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UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 401k Plan overview

Plan NameUFCW LOCAL 555-EMPLOYERS HEALTH TRUST
Plan identification number 501

UFCW LOCAL 555-EMPLOYERS HEALTH TRUST Benefits

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

401k Sponsoring company profile

BOARD OF TRUSTEES, UFCW LOCAL 555-EMPLOYERS HEALTH has sponsored the creation of one or more 401k plans.

Company Name:BOARD OF TRUSTEES, UFCW LOCAL 555-EMPLOYERS HEALTH
Employer identification number (EIN):237017278
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01
5012016-07-01MILLER KAPLAN ARASE LLP
5012015-07-01MILLER KAPLAN ARASE LLP MILLER KAPLAN ARASE LLP2017-03-24
5012014-07-01MILLER KAPLAN ARASE LLP MILLER KAPLAN ARASE LLP2016-04-15
5012013-07-01SANDY S. GARCIA SANDY S. GARCIA2015-04-08
5012012-07-01SANDY S. GARCIA SANDY S. GARCIA2014-04-09
5012011-07-01PATI PIRO-BOSLEY
5012009-07-01PATI PIRO-BOSLEY

Plan Statistics for UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

401k plan membership statisitcs for UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

Measure Date Value
2021: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2021 401k membership
Total participants, beginning-of-year2021-07-0111,312
Total number of active participants reported on line 7a of the Form 55002021-07-0110,057
Number of retired or separated participants receiving benefits2021-07-01426
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-0110,483
Total participants2021-07-0110,483
Number of employers contributing to the scheme2021-07-0144
2020: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2020 401k membership
Total participants, beginning-of-year2020-07-0111,155
Total number of active participants reported on line 7a of the Form 55002020-07-0110,904
Number of retired or separated participants receiving benefits2020-07-01408
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-0111,312
Total participants2020-07-0111,312
Number of employers contributing to the scheme2020-07-0144
2019: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2019 401k membership
Total participants, beginning-of-year2019-07-0111,365
Total number of active participants reported on line 7a of the Form 55002019-07-0110,756
Number of retired or separated participants receiving benefits2019-07-01399
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-0111,155
Total participants2019-07-0111,155
Number of employers contributing to the scheme2019-07-0148
2018: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2018 401k membership
Total participants, beginning-of-year2018-07-0111,937
Total number of active participants reported on line 7a of the Form 55002018-07-0110,974
Number of retired or separated participants receiving benefits2018-07-01391
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-0111,365
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-07-010
Total participants2018-07-0111,365
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
Number of employers contributing to the scheme2018-07-0148
2017: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2017 401k membership
Total participants, beginning-of-year2017-07-0111,503
Total number of active participants reported on line 7a of the Form 55002017-07-0111,344
Number of retired or separated participants receiving benefits2017-07-01593
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-0111,937
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-07-010
Total participants2017-07-0111,937
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
Number of employers contributing to the scheme2017-07-0148
2016: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2016 401k membership
Total participants, beginning-of-year2016-07-0110,847
Total number of active participants reported on line 7a of the Form 55002016-07-0111,048
Number of retired or separated participants receiving benefits2016-07-01455
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-0111,503
Total participants2016-07-0111,503
Number of employers contributing to the scheme2016-07-0148
2015: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2015 401k membership
Total participants, beginning-of-year2015-07-0111,130
Total number of active participants reported on line 7a of the Form 55002015-07-0110,448
Number of retired or separated participants receiving benefits2015-07-01399
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-0110,847
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-07-010
Total participants2015-07-0110,847
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
Number of employers contributing to the scheme2015-07-0152
2014: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2014 401k membership
Total participants, beginning-of-year2014-07-0111,881
Total number of active participants reported on line 7a of the Form 55002014-07-0110,687
Number of retired or separated participants receiving benefits2014-07-01443
Total of all active and inactive participants2014-07-0111,130
Total participants2014-07-0111,130
Number of employers contributing to the scheme2014-07-0161
2013: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2013 401k membership
Total participants, beginning-of-year2013-07-0112,446
Total number of active participants reported on line 7a of the Form 55002013-07-0111,499
Number of retired or separated participants receiving benefits2013-07-01382
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-0111,881
Total participants2013-07-0111,881
Number of employers contributing to the scheme2013-07-0159
2012: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2012 401k membership
Total participants, beginning-of-year2012-07-014,129
Total number of active participants reported on line 7a of the Form 55002012-07-013,845
Number of retired or separated participants receiving benefits2012-07-01276
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-014,121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-07-010
Total participants2012-07-014,121
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
Number of employers contributing to the scheme2012-07-0126
2011: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2011 401k membership
Total participants, beginning-of-year2011-07-015,165
Total number of active participants reported on line 7a of the Form 55002011-07-013,966
Number of retired or separated participants receiving benefits2011-07-01163
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-014,129
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-07-010
Total participants2011-07-014,129
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
Number of employers contributing to the scheme2011-07-0132
2009: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2009 401k membership
Total participants, beginning-of-year2009-07-016,323
Total number of active participants reported on line 7a of the Form 55002009-07-015,039
Number of retired or separated participants receiving benefits2009-07-01141
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-015,180
Total participants2009-07-015,180
Number of employers contributing to the scheme2009-07-0133

Financial Data on UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

Measure Date Value
2022 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-06-30$-1,446,273
Total unrealized appreciation/depreciation of assets2022-06-30$-1,446,273
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$36,660,329
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$33,883,235
Total income from all sources (including contributions)2022-06-30$133,691,664
Total loss/gain on sale of assets2022-06-30$6,869
Total of all expenses incurred2022-06-30$139,795,441
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$137,134,521
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$138,692,794
Value of total assets at end of year2022-06-30$148,467,269
Value of total assets at beginning of year2022-06-30$151,793,952
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$2,660,920
Total interest from all sources2022-06-30$325,783
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$228,569
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2022-06-30$228,569
Administrative expenses professional fees incurred2022-06-30$468,912
Was this plan covered by a fidelity bond2022-06-30Yes
Value of fidelity bond cover2022-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$7,367,615
Participant contributions at end of year2022-06-30$1,457,278
Participant contributions at beginning of year2022-06-30$1,678,504
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-06-30$2,696,308
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-06-30$1,660,833
Administrative expenses (other) incurred2022-06-30$710,459
Liabilities. Value of operating payables at end of year2022-06-30$185,185
Liabilities. Value of operating payables at beginning of year2022-06-30$178,386
Total non interest bearing cash at end of year2022-06-30$36,743,744
Total non interest bearing cash at beginning of year2022-06-30$35,729,921
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$-6,103,777
Value of net assets at end of year (total assets less liabilities)2022-06-30$111,806,940
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$117,910,717
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Investment advisory and management fees2022-06-30$255,858
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-06-30$10,683,951
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-06-30$11,643,159
Income. Interest from US Government securities2022-06-30$160,324
Income. Interest from corporate debt instruments2022-06-30$164,472
Value of interest in common/collective trusts at end of year2022-06-30$72,431,723
Value of interest in common/collective trusts at beginning of year2022-06-30$75,485,673
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-06-30$954,085
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-06-30$1,273,580
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-06-30$1,273,580
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-06-30$987
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$26,345,348
Asset value of US Government securities at end of year2022-06-30$7,208,109
Asset value of US Government securities at beginning of year2022-06-30$7,645,088
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-06-30$-1,062,128
Net investment gain or loss from common/collective trusts2022-06-30$-3,053,950
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30No
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$131,325,179
Employer contributions (assets) at end of year2022-06-30$11,340,471
Employer contributions (assets) at beginning of year2022-06-30$11,492,272
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$110,789,173
Asset. Corporate debt instrument preferred debt at end of year2022-06-30$2,929,295
Asset. Corporate debt instrument preferred debt at beginning of year2022-06-30$2,838,763
Asset. Corporate debt instrument debt (other) at end of year2022-06-30$2,022,305
Asset. Corporate debt instrument debt (other) at beginning of year2022-06-30$2,346,159
Contract administrator fees2022-06-30$1,225,691
Liabilities. Value of benefit claims payable at end of year2022-06-30$36,475,144
Liabilities. Value of benefit claims payable at beginning of year2022-06-30$33,704,849
