Fidelity bond in place
Not reported
Filing
Absolut Facilities Management LLC Flexible Benefits Plan
Absolut Facilities Management LLC • EIN 20-8471412 • Plan year 2007
Filing Insights
Participants
Up718 → 786
68 • 9.47%
Assets
No comparison- → -
No earlier value available.
Investment Management Fee
-
Admin expenses - • Total expenses -
Filing Details
ContextNo event flags were generated for this filing.
Status Flags
Limited-scope audit performed
Not reported
Contributions transmitted on time
Not reported
Participant loans in default
Not reported
Leases in default
Not reported
Reportable party-in-interest issues
Not reported
Loss discovered during year
Not reported
Assets with undetermined value
Not reported
Non-cash contributions
Not reported
Assets held for investment
Not reported
5% transactions reported
Not reported
All plan assets distributed
Not reported
Benefits paid when due
Not reported
Plan blackout period
Not reported
Plan termination resolution adopted
Not reported
Counterparties
Company Timeline
This filing is highlighted inside the broader sponsor history.
| Year / Filing | Filings | Participants | Assets | Contributions | Contrib./Participant |
|---|---|---|---|---|---|
| 2018 | 2 | 1,061 | $14,011,709 | $1,246,445 | $1,175iApproximate average salary by contribution assumption: employee only about $29,370 at 4% or $19,580 at 6%; with 50% employer match about $19,580 at 4% or $13,053 at 6%; with 100% employer match about $14,685 at 4% or $9,790 at 6%. |
| Absolut Retirement Savings Plan | - | 1,061 | $14,011,709 | $1,246,445 | $1,175iApproximate average salary by contribution assumption: employee only about $29,370 at 4% or $19,580 at 6%; with 50% employer match about $19,580 at 4% or $13,053 at 6%; with 100% employer match about $14,685 at 4% or $9,790 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 727 | - | - | - |
| 2017 | 2 | 1,025 | $15,170,289 | $1,279,852 | $1,249iApproximate average salary by contribution assumption: employee only about $31,216 at 4% or $20,811 at 6%; with 50% employer match about $20,811 at 4% or $13,874 at 6%; with 100% employer match about $15,608 at 4% or $10,405 at 6%. |
| Absolut Retirement Savings Plan | - | 861 | $15,170,289 | $1,279,852 | $1,486iApproximate average salary by contribution assumption: employee only about $37,162 at 4% or $24,775 at 6%; with 50% employer match about $24,775 at 4% or $16,516 at 6%; with 100% employer match about $18,581 at 4% or $12,387 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 1,025 | - | - | - |
| 2016 | 2 | 1,089 | $12,511,055 | $1,252,110 | $1,150iApproximate average salary by contribution assumption: employee only about $28,744 at 4% or $19,163 at 6%; with 50% employer match about $19,163 at 4% or $12,775 at 6%; with 100% employer match about $14,372 at 4% or $9,581 at 6%. |
| Absolut Retirement Savings Plan | - | 1,067 | $12,511,055 | $1,252,110 | $1,173iApproximate average salary by contribution assumption: employee only about $29,337 at 4% or $19,558 at 6%; with 50% employer match about $19,558 at 4% or $13,039 at 6%; with 100% employer match about $14,669 at 4% or $9,779 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 1,089 | - | - | - |
| 2015 | 2 | 1,045 | $12,002,338 | $1,082,216 | $1,036iApproximate average salary by contribution assumption: employee only about $25,890 at 4% or $17,260 at 6%; with 50% employer match about $17,260 at 4% or $11,507 at 6%; with 100% employer match about $12,945 at 4% or $8,630 at 6%. |
| Absolut Retirement Savings Plan | - | 665 | $12,002,338 | $1,082,216 | $1,627iApproximate average salary by contribution assumption: employee only about $40,685 at 4% or $27,123 at 6%; with 50% employer match about $27,123 at 4% or $18,082 at 6%; with 100% employer match about $20,342 at 4% or $13,562 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 1,045 | - | - | - |
| 2014 | 2 | 663 | $13,023,616 | $1,165,728 | $1,758iApproximate average salary by contribution assumption: employee only about $43,957 at 4% or $29,304 at 6%; with 50% employer match about $29,304 at 4% or $19,536 at 6%; with 100% employer match about $21,978 at 4% or $14,652 at 6%. |
