 |
| Policy instance | 4 |
| Insurance contract or identification number | 2996 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $11,291 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $246,191 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,029 | | Insurance broker organization code? | 3 |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AKC8 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AKC8 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2019-01-01 | | Total amount of commissions paid to insurance broker | USD $1,117 | | Total amount of fees paid to insurance company | USD $478 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,117 | | Amount paid for insurance broker fees | 478 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 856417-099,000 |
| Policy instance | 2 |
| Insurance contract or identification number | 856417-099,000 | | Number of Individuals Covered | 152 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $4,120 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,218 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,120 | | Additional information about fees paid to insurance broker | DENTAL | | Insurance broker organization code? | 3 |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2683 |
| Policy instance | 1 |
| Insurance contract or identification number | 2683 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $12,919 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $385,982 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,484 | | Additional information about fees paid to insurance broker | HEALTH INSURANCE | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 856417-099,000 |
| Policy instance | 2 |
| Insurance contract or identification number | 856417-099,000 | | Number of Individuals Covered | 171 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $5,296 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63,334 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,296 | | Additional information about fees paid to insurance broker | DENTAL | | Insurance broker organization code? | 3 | | Insurance broker name | THE FRIEDEN AGENCY, INC. |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AKC8 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AKC8 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2018-01-01 | | Total amount of commissions paid to insurance broker | USD $1,292 | | Total amount of fees paid to insurance company | USD $758 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,910 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,292 | | Amount paid for insurance broker fees | 758 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FRIEDEN AGENCY, INC |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2996 |
| Policy instance | 4 |
| Insurance contract or identification number | 2996 | | Number of Individuals Covered | 94 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $12,847 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $303,940 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,847 | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2683 |
| Policy instance | 1 |
| Insurance contract or identification number | 2683 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $11,756 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $390,906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,756 | | Additional information about fees paid to insurance broker | HEALTH INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 856417-099,000 |
| Policy instance | 2 |
| Insurance contract or identification number | 856417-099,000 | | Number of Individuals Covered | 176 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $4,396 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,222 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,396 | | Additional information about fees paid to insurance broker | DENTAL | | Insurance broker organization code? | 3 | | Insurance broker name | THE FRIEDEN AGENCY, INC. |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2996 |
| Policy instance | 4 |
| Insurance contract or identification number | 2996 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,893 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $188,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,893 | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AKC8 |
| Policy instance | 3 |
| Insurance contract or identification number | G000AKC8 | | Number of Individuals Covered | 97 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2016-01-01 | | Total amount of commissions paid to insurance broker | USD $1,766 | | Total amount of fees paid to insurance company | USD $479 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,766 | | Amount paid for insurance broker fees | 479 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FRIEDEN AGENCY, INC |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2683 |
| Policy instance | 1 |
| Insurance contract or identification number | 2683 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $8,553 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $416,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,553 | | Additional information about fees paid to insurance broker | HEALTH INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2683 |
| Policy instance | 1 |
| Insurance contract or identification number | 2683 | | Number of Individuals Covered | 123 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $9,972 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $443,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,972 | | Additional information about fees paid to insurance broker | HEALTH INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2996 |
| Policy instance | 5 |
| Insurance contract or identification number | 2996 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $3,388 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $150,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,388 | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AKC8 |
| Policy instance | 4 |
| Insurance contract or identification number | G000AKC8 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,810 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,810 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FRIEDEN AGENCY, INC |
|
| OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 ) |
| Policy contract number | 63012 |
| Policy instance | 2 |
| Insurance contract or identification number | 63012 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $95 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,235 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $95 | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 856417-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 856417-0000 | | Number of Individuals Covered | 166 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,172 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,353 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,172 | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AKC8 |
| Policy instance | 4 |
| Insurance contract or identification number | G000AKC8 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,786 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,533 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,786 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FREIDEN AGENCY INC |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 856417-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 856417-0000 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,634 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,287 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,634 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FRIEDEN AGENCY, INC |
|
| OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 ) |
| Policy contract number | 63012 |
| Policy instance | 2 |
| Insurance contract or identification number | 63012 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $379 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $379 | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2683 |
| Policy instance | 1 |
| Insurance contract or identification number | 2683 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $11,559 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $513,716 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,559 | | Additional information about fees paid to insurance broker | HEALTH INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 ) |
| Policy contract number | 63012 |
| Policy instance | 2 |
| Insurance contract or identification number | 63012 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $317 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,107 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $317 | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 856417-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 856417-0000 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,227 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,227 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FRIEDEN AGENCY, INC |
|
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | G000AKC8 |
| Policy instance | 4 |
| Insurance contract or identification number | G000AKC8 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $2,033 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,582 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,033 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FREIDEN AGENCY INC |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2683 |
| Policy instance | 1 |
| Insurance contract or identification number | 2683 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $16,375 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $727,760 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,375 | | Additional information about fees paid to insurance broker | HEALTH INSURANCE | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2683 |
| Policy instance | 1 |
| Insurance contract or identification number | 2683 | | Number of Individuals Covered | 164 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $13,542 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $601,851 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 ) |
| Policy contract number | 63012 |
| Policy instance | 2 |
| Insurance contract or identification number | 63012 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $829 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,853 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 856417-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 856417-0000 | | Number of Individuals Covered | 224 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Total amount of commissions paid to insurance broker | USD $6,686 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F006423 |
| Policy instance | 4 |
| Insurance contract or identification number | F006423 | | Number of Individuals Covered | 115 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,929 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2901 |
| Policy instance | 5 |
| Insurance contract or identification number | 2901 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $6,067 | | Welfare Benefit Premiums Paid to Carrier | USD $269,651 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OHIC-OOA IND (National Association of Insurance Commissioners NAIC id number: 70715 ) |
| Policy contract number | 63012 |
| Policy instance | 2 |
| Insurance contract or identification number | 63012 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $602 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $602 | | Insurance broker name | TFA BENEFITS |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 856417-0000 |
| Policy instance | 3 |
| Insurance contract or identification number | 856417-0000 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Total amount of commissions paid to insurance broker | USD $5,039 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $65,370 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,039 | | Insurance broker name | THE FRIEDEN AGENCY, INC |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F006423 |
| Policy instance | 4 |
| Insurance contract or identification number | F006423 | | Number of Individuals Covered | 131 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,706 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,706 | | Insurance broker organization code? | 3 | | Insurance broker name | THE FREIDEN AGENCY, INC. |
|
| OHP MANDATED POS-HMO (National Association of Insurance Commissioners NAIC id number: 95281 ) |
| Policy contract number | 2683 |
| Policy instance | 1 |
| Insurance contract or identification number | 2683 | | Number of Individuals Covered | 256 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $16,873 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $749,391 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,873 | | Insurance broker organization code? | 3 | | Insurance broker name | TFA BENEFITS |
|
