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PROVIDER SERVICES WELFARE BENEFIT PLAN 401k Plan overview

Plan NamePROVIDER SERVICES WELFARE BENEFIT PLAN
Plan identification number 501

PROVIDER SERVICES WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Other welfare benefit cover

401k Sponsoring company profile

PROVIDER SERVICES has sponsored the creation of one or more 401k plans.

Company Name:PROVIDER SERVICES
Employer identification number (EIN):810681796
NAIC Classification:623000
NAIC Description: Nursing and Residential Care Facilities

Additional information about PROVIDER SERVICES

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 2005-11-16
Company Identification Number: 1581849
Legal Registered Office Address: 2500 COUNTRY CLUB BLVD
SUITE 255
NORTH OLMSTED
United States of America (USA)
44070

More information about PROVIDER SERVICES

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PROVIDER SERVICES WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-01-01JOHN KRYSTOWSKI
5012016-01-01JOHN KRYSTOWSKI
5012015-01-01JOHN KRYSTOWSKI
5012014-01-01
5012013-01-01
5012012-01-01JOHN KRYSTOWSKI
5012011-01-01JOHN KRYSTOWSKI

Plan Statistics for PROVIDER SERVICES WELFARE BENEFIT PLAN

401k plan membership statisitcs for PROVIDER SERVICES WELFARE BENEFIT PLAN

Measure Date Value
2017: PROVIDER SERVICES WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-011,493
Total number of active participants reported on line 7a of the Form 55002017-01-010
Total of all active and inactive participants2017-01-010
Total participants2017-01-010
2016: PROVIDER SERVICES WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-011,302
Total number of active participants reported on line 7a of the Form 55002016-01-011,493
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-011,493
Total participants2016-01-011,493
2015: PROVIDER SERVICES WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-017,226
Total number of active participants reported on line 7a of the Form 55002015-01-011,302
Total of all active and inactive participants2015-01-011,302
Total participants2015-01-011,302
2014: PROVIDER SERVICES WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-013,153
Total number of active participants reported on line 7a of the Form 55002014-01-017,226
Total of all active and inactive participants2014-01-017,226
2013: PROVIDER SERVICES WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-014,237
Total number of active participants reported on line 7a of the Form 55002013-01-013,153
Total of all active and inactive participants2013-01-013,153
2012: PROVIDER SERVICES WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-012,342
Total number of active participants reported on line 7a of the Form 55002012-01-013,147
Total of all active and inactive participants2012-01-013,147
2011: PROVIDER SERVICES WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-012,827
Total number of active participants reported on line 7a of the Form 55002011-01-012,342
Total of all active and inactive participants2011-01-012,342

