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ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 401k Plan overview

Plan NameROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN
Plan identification number 502

ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Prepaid legal
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

JOINT BOARD OF TRUSTEES ROOFERS UNION LOCAL 30 has sponsored the creation of one or more 401k plans.

Company Name:JOINT BOARD OF TRUSTEES ROOFERS UNION LOCAL 30
Employer identification number (EIN):232258631
NAIC Classification:238100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022022-01-01SHAWN MCCULLOUGH2023-12-05 JUDY FINNEN2023-12-05
5022021-01-01SHAWN MCCULLOUGH2022-10-14 RICHARD HARVEY2022-10-14
5022020-01-01SHAWN MCCULLOUGH2021-10-15 RICHARD HARVEY2021-10-15
5022019-01-01SHAWN MCCULLOUGH2020-10-11 RICHARD HARVEY2020-10-11
5022018-01-01TOM PEDRICK2019-10-02 RICHARD HARVEY2019-10-02
5022017-01-01
5022016-01-01
5022015-01-01
5022014-01-01
5022013-01-01

Plan Statistics for ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN

401k plan membership statisitcs for ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN

Measure Date Value
2022: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01283
Total number of active participants reported on line 7a of the Form 55002022-01-01237
Total of all active and inactive participants2022-01-01237
Number of employers contributing to the scheme2022-01-010
2021: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01302
Total number of active participants reported on line 7a of the Form 55002021-01-01283
Total of all active and inactive participants2021-01-01283
Number of employers contributing to the scheme2021-01-010
2020: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01310
Total number of active participants reported on line 7a of the Form 55002020-01-01302
Total of all active and inactive participants2020-01-01302
2019: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01278
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-01310
Total of all active and inactive participants2019-01-01310
Number of employers contributing to the scheme2019-01-0152
2018: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01325
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-01278
Total of all active and inactive participants2018-01-01278
Number of employers contributing to the scheme2018-01-0143
2017: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01328
Number of retired or separated participants receiving benefits2017-01-01325
Total of all active and inactive participants2017-01-01325
Number of employers contributing to the scheme2017-01-0153
2016: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01333
Number of retired or separated participants receiving benefits2016-01-01328
Total of all active and inactive participants2016-01-01328
Number of employers contributing to the scheme2016-01-0148
2015: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01322
Number of retired or separated participants receiving benefits2015-01-01333
Total of all active and inactive participants2015-01-01333
Number of employers contributing to the scheme2015-01-01120
2014: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01323
Number of retired or separated participants receiving benefits2014-01-01322
Total of all active and inactive participants2014-01-01322
Number of employers contributing to the scheme2014-01-01112
2013: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-010
Number of retired or separated participants receiving benefits2013-01-01323
Total of all active and inactive participants2013-01-01323
Number of employers contributing to the scheme2013-01-010