Did the plan have assets held for investment2022-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Aggregate proceeds on sale of assets2022-06-30$3,779,612
Aggregate carrying amount (costs) on sale of assets2022-06-30$3,772,743
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2022-06-30952036255
2021 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-06-30$-1,882,602
Total unrealized appreciation/depreciation of assets2021-06-30$-1,882,602
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$33,883,235
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$31,480,456
Total income from all sources (including contributions)2021-06-30$129,432,805
Total loss/gain on sale of assets2021-06-30$2,040,367
Total of all expenses incurred2021-06-30$140,692,450
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$137,824,449
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$124,624,469
Value of total assets at end of year2021-06-30$151,793,952
Value of total assets at beginning of year2021-06-30$160,650,818
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$2,868,001
Total interest from all sources2021-06-30$405,755
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$317,941
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2021-06-30$256,205
Administrative expenses professional fees incurred2021-06-30$556,256
Was this plan covered by a fidelity bond2021-06-30Yes
Value of fidelity bond cover2021-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$8,172,836
Participant contributions at end of year2021-06-30$1,678,504
Participant contributions at beginning of year2021-06-30$1,715,217
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-06-30$1,660,833
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-06-30$154,820
Administrative expenses (other) incurred2021-06-30$792,107
Liabilities. Value of operating payables at end of year2021-06-30$178,386
Liabilities. Value of operating payables at beginning of year2021-06-30$115,655
Total non interest bearing cash at end of year2021-06-30$35,729,921
Total non interest bearing cash at beginning of year2021-06-30$12,176,587
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$-11,259,645
Value of net assets at end of year (total assets less liabilities)2021-06-30$117,910,717
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$129,170,362
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Investment advisory and management fees2021-06-30$276,124
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-06-30$11,643,159
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-06-30$16,661,699
Income. Interest from US Government securities2021-06-30$195,304
Income. Interest from corporate debt instruments2021-06-30$210,375
Value of interest in common/collective trusts at end of year2021-06-30$75,485,673
Value of interest in common/collective trusts at beginning of year2021-06-30$98,669,071
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-06-30$1,273,580
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-06-30$1,780,043
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-06-30$1,780,043
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-06-30$76
Expenses. Payments to insurance carriers foe the provision of benefits2021-06-30$27,072,764
Asset value of US Government securities at end of year2021-06-30$7,645,088
Asset value of US Government securities at beginning of year2021-06-30$14,450,104
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-06-30$2,110,273
Net investment gain or loss from common/collective trusts2021-06-30$1,816,602
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30Yes
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$116,451,633
Employer contributions (assets) at end of year2021-06-30$11,492,272
Employer contributions (assets) at beginning of year2021-06-30$257,957
Income. Dividends from common stock2021-06-30$61,736
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$110,751,685
Asset. Corporate debt instrument preferred debt at end of year2021-06-30$2,838,763
Asset. Corporate debt instrument preferred debt at beginning of year2021-06-30$7,345,988
Asset. Corporate debt instrument debt (other) at end of year2021-06-30$2,346,159
Asset. Corporate debt instrument debt (other) at beginning of year2021-06-30$2,980,428
Contract administrator fees2021-06-30$1,243,514
Assets. Corporate common stocks other than exployer securities at end of year2021-06-30$0
Assets. Corporate common stocks other than exployer securities at beginning of year2021-06-30$4,458,904
Liabilities. Value of benefit claims payable at end of year2021-06-30$33,704,849
Liabilities. Value of benefit claims payable at beginning of year2021-06-30$31,364,801
Did the plan have assets held for investment2021-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Aggregate proceeds on sale of assets2021-06-30$53,863,759
Aggregate carrying amount (costs) on sale of assets2021-06-30$51,823,392
Opinion of an independent qualified public accountant for this plan2021-06-30Unqualified
Accountancy firm name2021-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2021-06-30952036255
2020 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-06-30$1,459,992
Total unrealized appreciation/depreciation of assets2020-06-30$1,459,992
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$31,480,456
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$33,975,639
Total income from all sources (including contributions)2020-06-30$58,099,403
Total loss/gain on sale of assets2020-06-30$405,999
Total of all expenses incurred2020-06-30$133,423,403
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-06-30$130,875,498
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-06-30$48,680,019
Value of total assets at end of year2020-06-30$160,650,818
Value of total assets at beginning of year2020-06-30$238,470,001
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-06-30$2,547,905
Total interest from all sources2020-06-30$662,445
Total dividends received (eg from common stock, registered investment company shares)2020-06-30$493,998
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2020-06-30$385,248
Administrative expenses professional fees incurred2020-06-30$451,781
Was this plan covered by a fidelity bond2020-06-30Yes
Value of fidelity bond cover2020-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2020-06-30No
Contributions received from participants2020-06-30$8,249,333
Participant contributions at end of year2020-06-30$1,715,217
Participant contributions at beginning of year2020-06-30$1,914,613
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-06-30$154,820
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-06-30$457,725
Administrative expenses (other) incurred2020-06-30$488,261
Liabilities. Value of operating payables at end of year2020-06-30$115,655
Liabilities. Value of operating payables at beginning of year2020-06-30$357,090
Total non interest bearing cash at end of year2020-06-30$12,176,587
Total non interest bearing cash at beginning of year2020-06-30$50,891,621
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Value of net income/loss2020-06-30$-75,324,000
Value of net assets at end of year (total assets less liabilities)2020-06-30$129,170,362
Value of net assets at beginning of year (total assets less liabilities)2020-06-30$204,494,362
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-06-30No
Were any leases to which the plan was party in default or uncollectible2020-06-30No
Investment advisory and management fees2020-06-30$376,506
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-06-30$16,661,699
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-06-30$11,598,085
Income. Interest from US Government securities2020-06-30$357,912
Income. Interest from corporate debt instruments2020-06-30$290,394
Value of interest in common/collective trusts at end of year2020-06-30$98,669,071
Value of interest in common/collective trusts at beginning of year2020-06-30$128,201,968
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-06-30$1,780,043
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-06-30$1,643,130
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-06-30$1,643,130
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-06-30$14,139
Expenses. Payments to insurance carriers foe the provision of benefits2020-06-30$26,370,199
Asset value of US Government securities at end of year2020-06-30$14,450,104
Asset value of US Government securities at beginning of year2020-06-30$14,194,492
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-06-30$-70,154
Net investment gain or loss from common/collective trusts2020-06-30$6,467,104
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-06-30Yes
Was there a failure to transmit to the plan any participant contributions2020-06-30No
Has the plan failed to provide any benefit when due under the plan2020-06-30No
Contributions received in cash from employer2020-06-30$40,430,686
Employer contributions (assets) at end of year2020-06-30$257,957
Employer contributions (assets) at beginning of year2020-06-30$12,253,483
Income. Dividends from common stock2020-06-30$108,750
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-06-30$104,505,299
Asset. Corporate debt instrument preferred debt at end of year2020-06-30$7,345,988
Asset. Corporate debt instrument preferred debt at beginning of year2020-06-30$8,942,721
Asset. Corporate debt instrument debt (other) at end of year2020-06-30$2,980,428
Asset. Corporate debt instrument debt (other) at beginning of year2020-06-30$4,026,966
Contract administrator fees2020-06-30$1,231,357
Assets. Corporate common stocks other than exployer securities at end of year2020-06-30$4,458,904
Assets. Corporate common stocks other than exployer securities at beginning of year2020-06-30$4,279,631
Liabilities. Value of benefit claims payable at end of year2020-06-30$31,364,801
Liabilities. Value of benefit claims payable at beginning of year2020-06-30$33,618,549
Assets. Value of buildings and other operty used in plan operation at end of year2020-06-30$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2020-06-30$65,566
Did the plan have assets held for investment2020-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-06-30No
Aggregate proceeds on sale of assets2020-06-30$18,201,256
Aggregate carrying amount (costs) on sale of assets2020-06-30$17,795,257
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-06-30No
Opinion of an independent qualified public accountant for this plan2020-06-30Unqualified
Accountancy firm name2020-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2020-06-30952036255
2019 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-06-30$2,062,763
Total unrealized appreciation/depreciation of assets2019-06-30$2,062,763
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$33,975,639
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$31,282,504
Total income from all sources (including contributions)2019-06-30$163,427,424
Total loss/gain on sale of assets2019-06-30$-197,561
Total of all expenses incurred2019-06-30$137,110,589
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$134,083,266
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$154,175,535
Value of total assets at end of year2019-06-30$238,470,001
Value of total assets at beginning of year2019-06-30$209,460,031
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$3,027,323
Total interest from all sources2019-06-30$677,795
