PRESTERA CENTER FOR MENTAL HEALTH SERVICES, INC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD
401k plan membership statisitcs for PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD
| Measure | Date | Value |
|---|
| 2019: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 663 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 0 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 663 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 663 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 663 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 663 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 663 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 663 |
| Number of employers contributing to the scheme | 2017-01-01 | 0 |
| 2016: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 663 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 663 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 663 |
| Number of employers contributing to the scheme | 2016-01-01 | 0 |
| 2015: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 663 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 663 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 663 |
| Number of employers contributing to the scheme | 2015-01-01 | 0 |
| 2014: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 663 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 663 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 663 |
| Number of employers contributing to the scheme | 2014-01-01 | 0 |
| 2013: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 663 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 663 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 663 |
| Number of employers contributing to the scheme | 2013-01-01 | 0 |
| 2012: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 663 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 663 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 663 |
| Number of employers contributing to the scheme | 2012-01-01 | 0 |
| 2011: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 663 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 663 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 663 |
| Number of employers contributing to the scheme | 2011-01-01 | 0 |
| 2010: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 685 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 684 |
| Total of all active and inactive participants | 2010-01-01 | 684 |
| Total participants | 2010-01-01 | 684 |
| 2009: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 700 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 685 |
| Total of all active and inactive participants | 2009-07-01 | 685 |
| Total participants | 2009-07-01 | 685 |
| 2019: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Submission has been amended | Yes |
| 2019-01-01 | This submission is the final filing | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: PRESTERA CENTER FOR MENTAL HEALTH SERVICES INC MT STATE BLUE CROSS BLUS SHIELD 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 |
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X42 ET AL |
| Policy instance | 2 |
| Insurance contract or identification number | X42 ET AL | | Number of Individuals Covered | 527 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $843 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $843 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 ) |
| Policy contract number | 168458 |
| Policy instance | 1 |
| Insurance contract or identification number | 168458 | | Number of Individuals Covered | 373 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $118,342 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,273,575 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $118,342 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X42 ET AL |
| Policy instance | 2 |
| Insurance contract or identification number | X42 ET AL | | Number of Individuals Covered | 844 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,201 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,044 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,201 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 ) |
| Policy contract number | 168458 |
| Policy instance | 1 |
| Insurance contract or identification number | 168458 | | Number of Individuals Covered | 444 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $138,307 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,881,157 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $138,307 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X42 ET AL |
| Policy instance | 2 |
| Insurance contract or identification number | X42 ET AL | | Number of Individuals Covered | 827 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,201 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,048 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,201 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 ) |
| Policy contract number | 168458 |
| Policy instance | 1 |
| Insurance contract or identification number | 168458 | | Number of Individuals Covered | 442 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $140,667 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,938,698 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $140,667 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X42 ET AL |
| Policy instance | 2 |
| Insurance contract or identification number | X42 ET AL | | Number of Individuals Covered | 817 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-12-31 | | Total amount of commissions paid to insurance broker | USD $1,217 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,217 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 ) |
| Policy contract number | 168458 |
| Policy instance | 1 |
| Insurance contract or identification number | 168458 | | Number of Individuals Covered | 443 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2016-12-31 | | Total amount of commissions paid to insurance broker | USD $150,869 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,259,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $150,869 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | X42 ET AL |
| Policy instance | 2 |
| Insurance contract or identification number | X42 ET AL | | Number of Individuals Covered | 845 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,220 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,668 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $1,220 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 ) |
| Policy contract number | 168458 |
| Policy instance | 1 |
| Insurance contract or identification number | 168458 | | Number of Individuals Covered | 663 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $127,086 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,516,221 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $127,086 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 1000000033 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000000033 | | Number of Individuals Covered | 663 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HIGHMARK WEST VIRGINIA (National Association of Insurance Commissioners NAIC id number: 54828 ) |
| Policy contract number | 168458 |
| Policy instance | 1 |
| Insurance contract or identification number | 168458 | | Number of Individuals Covered | 663 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $124,624 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,624,505 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $104,338 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 1000000033 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000000033 | | Number of Individuals Covered | 663 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HEALTH PLAN UPPER OHIO VALLEY (National Association of Insurance Commissioners NAIC id number: 95677 ) |
| Policy contract number | 124330/127334 |
| Policy instance | 1 |
| Insurance contract or identification number | 124330/127334 | | Number of Individuals Covered | 589 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,485 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $262,018 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,485 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 1000000033 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000000033 | | Number of Individuals Covered | 663 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HEALTH PLAN UPPER OHIO VALLEY (National Association of Insurance Commissioners NAIC id number: 95677 ) |
| Policy contract number | 124330/127334 |
| Policy instance | 1 |
| Insurance contract or identification number | 124330/127334 | | Number of Individuals Covered | 589 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $66,004 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $737,981 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $66,004 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 1000000033 |
| Policy instance | 2 |
| Insurance contract or identification number | 1000000033 | | Number of Individuals Covered | 663 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED HEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 8044100000 |
| Policy instance | 1 |
| Insurance contract or identification number | 8044100000 | | Number of Individuals Covered | 663 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