Financial Data on ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN

Measure Date Value
2022 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$89,162
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$187,432
Total income from all sources (including contributions)2022-12-31$2,098,026
Total of all expenses incurred2022-12-31$2,098,026
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$2,090,521
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$2,098,026
Value of total assets at end of year2022-12-31$89,162
Value of total assets at beginning of year2022-12-31$187,432
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$7,505
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$7,500
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$935,298
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$89,162
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$187,432
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$86,162
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$155,571
Administrative expenses (other) incurred2022-12-31$5
Liabilities. Value of operating payables at end of year2022-12-31$3,000
Liabilities. Value of operating payables at beginning of year2022-12-31$31,861
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$0
Value of net assets at end of year (total assets less liabilities)2022-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$0
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
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$1,262,830
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$1,162,728
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$827,691
Did the plan have assets held for investment2022-12-31No
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 name2022-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2022-12-31222951202
2021 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$187,432
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$148,563
Total income from all sources (including contributions)2021-12-31$2,472,390
Total of all expenses incurred2021-12-31$2,472,390
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$2,447,438
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$2,265,231
Value of total assets at end of year2021-12-31$187,432
Value of total assets at beginning of year2021-12-31$148,563
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$24,952
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$7,500
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$1,032,969
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$187,432
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$148,563
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$155,571
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$122,121
Other income not declared elsewhere2021-12-31$207,159
Administrative expenses (other) incurred2021-12-31$17,452
Liabilities. Value of operating payables at end of year2021-12-31$31,861
Liabilities. Value of operating payables at beginning of year2021-12-31$26,442
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$0
Value of net assets at end of year (total assets less liabilities)2021-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$1,255,300
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$1,232,262
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,192,138
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2021-12-31222951202
2020 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$148,563
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$167,181
Total income from all sources (including contributions)2020-12-31$2,463,918
Total of all expenses incurred2020-12-31$2,463,918
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$2,456,108
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$2,218,220
Value of total assets at end of year2020-12-31$148,563
Value of total assets at beginning of year2020-12-31$167,181
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$7,810
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$7,500
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$1,018,589
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$148,563
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$167,181
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$122,121
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$132,406
Other income not declared elsewhere2020-12-31$245,698
Administrative expenses (other) incurred2020-12-31$310
Liabilities. Value of operating payables at end of year2020-12-31$26,442
Liabilities. Value of operating payables at beginning of year2020-12-31$34,775
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$0
Value of net assets at end of year (total assets less liabilities)2020-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$1,313,324
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$1,199,631
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$1,142,784
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2020-12-31222951202
2019 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$167,181
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$147,337
Total income from all sources (including contributions)2019-12-31$2,543,201
Total of all expenses incurred2019-12-31$2,543,201
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$2,534,240
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$2,423,510
Value of total assets at end of year2019-12-31$167,181
Value of total assets at beginning of year2019-12-31$147,337
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$8,961
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$7,720
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$1,029,703
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$167,181
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$147,337
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$132,406
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-12-31$127,632
Other income not declared elsewhere2019-12-31$119,691
Administrative expenses (other) incurred2019-12-31$1,241
Liabilities. Value of operating payables at end of year2019-12-31$34,775
Liabilities. Value of operating payables at beginning of year2019-12-31$19,705
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$0
Value of net assets at end of year (total assets less liabilities)2019-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$0
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
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$1,551,413
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$1,393,807
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$982,827
Did the plan have assets held for investment2019-12-31No
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)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2019-12-31222951202
2018 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$147,337
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$200,623
Total income from all sources (including contributions)2018-12-31$3,048,890
Total of all expenses incurred2018-12-31$3,048,890
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$3,040,950
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$2,950,378
Value of total assets at end of year2018-12-31$147,337
Value of total assets at beginning of year2018-12-31$200,623
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$7,940
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$7,940
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$1,037,381
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$147,337
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$200,623
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-12-31$127,632
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$161,641
Other income not declared elsewhere2018-12-31$98,512
Liabilities. Value of operating payables at end of year2018-12-31$19,705
Liabilities. Value of operating payables at beginning of year2018-12-31$38,982
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$0
Value of net assets at end of year (total assets less liabilities)2018-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$0
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
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$1,831,770
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$1,912,997
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$1,209,180
Did the plan have assets held for investment2018-12-31No
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)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2018-12-31222951202
2017 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$200,623
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$11,456
Total income from all sources (including contributions)2017-12-31$2,516,202
Total of all expenses incurred2017-12-31$2,516,202
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$2,505,302
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$2,516,202
Value of total assets at end of year2017-12-31$200,623
Value of total assets at beginning of year2017-12-31$11,456
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$10,900
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$9,258
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$1,025,877
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$200,623
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$11,456
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$161,641
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$3,956
Administrative expenses (other) incurred2017-12-31$1,642
Liabilities. Value of operating payables at end of year2017-12-31$38,982
Liabilities. Value of operating payables at beginning of year2017-12-31$7,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$0
Value of net assets at end of year (total assets less liabilities)2017-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$1,720,689
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$1,490,325
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$784,613
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2017-12-31222951202
2016 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$11,456
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$9,115
Total income from all sources (including contributions)2016-12-31$2,450,486
Total of all expenses incurred2016-12-31$2,450,486
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$2,432,612
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$2,447,638
Value of total assets at end of year2016-12-31$11,456
Value of total assets at beginning of year2016-12-31$9,115
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$17,874
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$12,712
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$1,075,026
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$11,456
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$9,115
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$3,956
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$1,415
Other income not declared elsewhere2016-12-31$2,848
Administrative expenses (other) incurred2016-12-31$5,162
Liabilities. Value of operating payables at end of year2016-12-31$7,500
Liabilities. Value of operating payables at beginning of year2016-12-31$7,700
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$0
Value of net assets at end of year (total assets less liabilities)2016-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$1,636,566
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$1,372,612
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$796,046
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2016-12-31222951202
2015 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$9,115
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$8,371
Total income from all sources (including contributions)2015-12-31$2,874,371
Total of all expenses incurred2015-12-31$2,874,371
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$2,871,553
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$2,874,371
Value of total assets at end of year2015-12-31$9,115
Value of total assets at beginning of year2015-12-31$8,371
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$2,818
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$12,804
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$992,708
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$9,115
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$8,371
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$1,415
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$871
Administrative expenses (other) incurred2015-12-31$-9,986
Liabilities. Value of operating payables at end of year2015-12-31$7,700
Liabilities. Value of operating payables at beginning of year2015-12-31$7,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$0
Value of net assets at end of year (total assets less liabilities)2015-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$1,950,170
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$1,881,663
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$921,383
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2015-12-31222951202
2014 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$8,371
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$13,110
Total income from all sources (including contributions)2014-12-31$2,732,234
Total of all expenses incurred2014-12-31$2,732,234
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$2,729,473
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$2,732,234
Value of total assets at end of year2014-12-31$8,371
Value of total assets at beginning of year2014-12-31$13,110
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$2,761
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$7,500
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$756,975
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$8,371
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$13,110
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$871
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$5,610
Administrative expenses (other) incurred2014-12-31$-4,739
Liabilities. Value of operating payables at end of year2014-12-31$7,500
Liabilities. Value of operating payables at beginning of year2014-12-31$7,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$0
Value of net assets at end of year (total assets less liabilities)2014-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$1,945,523
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$1,975,259
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$783,950
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Did the plan have assets held for investment2014-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2014-12-31222951202
2013 : ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$13,110
Total income from all sources (including contributions)2013-12-31$2,467,088
Total of all expenses incurred2013-12-31$2,467,088
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$2,453,978
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$2,467,088
Value of total assets at end of year2013-12-31$13,110
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$13,110
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$7,500
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$758,383
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$13,110
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$5,610
Administrative expenses (other) incurred2013-12-31$5,610
Liabilities. Value of operating payables at end of year2013-12-31$7,500
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$0
Value of net assets at end of year (total assets less liabilities)2013-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$1,708,705
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$2,453,978
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31MSPC CERTIFIED PUBLIC ACCOUNTANTS A
Accountancy firm EIN2013-12-31222951202

