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GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 401k Plan overview

Plan NameGROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC.
Plan identification number 501

GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Life insurance

401k Sponsoring company profile

ELDER SERVICES OF WORCESTER AREA, I NC. has sponsored the creation of one or more 401k plans.

Company Name:ELDER SERVICES OF WORCESTER AREA, I NC.
Employer identification number (EIN):042545221
NAIC Classification:624200

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01
5012020-07-01
5012018-07-01
5012017-07-01
5012016-07-01
5012015-07-01
5012014-07-01
5012013-07-01
5012012-07-01
5012011-07-01
5012010-07-01

Plan Statistics for GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC.

401k plan membership statisitcs for GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC.

Measure Date Value
2021: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2021 401k membership
Total participants, beginning-of-year2021-07-01166
Total number of active participants reported on line 7a of the Form 55002021-07-01173
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01173
Total participants2021-07-01173
2020: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2020 401k membership
Total participants, beginning-of-year2020-07-01164
Total number of active participants reported on line 7a of the Form 55002020-07-01166
Number of retired or separated participants receiving benefits2020-07-010
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01166
Total participants2020-07-01166
2018: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2018 401k membership
Total participants, beginning-of-year2018-07-01150
Total number of active participants reported on line 7a of the Form 55002018-07-01157
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01157
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-07-010
Total participants2018-07-01157
Number of participants with account balances2018-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-07-010
2017: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2017 401k membership
Total participants, beginning-of-year2017-07-01147
Total number of active participants reported on line 7a of the Form 55002017-07-01150
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-07-010
Total participants2017-07-01150
Number of participants with account balances2017-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-07-010
2016: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2016 401k membership
Total participants, beginning-of-year2016-07-01155
Total number of active participants reported on line 7a of the Form 55002016-07-01147
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01147
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-07-010
Total participants2016-07-01147
Number of participants with account balances2016-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-07-010
2015: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2015 401k membership
Total participants, beginning-of-year2015-07-01150
Total number of active participants reported on line 7a of the Form 55002015-07-01155
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-07-010
Total participants2015-07-01155
Number of participants with account balances2015-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-07-010
2014: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2014 401k membership
Total participants, beginning-of-year2014-07-01141
Total number of active participants reported on line 7a of the Form 55002014-07-01150
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-010
Total participants2014-07-01150
Number of participants with account balances2014-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-07-010
2013: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2013 401k membership
Total participants, beginning-of-year2013-07-01362
Total number of active participants reported on line 7a of the Form 55002013-07-01141
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01141
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-07-010
Total participants2013-07-01141
Number of participants with account balances2013-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-07-010
2012: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2012 401k membership
Total participants, beginning-of-year2012-07-01171
Total number of active participants reported on line 7a of the Form 55002012-07-01362
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01362
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-01362
Number of participants with account balances2012-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-07-010
2011: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2011 401k membership
Total participants, beginning-of-year2011-07-01110
Total number of active participants reported on line 7a of the Form 55002011-07-01171
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01171
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-010
Total participants2011-07-01171
Number of participants with account balances2011-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-07-010
2010: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2010 401k membership
Total participants, beginning-of-year2010-07-01131
Total number of active participants reported on line 7a of the Form 55002010-07-01110
Number of retired or separated participants receiving benefits2010-07-010
Number of other retired or separated participants entitled to future benefits2010-07-010
Total of all active and inactive participants2010-07-01110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-07-010
Total participants2010-07-01110
Number of participants with account balances2010-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-07-010

Financial Data on GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC.

