PPG INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.
Additional information about PPG INDUSTRIES, INC.
Submission information for form 5500 for 401k plan GROUP BENEFITS PLAN - PAF LOUISVILLE, KY
| Measure | Date | Value |
|---|
| 2021: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-12-31 | 22 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-31 | 16 |
| Total of all active and inactive participants | 2021-12-31 | 16 |
| Total participants | 2021-12-31 | 16 |
| 2020: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-12-31 | 25 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-31 | 22 |
| Total of all active and inactive participants | 2020-12-31 | 22 |
| Total participants | 2020-12-31 | 22 |
| 2019: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-12-31 | 26 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-12-31 | 25 |
| Total of all active and inactive participants | 2019-12-31 | 25 |
| Total participants | 2019-12-31 | 25 |
| 2018: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-12-31 | 35 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-31 | 26 |
| Total of all active and inactive participants | 2018-12-31 | 26 |
| Total participants | 2018-12-31 | 26 |
| 2017: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-12-31 | 43 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-31 | 35 |
| Total of all active and inactive participants | 2017-12-31 | 35 |
| Total participants | 2017-12-31 | 35 |
| 2016: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-12-31 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-31 | 43 |
| Total of all active and inactive participants | 2016-12-31 | 43 |
| Total participants | 2016-12-31 | 43 |
| 2015: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-12-31 | 34 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-31 | 45 |
| Total of all active and inactive participants | 2015-12-31 | 45 |
| Total participants | 2015-12-31 | 0 |
| 2014: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-12-31 | 35 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-12-31 | 34 |
| Total of all active and inactive participants | 2014-12-31 | 34 |
| Total participants | 2014-12-31 | 0 |
| 2013: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-12-31 | 40 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-12-31 | 35 |
| Total of all active and inactive participants | 2013-12-31 | 35 |
| Total participants | 2013-12-31 | 0 |
| 2012: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-12-31 | 52 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-12-31 | 40 |
| Total of all active and inactive participants | 2012-12-31 | 40 |
| Total participants | 2012-12-31 | 0 |
| 2011: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-12-31 | 58 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-12-31 | 52 |
| Total of all active and inactive participants | 2011-12-31 | 52 |
| Total participants | 2011-12-31 | 52 |
| 2010: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-12-31 | 64 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-12-31 | 58 |
| Total of all active and inactive participants | 2010-12-31 | 58 |
| Total participants | 2010-12-31 | 58 |
| 2009: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-12-31 | 66 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-12-31 | 64 |
| Total of all active and inactive participants | 2009-12-31 | 64 |
| Total participants | 2009-12-31 | 64 |
| 2021: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2021 form 5500 responses |
|---|
| 2021-12-31 | Type of plan entity | Single employer plan |
| 2021-12-31 | Plan is a collectively bargained plan | Yes |
| 2021-12-31 | Plan funding arrangement – Insurance | Yes |
| 2021-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2021-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2020 form 5500 responses |
|---|
| 2020-12-31 | Type of plan entity | Single employer plan |
| 2020-12-31 | Plan is a collectively bargained plan | Yes |
| 2020-12-31 | Plan funding arrangement – Insurance | Yes |
| 2020-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2020-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2019 form 5500 responses |
|---|
| 2019-12-31 | Type of plan entity | Single employer plan |
| 2019-12-31 | Plan is a collectively bargained plan | Yes |
| 2019-12-31 | Plan funding arrangement – Insurance | Yes |
| 2019-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2019-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2018 form 5500 responses |
|---|
| 2018-12-31 | Type of plan entity | Single employer plan |
| 2018-12-31 | Plan is a collectively bargained plan | Yes |
| 2018-12-31 | Plan funding arrangement – Insurance | Yes |
| 2018-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2018-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2017 form 5500 responses |
|---|
| 2017-12-31 | Type of plan entity | Single employer plan |
| 2017-12-31 | Plan is a collectively bargained plan | Yes |
| 2017-12-31 | Plan funding arrangement – Insurance | Yes |
| 2017-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2017-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2017-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2016: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2016 form 5500 responses |
|---|
| 2016-12-31 | Type of plan entity | Single employer plan |
| 2016-12-31 | Plan is a collectively bargained plan | Yes |
| 2016-12-31 | Plan funding arrangement – Insurance | Yes |
| 2016-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2016-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2016-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2015: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2015 form 5500 responses |
|---|
| 2015-12-31 | Type of plan entity | Single employer plan |
| 2015-12-31 | Plan is a collectively bargained plan | Yes |
| 2015-12-31 | Plan funding arrangement – Insurance | Yes |
| 2015-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2015-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2015-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2014: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2014 form 5500 responses |
|---|
| 2014-12-31 | Type of plan entity | Single employer plan |
| 2014-12-31 | Plan is a collectively bargained plan | Yes |
| 2014-12-31 | Plan funding arrangement – Insurance | Yes |
| 2014-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2014-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2014-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2013: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2013 form 5500 responses |
|---|
| 2013-12-31 | Type of plan entity | Single employer plan |
| 2013-12-31 | Plan is a collectively bargained plan | Yes |
| 2013-12-31 | Plan funding arrangement – Insurance | Yes |
| 2013-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2013-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2013-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2012: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2012 form 5500 responses |
|---|
| 2012-12-31 | Type of plan entity | Single employer plan |
| 2012-12-31 | Plan is a collectively bargained plan | Yes |
| 2012-12-31 | Plan funding arrangement – Insurance | Yes |
| 2012-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2012-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2012-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2011: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2011 form 5500 responses |
|---|
| 2011-12-31 | Type of plan entity | Single employer plan |
| 2011-12-31 | Plan is a collectively bargained plan | Yes |
| 2011-12-31 | Plan funding arrangement – Insurance | Yes |
| 2011-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2011-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2011-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2010: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2010 form 5500 responses |
|---|
| 2010-12-31 | Type of plan entity | Single employer plan |
| 2010-12-31 | Plan is a collectively bargained plan | Yes |