| Absolut Retirement Savings Plan | - | 663 | $13,023,616 | $1,165,728 | $1,758iApproximate average salary by contribution assumption: employee only about $43,957 at 4% or $29,304 at 6%; with 50% employer match about $29,304 at 4% or $19,536 at 6%; with 100% employer match about $21,978 at 4% or $14,652 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | - | - | - | - |
| 2013 | 2 | 910 | $12,284,084 | $999,985 | $1,099iApproximate average salary by contribution assumption: employee only about $27,472 at 4% or $18,315 at 6%; with 50% employer match about $18,315 at 4% or $12,210 at 6%; with 100% employer match about $13,736 at 4% or $9,157 at 6%. |
| Absolut Retirement Savings Plan | - | 664 | $12,284,084 | $999,985 | $1,506iApproximate average salary by contribution assumption: employee only about $37,650 at 4% or $25,100 at 6%; with 50% employer match about $25,100 at 4% or $16,733 at 6%; with 100% employer match about $18,825 at 4% or $12,550 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 910 | - | - | - |
| 2012 | 2 | 933 | $10,856,478 | $1,001,527 | $1,073iApproximate average salary by contribution assumption: employee only about $26,836 at 4% or $17,891 at 6%; with 50% employer match about $17,891 at 4% or $11,927 at 6%; with 100% employer match about $13,418 at 4% or $8,945 at 6%. |
| Absolut Retirement Savings Plan | - | 678 | $10,856,478 | $1,001,527 | $1,477iApproximate average salary by contribution assumption: employee only about $36,929 at 4% or $24,620 at 6%; with 50% employer match about $24,620 at 4% or $16,413 at 6%; with 100% employer match about $18,465 at 4% or $12,310 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 933 | - | - | - |
| 2011 | 2 | 1,105 | $9,508,369 | $1,163,814 | $1,053iApproximate average salary by contribution assumption: employee only about $26,331 at 4% or $17,554 at 6%; with 50% employer match about $17,554 at 4% or $11,703 at 6%; with 100% employer match about $13,165 at 4% or $8,777 at 6%. |
| Absolut Retirement Savings Plan | - | 1,105 | $9,508,369 | $1,163,814 | $1,053iApproximate average salary by contribution assumption: employee only about $26,331 at 4% or $17,554 at 6%; with 50% employer match about $17,554 at 4% or $11,703 at 6%; with 100% employer match about $13,165 at 4% or $8,777 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 968 | - | - | - |
| 2010 | 2 | 1,041 | $9,428,870 | $1,269,493 | $1,219iApproximate average salary by contribution assumption: employee only about $30,487 at 4% or $20,325 at 6%; with 50% employer match about $20,325 at 4% or $13,550 at 6%; with 100% employer match about $15,244 at 4% or $10,162 at 6%. |
| Absolut Retirement Savings Plan | - | 1,041 | $9,428,870 | $1,269,493 | $1,219iApproximate average salary by contribution assumption: employee only about $30,487 at 4% or $20,325 at 6%; with 50% employer match about $20,325 at 4% or $13,550 at 6%; with 100% employer match about $15,244 at 4% or $10,162 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 917 | - | - | - |
| 2009 | 2 | 1,084 | $7,958,232 | $1,098,763 | $1,014iApproximate average salary by contribution assumption: employee only about $25,340 at 4% or $16,894 at 6%; with 50% employer match about $16,894 at 4% or $11,262 at 6%; with 100% employer match about $12,670 at 4% or $8,447 at 6%. |
| Absolut Retirement Savings Plan | - | 1,084 | $7,958,232 | $1,098,763 | $1,014iApproximate average salary by contribution assumption: employee only about $25,340 at 4% or $16,894 at 6%; with 50% employer match about $16,894 at 4% or $11,262 at 6%; with 100% employer match about $12,670 at 4% or $8,447 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 807 | - | - | - |
| 2008 | 2 | 987 | $5,515,686 | $816,411 | $827iApproximate average salary by contribution assumption: employee only about $20,679 at 4% or $13,786 at 6%; with 50% employer match about $13,786 at 4% or $9,191 at 6%; with 100% employer match about $10,340 at 4% or $6,893 at 6%. |
| Absolut Retirement Savings Plan | - | 987 | $5,515,686 | $816,411 | $827iApproximate average salary by contribution assumption: employee only about $20,679 at 4% or $13,786 at 6%; with 50% employer match about $13,786 at 4% or $9,191 at 6%; with 100% employer match about $10,340 at 4% or $6,893 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | - | 796 | - | - | - |