Total dividends received (eg from common stock, registered investment company shares)2019-06-30$421,013
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2019-06-30$305,924
Administrative expenses professional fees incurred2019-06-30$680,899
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$8,744,163
Participant contributions at end of year2019-06-30$1,914,613
Participant contributions at beginning of year2019-06-30$2,047,500
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-06-30$457,725
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-06-30$161,997
Administrative expenses (other) incurred2019-06-30$753,975
Liabilities. Value of operating payables at end of year2019-06-30$357,090
Liabilities. Value of operating payables at beginning of year2019-06-30$304,230
Total non interest bearing cash at end of year2019-06-30$50,891,621
Total non interest bearing cash at beginning of year2019-06-30$61,054,899
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$26,316,835
Value of net assets at end of year (total assets less liabilities)2019-06-30$204,494,362
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$178,177,527
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Investment advisory and management fees2019-06-30$353,178
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-06-30$11,598,085
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-06-30$5,984,299
Income. Interest from US Government securities2019-06-30$285,713
Income. Interest from corporate debt instruments2019-06-30$362,539
Value of interest in common/collective trusts at end of year2019-06-30$128,201,968
Value of interest in common/collective trusts at beginning of year2019-06-30$98,267,171
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-06-30$1,643,130
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-06-30$1,743,594
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-06-30$1,743,594
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-06-30$29,543
Expenses. Payments to insurance carriers foe the provision of benefits2019-06-30$25,253,587
Asset value of US Government securities at end of year2019-06-30$14,194,492
Asset value of US Government securities at beginning of year2019-06-30$14,204,893
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-06-30$353,082
Net investment gain or loss from common/collective trusts2019-06-30$5,934,797
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30Yes
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Contributions received in cash from employer2019-06-30$145,431,372
Employer contributions (assets) at end of year2019-06-30$12,253,483
Employer contributions (assets) at beginning of year2019-06-30$12,458,803
Income. Dividends from common stock2019-06-30$115,089
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$108,829,679
Asset. Corporate debt instrument preferred debt at end of year2019-06-30$8,942,721
Asset. Corporate debt instrument preferred debt at beginning of year2019-06-30$6,114,996
Asset. Corporate debt instrument debt (other) at end of year2019-06-30$4,026,966
Asset. Corporate debt instrument debt (other) at beginning of year2019-06-30$3,213,411
Contract administrator fees2019-06-30$1,239,271
Assets. Corporate common stocks other than exployer securities at end of year2019-06-30$4,279,631
Assets. Corporate common stocks other than exployer securities at beginning of year2019-06-30$4,139,422
Liabilities. Value of benefit claims payable at end of year2019-06-30$33,618,549
Liabilities. Value of benefit claims payable at beginning of year2019-06-30$30,978,274
Assets. Value of buildings and other operty used in plan operation at end of year2019-06-30$65,566
Assets. Value of buildings and other operty used in plan operation at beginning of year2019-06-30$69,046
Did the plan have assets held for investment2019-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Aggregate proceeds on sale of assets2019-06-30$7,173,004
Aggregate carrying amount (costs) on sale of assets2019-06-30$7,370,565
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30No
Opinion of an independent qualified public accountant for this plan2019-06-30Unqualified
Accountancy firm name2019-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2019-06-30952036255
2018 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-06-30$-839,053
Total unrealized appreciation/depreciation of assets2018-06-30$-839,053
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$31,282,504
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$28,034,482
Total income from all sources (including contributions)2018-06-30$162,179,736
Total loss/gain on sale of assets2018-06-30$-82,517,242
Total of all expenses incurred2018-06-30$129,692,407
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-06-30$127,122,695
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-06-30$161,399,344
Value of total assets at end of year2018-06-30$209,460,031
Value of total assets at beginning of year2018-06-30$173,724,680
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-06-30$2,569,712
Total interest from all sources2018-06-30$601,842
Total dividends received (eg from common stock, registered investment company shares)2018-06-30$261,220
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2018-06-30$171,454
Administrative expenses professional fees incurred2018-06-30$530,795
Was this plan covered by a fidelity bond2018-06-30Yes
Value of fidelity bond cover2018-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2018-06-30No
Contributions received from participants2018-06-30$9,311,050
Participant contributions at end of year2018-06-30$2,047,500
Participant contributions at beginning of year2018-06-30$2,185,393
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-06-30$161,997
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-06-30$365,717
Administrative expenses (other) incurred2018-06-30$400,298
Liabilities. Value of operating payables at end of year2018-06-30$304,230
Liabilities. Value of operating payables at beginning of year2018-06-30$207,240
Total non interest bearing cash at end of year2018-06-30$61,054,899
Total non interest bearing cash at beginning of year2018-06-30$45,994,984
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Value of net income/loss2018-06-30$32,487,329
Value of net assets at end of year (total assets less liabilities)2018-06-30$178,177,527
Value of net assets at beginning of year (total assets less liabilities)2018-06-30$145,690,198
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-06-30No
Were any leases to which the plan was party in default or uncollectible2018-06-30No
Investment advisory and management fees2018-06-30$291,019
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-06-30$5,984,299
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-06-30$2,468,380
Income. Interest from US Government securities2018-06-30$280,361
Income. Interest from corporate debt instruments2018-06-30$308,496
Value of interest in common/collective trusts at end of year2018-06-30$98,267,171
Value of interest in common/collective trusts at beginning of year2018-06-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-06-30$1,743,594
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-06-30$200,905
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-06-30$200,905
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-06-30$12,985
Expenses. Payments to insurance carriers foe the provision of benefits2018-06-30$24,980,773
Asset value of US Government securities at end of year2018-06-30$14,204,893
Asset value of US Government securities at beginning of year2018-06-30$45,403,715
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-06-30$243,719
Net investment gain or loss from common/collective trusts2018-06-30$83,029,906
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-06-30Yes
Was there a failure to transmit to the plan any participant contributions2018-06-30No
Has the plan failed to provide any benefit when due under the plan2018-06-30No
Contributions received in cash from employer2018-06-30$152,088,294
Employer contributions (assets) at end of year2018-06-30$12,458,803
Employer contributions (assets) at beginning of year2018-06-30$12,415,784
Income. Dividends from common stock2018-06-30$89,766
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-06-30$102,141,922
Asset. Corporate debt instrument preferred debt at end of year2018-06-30$6,114,996
Asset. Corporate debt instrument preferred debt at beginning of year2018-06-30$52,971,012
Asset. Corporate debt instrument debt (other) at end of year2018-06-30$3,213,411
Asset. Corporate debt instrument debt (other) at beginning of year2018-06-30$11,639,894
Contract administrator fees2018-06-30$1,347,600
Assets. Corporate common stocks other than exployer securities at end of year2018-06-30$4,139,422
Assets. Corporate common stocks other than exployer securities at beginning of year2018-06-30$0
Liabilities. Value of benefit claims payable at end of year2018-06-30$30,978,274
Liabilities. Value of benefit claims payable at beginning of year2018-06-30$27,827,242
Assets. Value of buildings and other operty used in plan operation at end of year2018-06-30$69,046
Assets. Value of buildings and other operty used in plan operation at beginning of year2018-06-30$78,896
Did the plan have assets held for investment2018-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-06-30No
Aggregate proceeds on sale of assets2018-06-30$42,945,987
Aggregate carrying amount (costs) on sale of assets2018-06-30$125,463,229
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-06-30No
Opinion of an independent qualified public accountant for this plan2018-06-30Unqualified
Accountancy firm name2018-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2018-06-30952036255
2017 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-06-30$-522,132
Total unrealized appreciation/depreciation of assets2017-06-30$-522,132
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$28,034,482
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$27,469,123
Total income from all sources (including contributions)2017-06-30$155,694,842
Total loss/gain on sale of assets2017-06-30$30,092
Total of all expenses incurred2017-06-30$119,755,925
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$116,927,826
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$154,178,153
Value of total assets at end of year2017-06-30$173,724,680
Value of total assets at beginning of year2017-06-30$137,220,404
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$2,828,099
Total interest from all sources2017-06-30$1,636,785
Total dividends received (eg from common stock, registered investment company shares)2017-06-30$43,910
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2017-06-30$43,910
Administrative expenses professional fees incurred2017-06-30$412,872
Was this plan covered by a fidelity bond2017-06-30Yes
Value of fidelity bond cover2017-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2017-06-30No
Contributions received from participants2017-06-30$10,612,630
Participant contributions at end of year2017-06-30$2,185,393
Participant contributions at beginning of year2017-06-30$1,754,622
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-06-30$365,717
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-06-30$246,601
Administrative expenses (other) incurred2017-06-30$968,559