| 2010-12-31 | Plan funding arrangement – Insurance | Yes |
| 2010-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2010-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2010-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2009: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2009 form 5500 responses |
|---|
| 2009-12-31 | Type of plan entity | Single employer plan |
| 2009-12-31 | This submission is the final filing | No |
| 2009-12-31 | Plan is a collectively bargained plan | Yes |
| 2009-12-31 | Plan funding arrangement – Insurance | Yes |
| 2009-12-31 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2009-12-31 | Plan benefit arrangement – Insurance | Yes |
| 2009-12-31 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2008: GROUP BENEFITS PLAN - PAF LOUISVILLE, KY 2008 form 5500 responses |
|---|
| 2008-12-31 | Type of plan entity | Single employer plan |
| 2008-12-31 | Submission has been amended | No |
| 2008-12-31 | This submission is the final filing | No |
| 2008-12-31 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2008-12-31 | Plan is a collectively bargained plan | No |
| MAGELLAN HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | N/A |
| Policy instance | 7 |
| Insurance contract or identification number | N/A | | Number of Individuals Covered | 16 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Other welfare benefits provided | EMPLOYEE ASSISTANCE PROGRAM | | Welfare Benefit Premiums Paid to Carrier | USD $499 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 681077 |
| Policy instance | 1 |
| Insurance contract or identification number | 681077 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 6036796 |
| Policy instance | 2 |
| Insurance contract or identification number | G000C35F | | Number of Individuals Covered | 53 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,715 | | Total amount of fees paid to insurance company | USD $543 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | 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 Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | VOLUNTARY LIFE/AD&D | | 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 Carrier | USD $18,097 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,715 | | Amount paid for insurance broker fees | 543 | | Additional information about fees paid to insurance broker | ADMIN FEE | | Insurance broker organization code? | 5 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | VARIOUS |
| Policy instance | 3 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 15 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,284 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 6 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0229100 |
| Policy instance | 5 |
| Insurance contract or identification number | 0229100 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Other welfare benefits provided | BASIC CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0214387 |
| Policy instance | 6 |
| Insurance contract or identification number | 0214387 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Other welfare benefits provided | SEAT BELT AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $184 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | VARIOUS |
| Policy instance | 3 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 14 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 5 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0229100 |
| Policy instance | 5 |
| Insurance contract or identification number | 0229100 | | Number of Individuals Covered | 7 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Other welfare benefits provided | BASIC CRITICAL ILLNESS | | Welfare Benefit Premiums Paid to Carrier | USD $395 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0214387 |
| Policy instance | 6 |
| Insurance contract or identification number | 0214387 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Other welfare benefits provided | SEAT BELT AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 697331 |
| Policy instance | 7 |
| Insurance contract or identification number | 697331 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Other welfare benefits provided | LEAVE MANAGEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $639 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 378050 |
| Policy instance | 1 |
| Insurance contract or identification number | 378050 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,763 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 6036796 |
| Policy instance | 2 |
| Insurance contract or identification number | 6036796 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $508 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 12 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,371 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 6036796 |
| Policy instance | 3 |
| Insurance contract or identification number | 6036796 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $729 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 378050 |
| Policy instance | 2 |
| Insurance contract or identification number | 378050 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 ) |
| Policy contract number | 00-ADD-S06751 |
| Policy instance | 1 |
| Insurance contract or identification number | 00-ADD-S06751 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SEAT BELT AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $19 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 100004 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 100004 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $16,737 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 ) |
| Policy contract number | 00-ADD-S06751 |
| Policy instance | 2 |
| Insurance contract or identification number | 00-ADD-S06751 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SEAT BELT AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $20 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 378050 |
| Policy instance | 3 |
| Insurance contract or identification number | 378050 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,054 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 6036796 |
| Policy instance | 4 |
| Insurance contract or identification number | 6036796 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | VARIOUS |
| Policy instance | 5 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 18 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,792 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 ) |
| Policy contract number | VARIOUS |
| Policy instance | 6 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 22 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,910 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 6036796 |
| Policy instance | 5 |
| Insurance contract or identification number | 6036796 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 15 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Were dividends or retroactive rate refunds paid as a credit? | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 378050 |
| Policy instance | 3 |
| Insurance contract or identification number | 378050 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,707 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONTINENTAL CASUALTY COMPANY (National Association of Insurance Commissioners NAIC id number: 20443 ) |
| Policy contract number | 00-ADD-S06751 |
| Policy instance | 2 |
| Insurance contract or identification number | 00-ADD-S06751 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SEAT BELT AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $26 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | LK 100004 |
| Policy instance | 1 |
| Insurance contract or identification number | LK 100004 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Other welfare benefits provided | SHORT TERM DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $10,791 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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