| 2007 | 2 | 936 | $7,291,430 | $806,933 | $862iApproximate average salary by contribution assumption: employee only about $21,553 at 4% or $14,368 at 6%; with 50% employer match about $14,368 at 4% or $9,579 at 6%; with 100% employer match about $10,776 at 4% or $7,184 at 6%. |
| Absolut Retirement Savings Plan | - | 936 | $7,291,430 | $806,933 | $862iApproximate average salary by contribution assumption: employee only about $21,553 at 4% or $14,368 at 6%; with 50% employer match about $14,368 at 4% or $9,579 at 6%; with 100% employer match about $10,776 at 4% or $7,184 at 6%. |
| Absolut Facilities Management LLC Flexible Benefits Plan | Current | 786 | - | - | - |
Schedule Details
Schedule A
- Row 1
- Filing Id
- 84037347344278
- Form Id
- 93410003
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020003
- Ins Broker 01 Name
- LAWLEY BENEFITS GROVP LLC
- Ins Broker 01 Street Addr
- 361 DELAWARE AVE
- Ins Broker 01 City
- BUFFALO
- Ins Broker 01 State
- NY
- Ins Broker 01 ZIP Code
- 14202
- Ins Broker Comm Pd 01 Amount
- $1,562
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 2
- Filing Id
- 84037347344278
- Form Id
- 93410006
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020006
- Ins Broker 01 Name
- LAWLEY BENEFITS GROUP LLC
- Ins Broker 01 Street Addr
- 361 DELAWARE AVE
- Ins Broker 01 City
- BUFFALO
- Ins Broker 01 State
- NY
- Ins Broker 01 ZIP Code
- 14202
- Ins Broker Comm Pd 01 Amount
- $1,422
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 3
- Filing Id
- 84037347344278
- Form Id
- 93410008
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020008
- Ins Broker 01 Name
- LAWLEY BENEFITS GROUP LLC
- Ins Broker 01 Street Addr
- 361 DELAWAAE AVE
- Ins Broker 01 City
- BUFFALO
- Ins Broker 01 State
- NY
- Ins Broker 01 ZIP Code
- 14202
- Ins Broker Comm Pd 01 Amount
- $1,704
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 4
- Filing Id
- 84037347344278
- Form Id
- 93410005
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020005
- Ins Broker 01 Name
- LAWLEY SERVICE INC
- Ins Broker 01 Street Addr
- 361 DELAWARE AVE
- Ins Broker 01 City
- BUFFALO
- Ins Broker 01 State
- NY
- Ins Broker 01 ZIP Code
- 14202
- Ins Broker Comm Pd 01 Amount
- $2,921
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 5
- Filing Id
- 84037347344278
- Form Id
- 93410002
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020002
- Ins Broker 01 Name
- LAWLEY BENEFITS GROUP LLC
- Ins Broker 01 Street Addr
- 361 DELAWARE AVENUE
- Ins Broker 01 City
- BUFFALO
- Ins Broker 01 State
- NY
- Ins Broker 01 ZIP Code
- 14202
- Ins Broker Comm Pd 01 Amount
- $12,687
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 6
- Filing Id
- 84037347344278
- Form Id
- 93410010
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020010
- Ins Broker 01 Name
- LAWZEY BENEFITS GROUP LLC
- Ins Broker 01 Street Addr
- 361 DELAWARE AVE
- Ins Broker 01 City
- BUFFALO
- Ins Broker 01 State
- NY
- Ins Broker 01 ZIP Code
- 14202
- Ins Broker Comm Pd 01 Amount
- $5
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 7
- Filing Id
- 84037347344278
- Form Id
- 93410007
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020007
- Ins Broker 01 Name
- LAWLEY BENEFITS GROVP LLC
- Ins Broker 01 Street Addr
- 361 OELAWARE AVE
- Ins Broker 01 City
- BUFFALO
- Ins Broker 01 State
- NY
- Ins Broker 01 ZIP Code
- 14202
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 8
- Filing Id
- 84037347344278
- Form Id
- 93410009
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020009
- Ins Broker 01 Name
- LAWLEY BENEFITS GROUP LLC
- Ins Broker 01 Street Addr
- 361 DELAWARE AVE
- Ins Broker 01 City
- BUFFALO
- Ins Broker 01 State
- NY
- Ins Broker 01 ZIP Code
- 14202
- Ins Broker Comm Pd 01 Amount
- $1,422
- Ins Broker Fees Pd 01 Amount
- $0
- Ins Broker 01 Code
- 3
- Row 9
- Filing Id
- 84037347344278
- Form Id
- 93410004
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020004
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 10
- Filing Id
- 84037347344278
- Form Id
- 93410009
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 7020378347344020009
- Ins Broker 01 ZIP Code
- 1
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 11