Liabilities. Value of operating payables at end of year2017-06-30$207,240
Liabilities. Value of operating payables at beginning of year2017-06-30$139,142
Total non interest bearing cash at end of year2017-06-30$45,994,984
Total non interest bearing cash at beginning of year2017-06-30$29,306,987
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Value of net income/loss2017-06-30$35,938,917
Value of net assets at end of year (total assets less liabilities)2017-06-30$145,690,198
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$109,751,281
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-06-30No
Were any leases to which the plan was party in default or uncollectible2017-06-30No
Investment advisory and management fees2017-06-30$253,448
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-06-30$2,468,380
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-06-30$2,096,435
Interest earned on other investments2017-06-30$11,016
Income. Interest from US Government securities2017-06-30$609,759
Income. Interest from corporate debt instruments2017-06-30$1,012,900
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-06-30$200,905
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-06-30$4,140,544
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-06-30$4,140,544
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-06-30$3,110
Expenses. Payments to insurance carriers foe the provision of benefits2017-06-30$21,152,236
Asset value of US Government securities at end of year2017-06-30$45,403,715
Asset value of US Government securities at beginning of year2017-06-30$53,784,930
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-06-30$328,034
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-06-30Yes
Was there a failure to transmit to the plan any participant contributions2017-06-30No
Has the plan failed to provide any benefit when due under the plan2017-06-30No
Contributions received in cash from employer2017-06-30$143,565,523
Employer contributions (assets) at end of year2017-06-30$12,415,784
Employer contributions (assets) at beginning of year2017-06-30$11,604,275
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-06-30$95,775,590
Asset. Corporate debt instrument preferred debt at end of year2017-06-30$52,971,012
Asset. Corporate debt instrument preferred debt at beginning of year2017-06-30$26,186,514
Asset. Corporate debt instrument debt (other) at end of year2017-06-30$11,639,894
Asset. Corporate debt instrument debt (other) at beginning of year2017-06-30$8,088,660
Contract administrator fees2017-06-30$1,193,220
Liabilities. Value of benefit claims payable at end of year2017-06-30$27,827,242
Liabilities. Value of benefit claims payable at beginning of year2017-06-30$27,329,981
Assets. Value of buildings and other operty used in plan operation at end of year2017-06-30$78,896
Assets. Value of buildings and other operty used in plan operation at beginning of year2017-06-30$10,836
Did the plan have assets held for investment2017-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-06-30No
Aggregate proceeds on sale of assets2017-06-30$174,337,678
Aggregate carrying amount (costs) on sale of assets2017-06-30$174,307,586
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-06-30No
Opinion of an independent qualified public accountant for this plan2017-06-30Unqualified
Accountancy firm name2017-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2017-06-30952036255
2016 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-06-30$411,725
Total unrealized appreciation/depreciation of assets2016-06-30$411,725
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$27,469,123
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$26,119,370
Total income from all sources (including contributions)2016-06-30$147,311,838
Total loss/gain on sale of assets2016-06-30$-43,519
Total of all expenses incurred2016-06-30$122,681,124
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$119,413,265
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$146,083,995
Value of total assets at end of year2016-06-30$137,220,404
Value of total assets at beginning of year2016-06-30$111,239,937
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$3,267,859
Total interest from all sources2016-06-30$782,104
Total dividends received (eg from common stock, registered investment company shares)2016-06-30$40,863
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2016-06-30$40,863
Administrative expenses professional fees incurred2016-06-30$542,659
Was this plan covered by a fidelity bond2016-06-30Yes
Value of fidelity bond cover2016-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Contributions received from participants2016-06-30$7,527,195
Participant contributions at end of year2016-06-30$1,754,622
Participant contributions at beginning of year2016-06-30$1,759,130
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-06-30$246,601
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-06-30$106,241
Administrative expenses (other) incurred2016-06-30$1,318,050
Liabilities. Value of operating payables at end of year2016-06-30$139,142
Liabilities. Value of operating payables at beginning of year2016-06-30$78,190
Total non interest bearing cash at end of year2016-06-30$29,306,987
Total non interest bearing cash at beginning of year2016-06-30$57,513,348
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$24,630,714
Value of net assets at end of year (total assets less liabilities)2016-06-30$109,751,281
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$85,120,567
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Investment advisory and management fees2016-06-30$142,701
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-06-30$2,096,435
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-06-30$2,018,901
Income. Interest from US Government securities2016-06-30$289,551
Income. Interest from corporate debt instruments2016-06-30$490,679
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-06-30$4,140,544
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-06-30$983,242
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-06-30$983,242
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-06-30$1,874
Expenses. Payments to insurance carriers foe the provision of benefits2016-06-30$18,583,446
Asset value of US Government securities at end of year2016-06-30$53,784,930
Asset value of US Government securities at beginning of year2016-06-30$15,017,890
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-06-30$36,670
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30Yes
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$138,556,800
Employer contributions (assets) at end of year2016-06-30$11,604,275
Employer contributions (assets) at beginning of year2016-06-30$11,596,824
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-06-30$100,829,819
Asset. Corporate debt instrument preferred debt at end of year2016-06-30$26,186,514
Asset. Corporate debt instrument preferred debt at beginning of year2016-06-30$18,842,360
Asset. Corporate debt instrument debt (other) at end of year2016-06-30$8,088,660
Asset. Corporate debt instrument debt (other) at beginning of year2016-06-30$3,347,206
Contract administrator fees2016-06-30$1,264,449
Liabilities. Value of benefit claims payable at end of year2016-06-30$27,329,981
Liabilities. Value of benefit claims payable at beginning of year2016-06-30$26,041,180
Assets. Value of buildings and other operty used in plan operation at end of year2016-06-30$10,836
Assets. Value of buildings and other operty used in plan operation at beginning of year2016-06-30$54,795
Did the plan have assets held for investment2016-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No
Aggregate proceeds on sale of assets2016-06-30$46,945,961
Aggregate carrying amount (costs) on sale of assets2016-06-30$46,989,480
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30No
Opinion of an independent qualified public accountant for this plan2016-06-30Unqualified
Accountancy firm name2016-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2016-06-30952036255
2015 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-06-30$-147,770
Total unrealized appreciation/depreciation of assets2015-06-30$-147,770
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$26,119,370
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$27,642,296
Total income from all sources (including contributions)2015-06-30$141,619,480
Total loss/gain on sale of assets2015-06-30$17,055
Total of all expenses incurred2015-06-30$117,635,570
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$114,599,722
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$141,079,091
Value of total assets at end of year2015-06-30$111,239,937
Value of total assets at beginning of year2015-06-30$88,778,953
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$3,035,848
Total interest from all sources2015-06-30$534,081
Total dividends received (eg from common stock, registered investment company shares)2015-06-30$37,746
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2015-06-30$37,746
Administrative expenses professional fees incurred2015-06-30$467,592
Was this plan covered by a fidelity bond2015-06-30Yes
Value of fidelity bond cover2015-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Contributions received from participants2015-06-30$9,339,604
Participant contributions at end of year2015-06-30$1,759,130
Participant contributions at beginning of year2015-06-30$1,852,500
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-06-30$106,241
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-06-30$753,515
Administrative expenses (other) incurred2015-06-30$1,431,268
Liabilities. Value of operating payables at end of year2015-06-30$78,190
Liabilities. Value of operating payables at beginning of year2015-06-30$185,004
Total non interest bearing cash at end of year2015-06-30$57,513,348
Total non interest bearing cash at beginning of year2015-06-30$46,051,633
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$23,983,910
Value of net assets at end of year (total assets less liabilities)2015-06-30$85,120,567
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$61,136,657
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Investment advisory and management fees2015-06-30$93,207
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-06-30$2,018,901
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-06-30$1,881,878
Interest earned on other investments2015-06-30$610
Income. Interest from US Government securities2015-06-30$174,356
Income. Interest from corporate debt instruments2015-06-30$358,996
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-06-30$983,242
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-06-30$115,603
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-06-30$115,603
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-06-30$119
Expenses. Payments to insurance carriers foe the provision of benefits2015-06-30$19,176,666
Asset value of US Government securities at end of year2015-06-30$15,017,890
Asset value of US Government securities at beginning of year2015-06-30$11,484,902
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-06-30$99,277
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30Yes
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Contributions received in cash from employer2015-06-30$131,739,487