Measure Date Value
2022 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$0
Total income from all sources (including contributions)2022-06-30$0
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$0
Value of total assets at end of year2022-06-30$0
Value of total assets at beginning of year2022-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$0
Total interest from all sources2022-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$0
Was this plan covered by a fidelity bond2022-06-30No
Total non interest bearing cash at end of year2022-06-30$0
Total non interest bearing cash at beginning of year2022-06-30$0
Value of net income/loss2022-06-30$0
Value of net assets at end of year (total assets less liabilities)2022-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$0
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
2021 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$0
Total income from all sources (including contributions)2021-06-30$0
Total loss/gain on sale of assets2021-06-30$0
Total of all expenses incurred2021-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$0
Value of total assets at end of year2021-06-30$0
Value of total assets at beginning of year2021-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$0
Total interest from all sources2021-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$0
Was this plan covered by a fidelity bond2021-06-30No
Value of net income/loss2021-06-30$0
Value of net assets at end of year (total assets less liabilities)2021-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$0
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
2019 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$0
Total income from all sources (including contributions)2019-06-30$0
Total loss/gain on sale of assets2019-06-30$0
Total of all expenses incurred2019-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$0
Value of total assets at end of year2019-06-30$0
Value of total assets at beginning of year2019-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$0
Total interest from all sources2019-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$0
Total non interest bearing cash at end of year2019-06-30$0
Total non interest bearing cash at beginning of year2019-06-30$0
Value of net income/loss2019-06-30$0
Value of net assets at end of year (total assets less liabilities)2019-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$0
2018 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$0
Total income from all sources (including contributions)2018-06-30$0
Total loss/gain on sale of assets2018-06-30$0
Total of all expenses incurred2018-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-06-30$0
Value of total assets at end of year2018-06-30$0
Value of total assets at beginning of year2018-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-06-30$0
Total interest from all sources2018-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2018-06-30$0
Total non interest bearing cash at end of year2018-06-30$0
Total non interest bearing cash at beginning of year2018-06-30$0
Value of net income/loss2018-06-30$0
Value of net assets at end of year (total assets less liabilities)2018-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2018-06-30$0
2017 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$0
Total income from all sources (including contributions)2017-06-30$0
Total loss/gain on sale of assets2017-06-30$0
Total of all expenses incurred2017-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$0
Value of total assets at end of year2017-06-30$0
Value of total assets at beginning of year2017-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$0
Total interest from all sources2017-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2017-06-30$0
Total non interest bearing cash at end of year2017-06-30$0
Total non interest bearing cash at beginning of year2017-06-30$0
Value of net income/loss2017-06-30$0
Value of net assets at end of year (total assets less liabilities)2017-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$0
2016 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$0
Total income from all sources (including contributions)2016-06-30$0
Total loss/gain on sale of assets2016-06-30$0
Total of all expenses incurred2016-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$0
Value of total assets at end of year2016-06-30$0
Value of total assets at beginning of year2016-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$0
Total interest from all sources2016-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2016-06-30$0
Total non interest bearing cash at end of year2016-06-30$0
Total non interest bearing cash at beginning of year2016-06-30$0
Value of net income/loss2016-06-30$0
Value of net assets at end of year (total assets less liabilities)2016-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$0
2015 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$0
Total income from all sources (including contributions)2015-06-30$0
Total loss/gain on sale of assets2015-06-30$0
Total of all expenses incurred2015-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$0
Value of total assets at end of year2015-06-30$0
Value of total assets at beginning of year2015-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$0
Total interest from all sources2015-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2015-06-30$0
Total non interest bearing cash at end of year2015-06-30$0
Total non interest bearing cash at beginning of year2015-06-30$0
Value of net income/loss2015-06-30$0
Value of net assets at end of year (total assets less liabilities)2015-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$0
2014 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$0
Total income from all sources (including contributions)2014-06-30$0
Total loss/gain on sale of assets2014-06-30$0
Total of all expenses incurred2014-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$0
Value of total assets at end of year2014-06-30$0
Value of total assets at beginning of year2014-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$0
Total interest from all sources2014-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2014-06-30$0
Total non interest bearing cash at end of year2014-06-30$0
Total non interest bearing cash at beginning of year2014-06-30$0
Value of net income/loss2014-06-30$0
Value of net assets at end of year (total assets less liabilities)2014-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$0
2013 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$0
Total income from all sources (including contributions)2013-06-30$0
Total loss/gain on sale of assets2013-06-30$0
Total of all expenses incurred2013-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$0
Value of total assets at end of year2013-06-30$0
Value of total assets at beginning of year2013-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$0
Total interest from all sources2013-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$0
Total non interest bearing cash at end of year2013-06-30$0
Total non interest bearing cash at beginning of year2013-06-30$0
Value of net income/loss2013-06-30$0
Value of net assets at end of year (total assets less liabilities)2013-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$0
2012 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$0
Total income from all sources (including contributions)2012-06-30$0
Total loss/gain on sale of assets2012-06-30$0
Total of all expenses incurred2012-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$0
Value of total assets at end of year2012-06-30$0
Value of total assets at beginning of year2012-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$0
Total interest from all sources2012-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2012-06-30$0
Total non interest bearing cash at end of year2012-06-30$0
Total non interest bearing cash at beginning of year2012-06-30$0
Value of net income/loss2012-06-30$0
Value of net assets at end of year (total assets less liabilities)2012-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$0
2011 : GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$0
Total income from all sources (including contributions)2011-06-30$0
Total loss/gain on sale of assets2011-06-30$0
Total of all expenses incurred2011-06-30$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$0
Value of total assets at end of year2011-06-30$0
Value of total assets at beginning of year2011-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$0
Total interest from all sources2011-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2011-06-30$0
Total non interest bearing cash at end of year2011-06-30$0
Total non interest bearing cash at beginning of year2011-06-30$0
Value of net income/loss2011-06-30$0
Value of net assets at end of year (total assets less liabilities)2011-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$0

Form 5500 Responses for GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC.

2021: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01First time form 5500 has been submittedYes
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – InsuranceYes
2020: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01First time form 5500 has been submittedYes
2020-07-01Submission has been amendedNo
2020-07-01This submission is the final filingNo
2020-07-01This return/report is a short plan year return/report (less than 12 months)No
2020-07-01Plan is a collectively bargained planNo
2020-07-01Plan funding arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – InsuranceYes
2018: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01First time form 5500 has been submittedYes
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingNo
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planNo
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – InsuranceYes
2017: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01First time form 5500 has been submittedYes
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01First time form 5500 has been submittedYes
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01First time form 5500 has been submittedYes
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01First time form 5500 has been submittedYes
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01First time form 5500 has been submittedYes
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01First time form 5500 has been submittedYes
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01First time form 5500 has been submittedYes
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: GROUP LIFE INSURANCE PLAN OF ELDER SERVICES OF WORCESTER AREA, INC. 2010 form 5500 responses
2010-07-01Type of plan entitySingle employer plan
2010-07-01First time form 5500 has been submittedYes
2010-07-01Submission has been amendedNo
2010-07-01This submission is the final filingNo
2010-07-01This return/report is a short plan year return/report (less than 12 months)No
2010-07-01Plan is a collectively bargained planNo
2010-07-01Plan funding arrangement – InsuranceYes
2010-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered167
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered173
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $14
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,722
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees14
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered166
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $14
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees14
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered157
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $23
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees23
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered150
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $12
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,173
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees12
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered147
Insurance policy start date2016-07-01
Insurance policy end date2017-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $10
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $5,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees10
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered155
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $19
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,443
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees19
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered150
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $16
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees16
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered141
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $22
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,332
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees22
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered362
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $10
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,950
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees10
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered171
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $13
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees13
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3
MUTUAL OF AMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88668 )
Policy contract number050240-F
Policy instance 1
Insurance contract or identification number050240-F
Number of Individuals Covered110
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $9
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees1
Additional information about fees paid to insurance brokerCOMPENSATION
Insurance broker organization code?3

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