- Filing Id
- 84037347344278
- Form Id
- 93410008
- Page Id
- 2
- Page Seq
- 0
- Page Row Num
- 2
- Row Num
- 1
- Image Form Id
- 7020378347344020008
- Ins Broker 01 ZIP Code
- 1
- Ins Broker Comm Pd 01 Amount
- $0
- Ins Broker Fees Pd 01 Amount
- $0
- Row 12
- Ins Carrier Name: GHIHMO
- Filing Id
- 84037347344278
- Form Id
- 93410009
- Schedule A EIN
- 20-8471412
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2007-06-07
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- GHIHMO
- Ins Carrier EIN
- 13-4061844
- Ins Carrier Naic Code
- 95835
- Ins Contract Num
- 2059392601
- Ins Prsn Covered End of year Count
- 196
- Ins Policy From Date
- 2007-06-07
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $1,422
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- AHJ
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $40,639
- Wlfr Acquis Cost Amount
- $0
- Row 13
- Ins Carrier Name: MVP HEALTHCARE INC
- Filing Id
- 84037347344278
- Form Id
- 93410008
- Schedule A EIN
- 20-8471412
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2007-06-07
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- MVP HEALTHCARE INC
- Ins Carrier EIN
- 14-1640868
- Ins Carrier Naic Code
- 95521
- Ins Contract Num
- 214119
- Ins Prsn Covered End of year Count
- 21
- Ins Policy From Date
- 2007-06-07
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $1,704
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- AH
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $47,372
- Wlfr Acquis Cost Amount
- $0
- Row 14
- Ins Carrier Name: PROVIDENT LIFE AND ACCIDENT
- Filing Id
- 84037347344278
- Form Id
- 93410004
- Schedule A EIN
- 20-8471412
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2007-06-07
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- PROVIDENT LIFE AND ACCIDENT
- Ins Carrier EIN
- 62-0331200
- Ins Carrier Naic Code
- 68195
- Ins Contract Num
- 36806
- Ins Prsn Covered End of year Count
- 64
- Ins Policy From Date
- 2007-06-07
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $0
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- D
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $14,118
- Wlfr Acquis Cost Amount
- $0
- Row 15
- Ins Carrier Name: EXCELLUS BLUECROSS BLUESHIELD PLAN
- Filing Id
- 84037347344278
- Form Id
- 93410006
- Schedule A EIN
- 20-8471412
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2007-06-07
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- EXCELLUS BLUECROSS BLUESHIELD PLAN
- Ins Carrier EIN
- 15-0329043
- Ins Carrier Naic Code
- 55107
- Ins Contract Num
- 501412002003004
- Ins Prsn Covered End of year Count
- 39
- Ins Policy From Date
- 2007-06-07
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $1,422
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- AH
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $50,278
- Wlfr Acquis Cost Amount
- $0
- Row 16
- Ins Carrier Name: FIRST UNUM LIFE INSVRANCE COMPANY
- Filing Id
- 84037347344278
- Form Id
- 93410003
- Schedule A EIN
- 20-8471412
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2007-06-07
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- FIRST UNUM LIFE INSVRANCE COMPANY
- Ins Carrier EIN
- 13-1898173
- Ins Carrier Naic Code
- 64297
- Ins Contract Num
- 465302
- Ins Prsn Covered End of year Count
- 148
- Ins Policy From Date
- 2007-06-07
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $1,562
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- D
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $10,158
- Wlfr Acquis Cost Amount
- $0
- Row 17
- Ins Carrier Name: INDEPENDENT HEALTH
- Filing Id
- 84037347344278
- Form Id
- 93410010
- Schedule A EIN
- 20-8471412
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2007-06-07
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- INDEPENDENT HEALTH
- Ins Carrier EIN
- 16-1080163
- Ins Carrier Naic Code
- 95308
- Ins Contract Num
- 10584F
- Ins Prsn Covered End of year Count
- 192
- Ins Policy From Date
- 2007-06-07
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $5
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- AHJ
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $416,687
- Wlfr Acquis Cost Amount
- $0
- Row 18
- Ins Carrier Name: THE HARTFORD
- Filing Id