Employer contributions (assets) at end of year2015-06-30$11,596,824
Employer contributions (assets) at beginning of year2015-06-30$10,426,136
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-06-30$95,423,056
Asset. Corporate debt instrument preferred debt at end of year2015-06-30$18,842,360
Asset. Corporate debt instrument preferred debt at beginning of year2015-06-30$14,330,391
Asset. Corporate debt instrument debt (other) at end of year2015-06-30$3,347,206
Asset. Corporate debt instrument debt (other) at beginning of year2015-06-30$1,879,278
Contract administrator fees2015-06-30$1,043,781
Liabilities. Value of benefit claims payable at end of year2015-06-30$26,041,180
Liabilities. Value of benefit claims payable at beginning of year2015-06-30$27,457,292
Assets. Value of buildings and other operty used in plan operation at end of year2015-06-30$54,795
Assets. Value of buildings and other operty used in plan operation at beginning of year2015-06-30$3,117
Did the plan have assets held for investment2015-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Aggregate proceeds on sale of assets2015-06-30$21,464,325
Aggregate carrying amount (costs) on sale of assets2015-06-30$21,447,270
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30No
Opinion of an independent qualified public accountant for this plan2015-06-30Unqualified
Accountancy firm name2015-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2015-06-30952036255
2014 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-06-30$160,699
Total unrealized appreciation/depreciation of assets2014-06-30$160,699
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$27,642,296
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$25,737,932
Total income from all sources (including contributions)2014-06-30$133,887,077
Total loss/gain on sale of assets2014-06-30$-195,753
Total of all expenses incurred2014-06-30$116,316,858
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$113,925,427
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$133,030,246
Value of total assets at end of year2014-06-30$88,778,953
Value of total assets at beginning of year2014-06-30$69,304,370
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$2,391,431
Total interest from all sources2014-06-30$522,856
Total dividends received (eg from common stock, registered investment company shares)2014-06-30$32,025
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2014-06-30$32,025
Administrative expenses professional fees incurred2014-06-30$581,009
Was this plan covered by a fidelity bond2014-06-30Yes
Value of fidelity bond cover2014-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Contributions received from participants2014-06-30$10,010,180
Participant contributions at end of year2014-06-30$1,852,500
Participant contributions at beginning of year2014-06-30$1,892,014
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-06-30$753,515
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-06-30$1,493,352
Administrative expenses (other) incurred2014-06-30$569,985
Liabilities. Value of operating payables at end of year2014-06-30$185,004
Liabilities. Value of operating payables at beginning of year2014-06-30$99,851
Total non interest bearing cash at end of year2014-06-30$46,051,633
Total non interest bearing cash at beginning of year2014-06-30$27,066,800
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Value of net income/loss2014-06-30$17,570,219
Value of net assets at end of year (total assets less liabilities)2014-06-30$61,136,657
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$43,566,438
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Investment advisory and management fees2014-06-30$85,121
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-06-30$1,881,878
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-06-30$1,512,849
Income. Interest from US Government securities2014-06-30$259,078
Income. Interest from corporate debt instruments2014-06-30$263,684
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-06-30$115,603
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-06-30$729,953
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-06-30$729,953
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-06-30$94
Expenses. Payments to insurance carriers foe the provision of benefits2014-06-30$12,033,441
Asset value of US Government securities at end of year2014-06-30$11,484,902
Asset value of US Government securities at beginning of year2014-06-30$15,074,258
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-06-30$337,004
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30Yes
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Contributions received in cash from employer2014-06-30$123,020,066
Employer contributions (assets) at end of year2014-06-30$10,426,136
Employer contributions (assets) at beginning of year2014-06-30$10,038,047
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$101,891,986
Asset. Corporate debt instrument preferred debt at end of year2014-06-30$14,330,391
Asset. Corporate debt instrument preferred debt at beginning of year2014-06-30$9,601,974
Asset. Corporate debt instrument debt (other) at end of year2014-06-30$1,879,278
Asset. Corporate debt instrument debt (other) at beginning of year2014-06-30$1,867,740
Contract administrator fees2014-06-30$1,155,316
Liabilities. Value of benefit claims payable at end of year2014-06-30$27,457,292
Liabilities. Value of benefit claims payable at beginning of year2014-06-30$25,638,081
Assets. Value of buildings and other operty used in plan operation at end of year2014-06-30$3,117
Assets. Value of buildings and other operty used in plan operation at beginning of year2014-06-30$27,383
Did the plan have assets held for investment2014-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Aggregate proceeds on sale of assets2014-06-30$21,507,467
Aggregate carrying amount (costs) on sale of assets2014-06-30$21,703,220
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30No
Opinion of an independent qualified public accountant for this plan2014-06-30Unqualified
Accountancy firm name2014-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2014-06-30952036255
2013 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-06-30$-206,039
Total unrealized appreciation/depreciation of assets2013-06-30$-206,039
Total transfer of assets to this plan2013-06-30$19,015,745
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$25,737,932
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$8,813,812
Total income from all sources (including contributions)2013-06-30$39,118,142
Total loss/gain on sale of assets2013-06-30$-32,292
Total of all expenses incurred2013-06-30$35,335,918
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$34,356,322
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$38,683,279
Value of total assets at end of year2013-06-30$69,304,370
Value of total assets at beginning of year2013-06-30$29,582,281
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$979,596
Total interest from all sources2013-06-30$477,708
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$22,203
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2013-06-30$22,203
Administrative expenses professional fees incurred2013-06-30$342,656
Was this plan covered by a fidelity bond2013-06-30Yes
Value of fidelity bond cover2013-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Contributions received from participants2013-06-30$3,063,870
Participant contributions at end of year2013-06-30$1,892,014
Participant contributions at beginning of year2013-06-30$650,861
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-06-30$1,493,352
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-06-30$281,736
Administrative expenses (other) incurred2013-06-30$148,010
Liabilities. Value of operating payables at end of year2013-06-30$99,851
Liabilities. Value of operating payables at beginning of year2013-06-30$27,205
Total non interest bearing cash at end of year2013-06-30$27,066,800
Total non interest bearing cash at beginning of year2013-06-30$5,215,847
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Value of net income/loss2013-06-30$3,782,224
Value of net assets at end of year (total assets less liabilities)2013-06-30$43,566,438
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$20,768,469
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-06-30No
Were any leases to which the plan was party in default or uncollectible2013-06-30No
Investment advisory and management fees2013-06-30$101,814
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-06-30$1,512,849
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-06-30$957,546
Interest earned on other investments2013-06-30$10,855
Income. Interest from US Government securities2013-06-30$265,022
Income. Interest from corporate debt instruments2013-06-30$201,827
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-06-30$729,953
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-06-30$414,767
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-06-30$414,767
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-06-30$4
Expenses. Payments to insurance carriers foe the provision of benefits2013-06-30$3,038,329
Asset value of US Government securities at end of year2013-06-30$15,074,258
Asset value of US Government securities at beginning of year2013-06-30$11,535,921
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-06-30$173,283
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-06-30Yes
Was there a failure to transmit to the plan any participant contributions2013-06-30No
Has the plan failed to provide any benefit when due under the plan2013-06-30No
Contributions received in cash from employer2013-06-30$35,619,409
Employer contributions (assets) at end of year2013-06-30$10,038,047
Employer contributions (assets) at beginning of year2013-06-30$2,975,009
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-06-30$31,317,993
Asset. Corporate debt instrument preferred debt at end of year2013-06-30$9,601,974
Asset. Corporate debt instrument preferred debt at beginning of year2013-06-30$6,489,485
Asset. Corporate debt instrument debt (other) at end of year2013-06-30$1,867,740
Asset. Corporate debt instrument debt (other) at beginning of year2013-06-30$1,051,680
Contract administrator fees2013-06-30$387,116
Liabilities. Value of benefit claims payable at end of year2013-06-30$25,638,081
Liabilities. Value of benefit claims payable at beginning of year2013-06-30$8,786,607
Assets. Value of buildings and other operty used in plan operation at end of year2013-06-30$27,383
Assets. Value of buildings and other operty used in plan operation at beginning of year2013-06-30$9,429
Did the plan have assets held for investment2013-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-06-30No
Aggregate proceeds on sale of assets2013-06-30$22,614,161
Aggregate carrying amount (costs) on sale of assets2013-06-30$22,646,453
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30No
Opinion of an independent qualified public accountant for this plan2013-06-30Unqualified
Accountancy firm name2013-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2013-06-30952036255
2012 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-06-30$-41,771
Total unrealized appreciation/depreciation of assets2012-06-30$-41,771
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$8,813,812