Financial Data on PROVIDER SERVICES WELFARE BENEFIT PLAN

Measure Date Value
2012 : PROVIDER SERVICES WELFARE BENEFIT PLAN 2012 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$3,158,000
Total income from all sources (including contributions)2012-12-31$33,578,392
Total of all expenses incurred2012-12-31$23,263,598
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$23,239,178
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$33,192,078
Value of total assets at end of year2012-12-31$13,407,187
Value of total assets at beginning of year2012-12-31$6,250,394
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$24,420
Total interest from all sources2012-12-31$6,479
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$91,779
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Assets. Corporate prefeered stocks other than exployer securities at end of year2012-12-31$3,111,418
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2012-12-31$235,510
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$8,175
Total non interest bearing cash at end of year2012-12-31$4,193
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$10,314,794
Value of net assets at end of year (total assets less liabilities)2012-12-31$13,407,187
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$3,092,394
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Investment advisory and management fees2012-12-31$21,602
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$503,628
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$2,411,585
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$9,779,773
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$3,603,299
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$3,603,299
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$6,479
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$288,056
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$33,192,078
Income. Dividends from common stock2012-12-31$91,779
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$23,239,178
Contract administrator fees2012-12-31$2,818
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$3,158,000
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31CORRIGAN KRAUSE
Accountancy firm EIN2012-12-31371574855
2011 : PROVIDER SERVICES WELFARE BENEFIT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$-14,215
Total unrealized appreciation/depreciation of assets2011-12-31$-14,215
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$3,158,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$1,955,523
Total income from all sources (including contributions)2011-12-31$21,104,258
Total of all expenses incurred2011-12-31$19,057,009
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$19,057,009
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$21,104,532
Value of total assets at end of year2011-12-31$6,250,394
Value of total assets at beginning of year2011-12-31$3,000,668
Total interest from all sources2011-12-31$1,228
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$71,633
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$61,774
Assets. Corporate prefeered stocks other than exployer securities at end of year2011-12-31$235,510
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$2,047,249
Value of net assets at end of year (total assets less liabilities)2011-12-31$3,092,394
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$1,045,145
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$2,411,585
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$3,603,299
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$3,000,668
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$3,000,668
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$1,228
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$19,057,009
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-58,920
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$21,104,532
Income. Dividends from preferred stock2011-12-31$9,859
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$3,158,000
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$1,955,523
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31CORRIGAN KRAUSE
Accountancy firm EIN2011-12-31371574855
2010 : PROVIDER SERVICES WELFARE BENEFIT PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$1,955,523
Total income from all sources (including contributions)2010-12-31$18,987,810
Total of all expenses incurred2010-12-31$17,942,665
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$17,942,665
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$18,987,613
Value of total assets at end of year2010-12-31$3,000,668
Total interest from all sources2010-12-31$197
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$1,045,145
Value of net assets at end of year (total assets less liabilities)2010-12-31$1,045,145
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$3,000,668
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$197
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$17,942,665
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$18,987,613
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$1,955,523
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31CORRIGAN KRAUSE
Accountancy firm EIN2010-12-31371574855

Form 5500 Responses for PROVIDER SERVICES WELFARE BENEFIT PLAN

2017: PROVIDER SERVICES WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01This submission is the final filingYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: PROVIDER SERVICES WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – General assets of the sponsorYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement – General assets of the sponsorYes
2015: PROVIDER SERVICES WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: PROVIDER SERVICES WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: PROVIDER SERVICES WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: PROVIDER SERVICES WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: PROVIDER SERVICES WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