- 84037347344278
- Form Id
- 93410005
- Schedule A EIN
- 20-8471412
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2007-06-07
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- THE HARTFORD
- Ins Carrier EIN
- 06-0974148
- Ins Carrier Naic Code
- 88072
- Ins Contract Num
- 3038256
- Ins Prsn Covered End of year Count
- 250
- Ins Policy From Date
- 2007-06-07
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $2,921
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- DJ
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $21,250
- Wlfr Acquis Cost Amount
- $0
- Row 19
- Ins Carrier Name: HEALTHNOW NEW YORK DBA BLUECXOSS BLUESHIELD OF WESTERN NEW YORX
- Filing Id
- 84037347344278
- Form Id
- 93410002
- Schedule A EIN
- 20-8471412
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2007-06-07
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- HEALTHNOW NEW YORK DBA BLUECXOSS BLUESHIELD OF WESTERN NEW YORX
- Ins Carrier EIN
- 16-1105741
- Ins Carrier Naic Code
- 55204
- Ins Contract Num
- 00996459
- Ins Prsn Covered End of year Count
- 213
- Ins Policy From Date
- 2007-06-07
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $12,687
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- HJLM
- Wlfr Type Bnft Oth Text
- POS
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $487,259
- Wlfr Acquis Cost Amount
- $0
- Row 20
- Ins Carrier Name: UNIVERA HEALTHCARE
- Filing Id
- 84037347344278
- Form Id
- 93410007
- Schedule A EIN
- 20-8471412
- Schedule A Plan Num
- 501
- Schedule A Plan Year Begin Date
- 2007-06-07
- Schedule A Tax Period
- 20071231
- Ins Carrier Name
- UNIVERA HEALTHCARE
- Ins Carrier EIN
- 15-0329043
- Ins Carrier Naic Code
- 55107
- Ins Contract Num
- AH46
- Ins Prsn Covered End of year Count
- 153
- Ins Policy From Date
- 2007-06-07
- Ins Policy To Date
- 2007-12-31
- Ins Broker Comm Total Amount
- $11,219
- Ins Broker Fees Total Amount
- $0
- Pension End of year Gen Account Amount
- $0
- Pension End of year Sep Account Amount
- $0
- Pension Prem Paid Total Amount
- $0
- Pension Unpaid Premium Amount
- $0
- Pension Contract Cost Amount
- $0
- Pension End Prev Bal Amount
- $0
- Pension Contribution Dep Amount
- $0
- Pension Divnd Cr Dep Amount
- $0
- Pension Interest Cr Dur Yr Amount
- $0
- Pension Transfer From Amount
- $0
- Pension Other Amount
- $0
- Pension Total Additions Amount
- $0
- Pension Total Bal Addn Amount
- $0
- Pension Bnfts Dsbrsd Amount
- $0
- Pension Admin Chrg Amount
- $0
- Pension Transfer To Amount
- $0
- Pension Oth Ded Amount
- $0
- Pension Total Ded Amount
- $0
- Pension End of year Bal Amount
- $0
- Wlfr Type Bnft Indicator
- AH
- Wlfr Premium Rcvd Amount
- $0
- Wlfr Unpaid Due Amount
- $0
- Wlfr Reserve Amount
- $0
- Wlfr Total Earned Prem Amount
- $0
- Wlfr Claims Paid Amount
- $0
- Wlfr Incr Reserve Amount
- $0
- Wlfr Incurred Claim Amount
- $0
- Wlfr Claims Chrgd Amount
- $0
- Wlfr Ret Commissions Amount
- $0
- Wlfr Ret Admin Amount
- $0
- Wlfr Ret Oth Cost Amount
- $0
- Wlfr Ret Oth Expense Amount
- $0
- Wlfr Ret Taxes Amount
- $0
- Wlfr Ret Charges Amount
- $0
- Wlfr Ret Oth Chrgs Amount
- $0
- Wlfr Ret Total Amount
- $0
- Wlfr Refund Amount
- $0
- Wlfr Held Bnfts Amount
- $0
- Wlfr Claims Reserve Amount
- $0
- Wlfr Oth Reserve Amount
- $0
- Wlfr Divnds Due Amount
- $0
- Wlfr Total Charges Paid Amount
- $316,482
- Wlfr Acquis Cost Amount
- $0
Schedule C
Schedule C Provider
Provider 1
Provider details
Source fields
- Row 1
- Filing Id
- 84037347344278
- Page Id
- 1
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020011
- Provider 01 Name
- NOVA HEALTHCARE ADMINISTRATORS
- Provider 01 EIN
- 16-6443379
- Provider 01 Position
- CONTRACT ADMINISTRATOR
- Provider 01 Relation
- NONE
- Provider 01 Salary Amount
- $0
- Provider 01 Fees Amount
- $11,568
- Provider 01 Srvc Code
- 12
- Row 2
- Filing Id
- 84037347344278
- Page Id
- 3
- Page Seq
- 0
- Page Row Num
- 1
- Row Num
- 0
- Image Form Id
- 7020378347344020011
Schedule C Provider
Provider 2
Provider details
Source fields
- Row 3
- Filing Id
- 84037347344278
- Schedule C EIN
- 20-8471412
- Schedule C Plan number
- 501
- Schedule C Plan Year Begin Date
- 2007-06-07
- Schedule C Tax Period
- 20071231
- Provider Total Comp Paid Amount
- $0