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$9,265,160
Total income from all sources (including contributions)2012-06-30$38,836,565
Total loss/gain on sale of assets2012-06-30$82,367
Total of all expenses incurred2012-06-30$36,012,962
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$35,234,653
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$38,345,636
Value of total assets at end of year2012-06-30$29,582,281
Value of total assets at beginning of year2012-06-30$27,210,026
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$778,309
Total interest from all sources2012-06-30$402,200
Total dividends received (eg from common stock, registered investment company shares)2012-06-30$17,692
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2012-06-30$17,692
Administrative expenses professional fees incurred2012-06-30$226,522
Was this plan covered by a fidelity bond2012-06-30Yes
Value of fidelity bond cover2012-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2012-06-30No
Contributions received from participants2012-06-30$3,010,142
Participant contributions at end of year2012-06-30$650,861
Participant contributions at beginning of year2012-06-30$673,559
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-06-30$281,736
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-06-30$278,409
Administrative expenses (other) incurred2012-06-30$93,872
Liabilities. Value of operating payables at end of year2012-06-30$27,205
Liabilities. Value of operating payables at beginning of year2012-06-30$40,356
Total non interest bearing cash at end of year2012-06-30$5,215,847
Total non interest bearing cash at beginning of year2012-06-30$5,832,121
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Value of net income/loss2012-06-30$2,823,603
Value of net assets at end of year (total assets less liabilities)2012-06-30$20,768,469
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$17,944,866
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-06-30No
Were any leases to which the plan was party in default or uncollectible2012-06-30No
Investment advisory and management fees2012-06-30$84,818
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-06-30$957,546
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-06-30$909,413
Interest earned on other investments2012-06-30$9,457
Income. Interest from US Government securities2012-06-30$194,204
Income. Interest from corporate debt instruments2012-06-30$198,539
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-06-30$414,767
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-06-30$274,945
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-06-30$274,945
Expenses. Payments to insurance carriers foe the provision of benefits2012-06-30$3,155,650
Asset value of US Government securities at end of year2012-06-30$11,535,921
Asset value of US Government securities at beginning of year2012-06-30$9,743,314
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-06-30$30,441
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-06-30Yes
Was there a failure to transmit to the plan any participant contributions2012-06-30No
Has the plan failed to provide any benefit when due under the plan2012-06-30No
Contributions received in cash from employer2012-06-30$35,335,494
Employer contributions (assets) at end of year2012-06-30$2,975,009
Employer contributions (assets) at beginning of year2012-06-30$2,954,395
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-06-30$32,079,003
Asset. Corporate debt instrument preferred debt at end of year2012-06-30$6,489,485
Asset. Corporate debt instrument preferred debt at beginning of year2012-06-30$5,792,242
Asset. Corporate debt instrument debt (other) at end of year2012-06-30$1,051,680
Asset. Corporate debt instrument debt (other) at beginning of year2012-06-30$743,831
Contract administrator fees2012-06-30$373,097
Liabilities. Value of benefit claims payable at end of year2012-06-30$8,786,607
Liabilities. Value of benefit claims payable at beginning of year2012-06-30$9,224,804
Assets. Value of buildings and other operty used in plan operation at end of year2012-06-30$9,429
Assets. Value of buildings and other operty used in plan operation at beginning of year2012-06-30$7,797
Did the plan have assets held for investment2012-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-06-30No
Aggregate proceeds on sale of assets2012-06-30$16,129,846
Aggregate carrying amount (costs) on sale of assets2012-06-30$16,047,479
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-06-30No
Opinion of an independent qualified public accountant for this plan2012-06-30Unqualified
Accountancy firm name2012-06-30MILLER KAPLAN ARASE LLP
Accountancy firm EIN2012-06-30952036255
2011 : UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-06-30$-35,710
Total unrealized appreciation/depreciation of assets2011-06-30$-35,710
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$9,265,160
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$8,285,100
Total income from all sources (including contributions)2011-06-30$40,258,430
Total loss/gain on sale of assets2011-06-30$64,432
Total of all expenses incurred2011-06-30$33,883,399
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$33,038,692
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$39,717,533
Value of total assets at end of year2011-06-30$27,210,026
Value of total assets at beginning of year2011-06-30$19,854,935
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$844,707
Total interest from all sources2011-06-30$299,577
Total dividends received (eg from common stock, registered investment company shares)2011-06-30$15,261
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2011-06-30$15,261
Administrative expenses professional fees incurred2011-06-30$260,769
Was this plan covered by a fidelity bond2011-06-30Yes
Value of fidelity bond cover2011-06-30$500,000
Were there any nonexempt tranactions with any party-in-interest2011-06-30No
Contributions received from participants2011-06-30$3,733,979
Participant contributions at end of year2011-06-30$673,559
Participant contributions at beginning of year2011-06-30$529,284
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-06-30$278,409
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-06-30$259,152
Administrative expenses (other) incurred2011-06-30$166,210
Liabilities. Value of operating payables at end of year2011-06-30$40,356
Liabilities. Value of operating payables at beginning of year2011-06-30$28,653
Total non interest bearing cash at end of year2011-06-30$5,832,121
Total non interest bearing cash at beginning of year2011-06-30$6,567,976
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Value of net income/loss2011-06-30$6,375,031
Value of net assets at end of year (total assets less liabilities)2011-06-30$17,944,866
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$11,569,835
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-06-30No
Were any leases to which the plan was party in default or uncollectible2011-06-30No
Investment advisory and management fees2011-06-30$71,610
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-06-30$909,413
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-06-30$696,815
Income. Interest from US Government securities2011-06-30$147,647
Income. Interest from corporate debt instruments2011-06-30$150,987
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-06-30$274,945
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-06-30$1,170,122
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-06-30$1,170,122
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-06-30$943
Expenses. Payments to insurance carriers foe the provision of benefits2011-06-30$3,390,647
Asset value of US Government securities at end of year2011-06-30$9,743,314
Asset value of US Government securities at beginning of year2011-06-30$5,063,151
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-06-30$197,337
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-06-30Yes
Was there a failure to transmit to the plan any participant contributions2011-06-30No
Has the plan failed to provide any benefit when due under the plan2011-06-30No
Contributions received in cash from employer2011-06-30$35,983,554
Employer contributions (assets) at end of year2011-06-30$2,954,395
Employer contributions (assets) at beginning of year2011-06-30$3,016,698
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-06-30$29,648,045
Asset. Corporate debt instrument preferred debt at end of year2011-06-30$5,792,242
Asset. Corporate debt instrument preferred debt at beginning of year2011-06-30$2,010,262
Asset. Corporate debt instrument debt (other) at end of year2011-06-30$743,831
Asset. Corporate debt instrument debt (other) at beginning of year2011-06-30$530,743
Contract administrator fees2011-06-30$346,118
Liabilities. Value of benefit claims payable at end of year2011-06-30$9,224,804
Liabilities. Value of benefit claims payable at beginning of year2011-06-30$8,256,447
Assets. Value of buildings and other operty used in plan operation at end of year2011-06-30$7,797
Assets. Value of buildings and other operty used in plan operation at beginning of year2011-06-30$10,732
Did the plan have assets held for investment2011-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-06-30No
Aggregate proceeds on sale of assets2011-06-30$14,893,110
Aggregate carrying amount (costs) on sale of assets2011-06-30$14,828,678
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-06-30No
Opinion of an independent qualified public accountant for this plan2011-06-30Unqualified
Accountancy firm name2011-06-30MILLER, KAPLAN, ARASE & CO., LLP
Accountancy firm EIN2011-06-30952036255

Form 5500 Responses for UFCW LOCAL 555-EMPLOYERS HEALTH TRUST

2021: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2021 form 5500 responses
2021-07-01Type of plan entityMulti-employer plan
2021-07-01Plan is a collectively bargained planYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2020: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2020 form 5500 responses
2020-07-01Type of plan entityMulti-employer plan
2020-07-01Plan is a collectively bargained planYes
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement - TrustYes
2019: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2019 form 5500 responses
2019-07-01Type of plan entityMulti-employer plan
2019-07-01Plan is a collectively bargained planYes
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement - TrustYes
2018: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2018 form 5500 responses
2018-07-01Type of plan entityMulti-employer plan
2018-07-01Plan is a collectively bargained planYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2017 form 5500 responses
2017-07-01Type of plan entityMulti-employer plan
2017-07-01Plan is a collectively bargained planYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2016 form 5500 responses
2016-07-01Type of plan entityMulti-employer plan
2016-07-01Plan is a collectively bargained planYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2015 form 5500 responses
2015-07-01Type of plan entityMulti-employer plan
2015-07-01Plan is a collectively bargained planYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2014 form 5500 responses
2014-07-01Type of plan entityMulti-employer plan
2014-07-01Plan is a collectively bargained planYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2013 form 5500 responses
