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403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 401k Plan overview

Plan Name403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC.
Plan identification number 003

403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 403(b)(1) arrangement - See Limited Pension Plan Reporting instructions for Code section 403(b)(1) arrangements for certain exempt organizations.
  • Code section 403(b)(7) accounts - See Limited Pension Plan Reporting instructions for Code section 403(b)(7) custodial accounts for regulated investment company stock for certain exempt organizations.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

WEST BERGEN MENTAL HEALTHCARE, INC. has sponsored the creation of one or more 401k plans.

Company Name:WEST BERGEN MENTAL HEALTHCARE, INC.
Employer identification number (EIN):221736531
NAIC Classification:621420
NAIC Description:Outpatient Mental Health and Substance Abuse Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0032022-01-01
0032021-01-01CARLTON E MEIER2022-07-05 CARLTON E MEIER2022-07-05
0032020-01-01CARLTON E. MEIER2021-06-16 CARLTON E. MEIER2021-06-16
0032020-01-01CARLTON E. MEIER2021-06-16 CARLTON E. MEIER2021-06-16
0032019-01-01CARLTON MEIER2020-06-30
0032019-01-01
0032018-01-01CARLTON MEIER
0032018-01-01
0032017-01-01CARLTON E MEIER2018-04-10 CARLTON E MEIER2018-04-10
0032016-01-01CARLTON E. MEIER2017-03-28 CARLTON E. MEIER2017-03-28
0032015-01-01CARLTON E. MEIER2016-05-03 CARLTON E. MEIER2016-05-03
0032014-01-01CARLTON E. MEIER2015-05-18 CARLTON E. MEIER2015-05-18
0032013-01-01CARLTON E. MEIER2014-05-27 CARLTON E. MEIER2014-05-27
0032012-01-01CARLTON E. MEIER2013-04-08 CARLTON E. MEIER2013-04-08
0032011-01-01CARLTON E. MEIER2012-05-29 CARLTON E. MEIER2012-05-29
0032010-01-01WEST BERGEN MENTAL HEALTHCARE, INC.2011-07-26 BY CARLTON E. MEIER, CFO2011-07-26

Plan Statistics for 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC.

401k plan membership statisitcs for 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC.

Measure Date Value
2022: 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 2022 401k membership
Total participants, beginning-of-year2022-01-01195
Total number of active participants reported on line 7a of the Form 55002022-01-01162
Number of retired or separated participants receiving benefits2022-01-010
Number of other retired or separated participants entitled to future benefits2022-01-0125
Total of all active and inactive participants2022-01-01187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2022-01-010
Total participants2022-01-01187
Number of participants with account balances2022-01-0197
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2022-01-014
2019: 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 2019 401k membership
Total participants, beginning-of-year2019-01-01104
Total number of active participants reported on line 7a of the Form 55002019-01-0173
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-0128
Total of all active and inactive participants2019-01-01101
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2019-01-010
Total participants2019-01-01101
Number of participants with account balances2019-01-0199
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2019-01-011
2018: 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 2018 401k membership
Total participants, beginning-of-year2018-01-01102
Total number of active participants reported on line 7a of the Form 55002018-01-0174
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-0130
Total of all active and inactive participants2018-01-01104
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-01104
Number of participants with account balances2018-01-01104
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010

Financial Data on 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC.