ENVISION PHARMACEUTICAL SERVICES, LLC (National Association of Insurance Commissioners NAIC id number: )
Policy contract numberFIRSTSOURC
Policy instance 7
Insurance contract or identification numberFIRSTSOURC
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000403005034
Policy instance 1
Insurance contract or identification number000403005034
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,188
Total amount of fees paid to insurance companyUSD $1,276
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,576
Amount paid for insurance broker fees1141
Additional information about fees paid to insurance brokerBROKER BONUS
Insurance broker organization code?3
Insurance broker nameSTEVEN PAPPADAKES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0148502/0169564
Policy instance 2
Insurance contract or identification number0148502/0169564
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of fees paid to insurance companyUSD $1,387
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $83,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1387
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameWILLIS OF ILLINOIS
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701308
Policy instance 3
Insurance contract or identification number701308
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number9830100/9830118
Policy instance 4
Insurance contract or identification number9830100/9830118
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number246530
Policy instance 5
Insurance contract or identification number246530
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $256
Welfare Benefit Premiums Paid to CarrierUSD $1,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $256
Insurance broker organization code?3
Insurance broker nameWILLIS INSURANCE SERVICES OF CA
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number695971
Policy instance 6
Insurance contract or identification number695971
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $3,992
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,096
Insurance broker organization code?3
Insurance broker nameSTEVEN PAPPADAKES
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000010197284
Policy instance 3
Insurance contract or identification number000010197284
Number of Individuals Covered1170
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,113
Total amount of fees paid to insurance companyUSD $821
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $11,135
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,113
Amount paid for insurance broker fees821
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD CO.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number00010197285
Policy instance 4
Insurance contract or identification number00010197285
Number of Individuals Covered289
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $33,272
Total amount of fees paid to insurance companyUSD $6,207
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $133,087
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,272
Amount paid for insurance broker fees6207
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD CO.
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0148502
Policy instance 5
Insurance contract or identification number0148502
Number of Individuals Covered1302
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of fees paid to insurance companyUSD $2,966
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $271,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees2966
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD CO.
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract numberN/A
Policy instance 6
Insurance contract or identification numberN/A
Number of Individuals Covered0
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701308
Policy instance 7
Insurance contract or identification number701308
Number of Individuals Covered1027
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Welfare Benefit Premiums Paid to CarrierUSD $52,672
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number9830100/9830118
Policy instance 8
Insurance contract or identification number9830100/9830118
Number of Individuals Covered1298
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $46,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000400001000
Policy instance 2
Insurance contract or identification number000400001000
Number of Individuals Covered630
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $19,866
Total amount of fees paid to insurance companyUSD $6,888
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $90,301
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,866
Amount paid for insurance broker fees6888
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD CO.
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 )
Policy contract number000403005034
Policy instance 1
Insurance contract or identification number000403005034
Number of Individuals Covered314
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,774
Total amount of fees paid to insurance companyUSD $655
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,065
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,774
Amount paid for insurance broker fees655
Additional information about fees paid to insurance brokerSERVICE FEE AGREEMENT
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD CO.
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number9830100
Policy instance 5
Insurance contract or identification number9830100
Number of Individuals Covered6005
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $31,757
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees31757
Insurance broker name
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0148502
Policy instance 4
Insurance contract or identification number0148502
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker name
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701308
Policy instance 3
Insurance contract or identification number701308
Number of Individuals Covered1316
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $758,235
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $110,455
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees758235
Insurance broker organization code?3
Insurance broker name
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0148796
Policy instance 2
Insurance contract or identification number0148796
Number of Individuals Covered1516
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $63,668
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker name
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number672166
Policy instance 1
Insurance contract or identification number672166
Number of Individuals Covered1558
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $502,929
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees502929
Insurance broker name
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0148502
Policy instance 4
Insurance contract or identification number0148502
Number of Individuals Covered5846
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $16,690
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $994,839
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees16690
Insurance broker organization code?3
Insurance broker nameJAMES B OSWALD CO
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0148796
Policy instance 2
Insurance contract or identification number0148796
Number of Individuals Covered1626
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $342,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker name
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 29076 )
Policy contract number672166
Policy instance 1
Insurance contract or identification number672166
Number of Individuals Covered1875
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $539,631
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees539631
Insurance broker organization code?3
Insurance broker name
FIDELITY SECURITY LIFE INSURANCE COMPANY OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 67288 )
Policy contract number9830100
Policy instance 5
Insurance contract or identification number9830100
Number of Individuals Covered5621
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $23,773
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees23773
Insurance broker organization code?3
Insurance broker name
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701308
Policy instance 3
Insurance contract or identification number701308
Number of Individuals Covered1555
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $656,382
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $19,035
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees656382
Insurance broker organization code?3
Insurance broker name
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number701308
Policy instance 3
Insurance contract or identification number701308
Number of Individuals Covered299
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $496,793
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees496793
Insurance broker name
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number170708
Policy instance 2
Insurance contract or identification number170708
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number672166
Policy instance 1
Insurance contract or identification number672166
Number of Individuals Covered1826
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $531,021
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees531021
Insurance broker name
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number170708
Policy instance 2
Insurance contract or identification number170708
Number of Individuals Covered808
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number672166
Policy instance 1
Insurance contract or identification number672166
Number of Individuals Covered1534
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $477,174
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number170708
Policy instance 2
Insurance contract or identification number170708
Number of Individuals Covered772
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MEDICAL MUTUAL OF OHIO (National Association of Insurance Commissioners NAIC id number: 52429 )
Policy contract number672166
Policy instance 1
Insurance contract or identification number672166
Number of Individuals Covered2007
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $49,998
Total amount of fees paid to insurance companyUSD $38,858
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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