2013-07-01Type of plan entityMulti-employer plan
2013-07-01Plan is a collectively bargained planYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2012 form 5500 responses
2012-07-01Type of plan entityMulti-employer plan
2012-07-01Plan is a collectively bargained planYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2011: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2011 form 5500 responses
2011-07-01Type of plan entityMulti-employer plan
2011-07-01Plan is a collectively bargained planYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes
2009: UFCW LOCAL 555-EMPLOYERS HEALTH TRUST 2009 form 5500 responses
2009-07-01Type of plan entityMulti-employer plan
2009-07-01Plan is a collectively bargained planYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1024
Policy instance 3
Insurance contract or identification number1024
Number of Individuals Covered94
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $474,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE 1
Policy instance 9
Insurance contract or identification numberSEE FOOTNOTE 1
Number of Individuals Covered188
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedMEDIGAP
Welfare Benefit Premiums Paid to CarrierUSD $274,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )
Policy contract number034513
Policy instance 1
Insurance contract or identification number034513
Number of Individuals Covered9
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $49,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 2
Insurance contract or identification number612432
Number of Individuals Covered7823
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number111276
Policy instance 4
Insurance contract or identification number111276
Number of Individuals Covered26
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $121,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12227540
Policy instance 5
Insurance contract or identification number12227540
Number of Individuals Covered7102
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,643
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract numberSEE FOOTNOTE
Policy instance 6
Insurance contract or identification numberSEE FOOTNOTE
Number of Individuals Covered2
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Other welfare benefits providedPDP PLAN
Welfare Benefit Premiums Paid to CarrierUSD $1,955
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number0R093772
Policy instance 7
Insurance contract or identification number0R093772
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,336,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number19678
Policy instance 8
Insurance contract or identification number19678
Number of Individuals Covered2574
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,806,378
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1024
Policy instance 4
Insurance contract or identification number1024
Number of Individuals Covered103
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $522,448
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number111276
Policy instance 5
Insurance contract or identification number111276
Number of Individuals Covered30
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $153,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12227540
Policy instance 6
Insurance contract or identification number12227540
Number of Individuals Covered7487
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,224
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract numberSEE FOOTNOTE
Policy instance 7
Insurance contract or identification numberSEE FOOTNOTE
Number of Individuals Covered3
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,066
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number0R093772
Policy instance 8
Insurance contract or identification number0R093772
Number of Individuals Covered2396
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,451,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number19678
Policy instance 9
Insurance contract or identification number19678
Number of Individuals Covered2731
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,685,691
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE 1
Policy instance 10
Insurance contract or identification numberSEE FOOTNOTE 1
Number of Individuals Covered362
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitYes
Other welfare benefits providedMEDIGAP
Welfare Benefit Premiums Paid to CarrierUSD $515,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 3
Insurance contract or identification number612432
Number of Individuals Covered8033
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number034562
Policy instance 2
Insurance contract or identification number034562
Number of Individuals Covered1
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )
Policy contract number034513
Policy instance 1
Insurance contract or identification number034513
Number of Individuals Covered11
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,576
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )
Policy contract number034513
Policy instance 1
Insurance contract or identification number034513
Number of Individuals Covered12
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,828
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number034562
Policy instance 2
Insurance contract or identification number034562
Number of Individuals Covered2
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,927
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 3
Insurance contract or identification number612432
Number of Individuals Covered7691
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1024
Policy instance 4
Insurance contract or identification number1024
Number of Individuals Covered103
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $468,237
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number111276
Policy instance 5
Insurance contract or identification number111276
Number of Individuals Covered42
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $181,168
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12227540
Policy instance 6
Insurance contract or identification number12227540
Number of Individuals Covered0
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $32,512
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract numberSEE FOOTNOTE
Policy instance 7
Insurance contract or identification numberSEE FOOTNOTE
Number of Individuals Covered4
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number0R093772
Policy instance 8
Insurance contract or identification number0R093772
Number of Individuals Covered2369
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,342,160
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number19678
Policy instance 9
Insurance contract or identification number19678
Number of Individuals Covered2712
Insurance policy start date2019-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,671,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE 1
Policy instance 10
Insurance contract or identification numberSEE FOOTNOTE 1
Number of Individuals Covered330
Insurance policy start date2019-01-01
Insurance policy end date2020-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $489,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1024
Policy instance 4
Insurance contract or identification number1024
Number of Individuals Covered111
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $501,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 3
Insurance contract or identification number612432
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number034562
Policy instance 2
Insurance contract or identification number034562
Number of Individuals Covered2
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,603
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )
Policy contract number034513
Policy instance 1
Insurance contract or identification number034513
Number of Individuals Covered16
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $106,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number111276
Policy instance 5
Insurance contract or identification number111276
Number of Individuals Covered42
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $186,726
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12227540
Policy instance 6
Insurance contract or identification number12227540
Number of Individuals Covered7313
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,149
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract numberSEE FOOTNOTE
Policy instance 7
Insurance contract or identification numberSEE FOOTNOTE
Number of Individuals Covered7
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,750
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number0R093772
Policy instance 8
Insurance contract or identification number0R093772
Number of Individuals Covered2374
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,238,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number19678
Policy instance 9
Insurance contract or identification number19678
Number of Individuals Covered2590
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,017,613
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE 1
Policy instance 10
Insurance contract or identification numberSEE FOOTNOTE 1
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number034562
Policy instance 2
Insurance contract or identification number034562
Number of Individuals Covered3
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,215
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 3
Insurance contract or identification number612432
Number of Individuals Covered7740
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1024
Policy instance 4
Insurance contract or identification number1024
Number of Individuals Covered123
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $507,848
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number111276
Policy instance 5
Insurance contract or identification number111276
Number of Individuals Covered46
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $220,202
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12227540
Policy instance 6
Insurance contract or identification number12227540
Number of Individuals Covered7791
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract numberSEE FOOTNOTE
Policy instance 7
Insurance contract or identification numberSEE FOOTNOTE
Number of Individuals Covered8
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number0R093772
Policy instance 8
Insurance contract or identification number0R093772
Number of Individuals Covered2431
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,922,834
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number19678
Policy instance 9
Insurance contract or identification number19678
Number of Individuals Covered2470
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $13,122,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE 1
Policy instance 10
Insurance contract or identification numberSEE FOOTNOTE 1
Number of Individuals Covered299
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $448,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )
Policy contract number034513
Policy instance 1
Insurance contract or identification number034513