Form 5500 Responses for ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN

2022: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entityMulti-employer plan
2022-01-01Submission has been amendedYes
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entityMulti-employer plan
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entityMulti-employer plan
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entityMulti-employer plan
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entityMulti-employer plan
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entityMulti-employer plan
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entityMulti-employer plan
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2015 form 5500 responses
2015-01-01Type of plan entityMulti-employer plan
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2014 form 5500 responses
2014-01-01Type of plan entityMulti-employer plan
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: ROOFERS UNION LOCAL 30 COMBINED RETIREE HEALTH PLAN 2013 form 5500 responses
2013-01-01Type of plan entityMulti-employer plan
2013-01-01First time form 5500 has been submittedYes
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number40405
Policy instance 1
Insurance contract or identification number40405
Number of Individuals Covered335
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 $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number1579
Policy instance 2
Insurance contract or identification number1579
Number of Individuals Covered129
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 $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number40405
Policy instance 1
Insurance contract or identification number40405
Number of Individuals Covered255
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 $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number1579
Policy instance 2
Insurance contract or identification number1579
Number of Individuals Covered127
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 $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
UNITED CONCORDIA COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 89070 )
Policy contract number0057556
Policy instance 3
Insurance contract or identification number0057556
Number of Individuals Covered278
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 $0
Dental Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number40405
Policy instance 1
Insurance contract or identification number40405
Number of Individuals Covered299
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,720,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker name
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number1579
Policy instance 2
Insurance contract or identification number1579
Number of Individuals Covered178
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker name

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