Measure Date Value
2022 : 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-1,889,790
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,025,855
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,003,181
Value of total corrective distributions2022-12-31$4,063
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$674,287
Value of total assets at end of year2022-12-31$13,490,704
Value of total assets at beginning of year2022-12-31$16,406,349
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$18,611
Total interest from all sources2022-12-31$46,412
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$202,885
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$202,885
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$3,000,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$506,719
Participant contributions at end of year2022-12-31$83,921
Participant contributions at beginning of year2022-12-31$102,334
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-2,915,645
Value of net assets at end of year (total assets less liabilities)2022-12-31$13,490,704
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$16,406,349
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$6,809
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$9,810,228
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$13,682,661
Value of interest in pooled separate accounts at end of year2022-12-31$755,747
Value of interest in pooled separate accounts at beginning of year2022-12-31$1,069,037
Interest on participant loans2022-12-31$2,978
Income. Interest from loans (other than to participants)2022-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$2,840,808
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$1,552,317
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$1,552,317
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$43,434
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-2,536,480
Net investment gain or loss from common/collective trusts2022-12-31$-276,894
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$167,568
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,003,181
Contract administrator fees2022-12-31$11,802
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31GELTRUDE & COMPANY, LLC
Accountancy firm EIN2022-12-31223363665
2019 : 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$2,875,619
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$70,234
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$69,536
Expenses. Certain deemed distributions of participant loans2019-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$651,533
Value of total assets at end of year2019-12-31$12,957,579
Value of total assets at beginning of year2019-12-31$10,152,194
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$698
Total interest from all sources2019-12-31$35,945
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2019-12-31$0
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$483,512
Participant contributions at end of year2019-12-31$163,056
Participant contributions at beginning of year2019-12-31$99,527
Income. Received or receivable in cash from other sources (including rollovers)2019-12-31$2,206
Other income not declared elsewhere2019-12-31$0
Administrative expenses (other) incurred2019-12-31$698
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$2,805,385
Value of net assets at end of year (total assets less liabilities)2019-12-31$12,957,579
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$10,152,194
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$10,961,762
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$8,037,245
Interest on participant loans2019-12-31$0
Interest earned on other investments2019-12-31$35,945
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-12-31$1,832,761
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-12-31$2,015,422
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$0
Net investment gain/loss from pooled separate accounts2019-12-31$2,188,141
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$165,815
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$69,536
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
2018 : 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$430,646
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$122,410
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$121,692
Expenses. Certain deemed distributions of participant loans2018-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$988,860
Value of total assets at end of year2018-12-31$10,152,194
Value of total assets at beginning of year2018-12-31$9,843,958
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$718
Total interest from all sources2018-12-31$18,517
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$0
Total income from all sources2018-12-31$430,646
Expenses. Total of all expenses incurred2018-12-31$122,410
Benefits paid (including direct rollovers)2018-12-31$121,692
Total plan assets at end of year2018-12-31$10,152,194
Total plan assets at beginning of year2018-12-31$9,843,958
Value of fidelity bond covering the plan2018-12-31$3,000,000
Total contributions received or receivable from participants2018-12-31$463,114
Expenses. Other expenses not covered elsewhere2018-12-31$718
Contributions received from other sources (not participants or employers)2018-12-31$361,932
Other income received2018-12-31$-558,214
Net income (gross income less expenses)2018-12-31$308,236
Net plan assets at end of year (total assets less liabilities)2018-12-31$10,152,194
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$9,843,958
Assets. Value of participant loans2018-12-31$99,526
Total contributions received or receivable from employer(s)2018-12-31$163,814
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$3,000,000
If this is an individual account plan, was there a blackout period2018-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$463,114
Participant contributions at end of year2018-12-31$99,526
Participant contributions at beginning of year2018-12-31$48,286
Income. Received or receivable in cash from other sources (including rollovers)2018-12-31$361,932
Other income not declared elsewhere2018-12-31$0
Administrative expenses (other) incurred2018-12-31$718
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$308,236
Value of net assets at end of year (total assets less liabilities)2018-12-31$10,152,194
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$9,843,958
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$8,037,246
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$8,266,579
Interest on participant loans2018-12-31$0
Interest earned on other investments2018-12-31$18,517
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-12-31$2,015,422
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-12-31$1,529,093
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$0
Net investment gain/loss from pooled separate accounts2018-12-31$-576,731
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$163,814
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$121,692
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer

Form 5500 Responses for 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC.

2022: 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedYes
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2019: 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: 403(B) THRIFT PLAN OF WEST BERGEN MENTAL HEALTHCARE, INC. 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedYes
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan 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 number007505J
Policy instance 1
Insurance contract or identification number007505J
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,272
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 BenefitNo
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
Amount paid for insurance broker fees3272
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 number007505J
Policy instance 1
Insurance contract or identification number007505J
Number of Individuals Covered101
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $1,981
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 Administration1
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 BenefitNo
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
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 fees1981
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 number007505J
Policy instance 1
Insurance contract or identification number007505J
Number of Individuals Covered104
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,272
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 Administration1
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 BenefitNo
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
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 fees3272
Additional information about fees paid to insurance brokerPORTION OF INCENTIVE COMP. PROGRAM
Insurance broker organization code?3

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