Number of Individuals Covered20
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $122,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE 1
Policy instance 11
Insurance contract or identification numberSEE FOOTNOTE 1
Number of Individuals Covered113
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $148,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract number40000521
Policy instance 10
Insurance contract or identification number40000521
Number of Individuals Covered7
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,824
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number0R093772
Policy instance 8
Insurance contract or identification number5215073
Number of Individuals Covered142
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,379
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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 BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, DEPENDENT LIFE
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 $26,152
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,379
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?3
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract number40000509
Policy instance 7
Insurance contract or identification number40000509
Number of Individuals Covered3
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12227540
Policy instance 6
Insurance contract or identification number12227540
Number of Individuals Covered7946
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number111276
Policy instance 5
Insurance contract or identification number111276
Number of Individuals Covered54
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $196,184
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1024
Policy instance 4
Insurance contract or identification number1024
Number of Individuals Covered159
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $684,232
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 3
Insurance contract or identification number612432
Number of Individuals Covered7500
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number034562
Policy instance 2
Insurance contract or identification number034562
Number of Individuals Covered4
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,890
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )
Policy contract number034513
Policy instance 1
Insurance contract or identification number034513
Number of Individuals Covered23
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $127,514
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number19678
Policy instance 9
Insurance contract or identification number19678
Number of Individuals Covered2080
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,210,690
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE 2
Policy instance 12
Insurance contract or identification numberSEE FOOTNOTE 2
Number of Individuals Covered172
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $214,050
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 3
Insurance contract or identification number612432
Number of Individuals Covered9578
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE
Policy instance 11
Insurance contract or identification numberSEE FOOTNOTE
Number of Individuals Covered126
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $171,251
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number034562
Policy instance 2
Insurance contract or identification number034562
Number of Individuals Covered4
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,895
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number19678
Policy instance 9
Insurance contract or identification number19678
Number of Individuals Covered1806
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,776,532
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number0R093772
Policy instance 8
Insurance contract or identification number0R093772
Number of Individuals Covered1763
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,851,142
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract number40000509
Policy instance 7
Insurance contract or identification number40000509
Number of Individuals Covered6
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,200
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1024
Policy instance 4
Insurance contract or identification number1024
Number of Individuals Covered182
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $808,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12227540
Policy instance 6
Insurance contract or identification number12227540
Number of Individuals Covered8492
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract number40000521
Policy instance 10
Insurance contract or identification number40000521
Number of Individuals Covered7
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $4,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number111276
Policy instance 5
Insurance contract or identification number111276
Number of Individuals Covered55
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $183,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )
Policy contract number034513
Policy instance 1
Insurance contract or identification number034513
Number of Individuals Covered29
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $149,627
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number40000021
Policy instance 12
Insurance contract or identification number40000021
Number of Individuals Covered163
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $184,017
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number12227540
Policy instance 7
Insurance contract or identification number12227540
Number of Individuals Covered8792
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 )
Policy contract number034562
Policy instance 2
Insurance contract or identification number034562
Number of Individuals Covered4
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $16,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 3
Insurance contract or identification number612432
Number of Individuals Covered9575
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number1024
Policy instance 4
Insurance contract or identification number1024
Number of Individuals Covered171
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $725,115
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number800000017
Policy instance 5
Insurance contract or identification number800000017
Number of Individuals Covered21146
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $323,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number100544
Policy instance 6
Insurance contract or identification number100544
Number of Individuals Covered44
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $149,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract number40000509
Policy instance 8
Insurance contract or identification number40000509
Number of Individuals Covered6
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,440
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 )
Policy contract number0R093772
Policy instance 9
Insurance contract or identification number0R093772
Number of Individuals Covered222
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,791,855
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 )
Policy contract number034513
Policy instance 1
Insurance contract or identification number034513
Number of Individuals Covered29
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $145,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 1
Insurance contract or identification number612432
Number of Individuals Covered3153
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number9661
Policy instance 2
Insurance contract or identification number9661
Number of Individuals Covered29
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $120,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE
Policy instance 3
Insurance contract or identification numberSEE FOOTNOTE
Number of Individuals Covered133
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $153,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number100536
Policy instance 4
Insurance contract or identification number100536
Number of Individuals Covered21
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number03305998
Policy instance 5
Insurance contract or identification number03305998
Number of Individuals Covered2901
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract number40000509
Policy instance 6
Insurance contract or identification number40000509
Number of Individuals Covered6
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,440
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number9661
Policy instance 5
Insurance contract or identification number9661
Number of Individuals Covered29
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $116,593
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number100536
Policy instance 3
Insurance contract or identification number100536
Number of Individuals Covered21
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $74,525
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number03305998
Policy instance 2
Insurance contract or identification number03305998
Number of Individuals Covered3105
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ASURIS NORTHWEST HEALTH (National Association of Insurance Commissioners NAIC id number: 47350 )
Policy contract number40000509
Policy instance 1
Insurance contract or identification number40000509
Number of Individuals Covered0
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 6
Insurance contract or identification number612432
Number of Individuals Covered3242
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract numberSEE FOOTNOTE
Policy instance 4
Insurance contract or identification numberSEE FOOTNOTE
Number of Individuals Covered115
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $153,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PROVIDENCE MEDICARE SUPPLEMENT (National Association of Insurance Commissioners NAIC id number: 95005 )
Policy contract number100536
Policy instance 5
Insurance contract or identification number100536
Number of Individuals Covered30
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $96,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number9661
Policy instance 3
Insurance contract or identification number9661
Number of Individuals Covered35
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $142,027
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STANDARD INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number612432
Policy instance 2
Insurance contract or identification number612432
Number of Individuals Covered3671
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 $0
Life Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 )
Policy contract number813949
Policy instance 1
Insurance contract or identification number813949
Number of Individuals Covered109
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $225,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number03305998
Policy instance 4
Insurance contract or identification number03305998
Number of Individuals Covered3391
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
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

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