BNZ MATERIALS, INC. has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2021: MEDICAL INSURANCE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-12-01 | 80 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-12-01 | 76 |
| Number of retired or separated participants receiving benefits | 2021-12-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2021-12-01 | 0 |
| Total of all active and inactive participants | 2021-12-01 | 77 |
| 2020: MEDICAL INSURANCE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-12-01 | 81 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-12-01 | 80 |
| Number of retired or separated participants receiving benefits | 2020-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-12-01 | 0 |
| Total of all active and inactive participants | 2020-12-01 | 80 |
| 2019: MEDICAL INSURANCE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-12-01 | 80 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-12-01 | 81 |
| Number of retired or separated participants receiving benefits | 2019-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-12-01 | 0 |
| Total of all active and inactive participants | 2019-12-01 | 81 |
| 2018: MEDICAL INSURANCE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-12-01 | 73 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-12-01 | 92 |
| Number of retired or separated participants receiving benefits | 2018-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-12-01 | 0 |
| Total of all active and inactive participants | 2018-12-01 | 92 |
| 2017: MEDICAL INSURANCE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-12-01 | 80 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-12-01 | 73 |
| Number of retired or separated participants receiving benefits | 2017-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-12-01 | 0 |
| Total of all active and inactive participants | 2017-12-01 | 73 |
| 2016: MEDICAL INSURANCE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-12-01 | 88 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-12-01 | 80 |
| Number of retired or separated participants receiving benefits | 2016-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-12-01 | 0 |
| Total of all active and inactive participants | 2016-12-01 | 80 |
| 2015: MEDICAL INSURANCE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-12-01 | 78 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-12-01 | 88 |
| Number of retired or separated participants receiving benefits | 2015-12-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-12-01 | 0 |
| Total of all active and inactive participants | 2015-12-01 | 88 |
| 2010: MEDICAL INSURANCE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 74 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 11 |
| Total of all active and inactive participants | 2010-01-01 | 85 |
| Total participants | 2010-01-01 | 85 |
| 2009: MEDICAL INSURANCE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 101 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 95 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 6 |
| Total of all active and inactive participants | 2009-01-01 | 101 |
| Total participants | 2009-01-01 | 101 |
| Measure | Date | Value |
|---|
| 2022 : MEDICAL INSURANCE PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-11-30 | $65,768 |
| Total plan liabilities at beginning of year | 2022-11-30 | $155,352 |
| Total income from all sources | 2022-11-30 | $1,148,266 |
| Expenses. Total of all expenses incurred | 2022-11-30 | $1,110,450 |
| Benefits paid (including direct rollovers) | 2022-11-30 | $655,316 |
| Total plan assets at end of year | 2022-11-30 | $58,010 |
| Total plan assets at beginning of year | 2022-11-30 | $109,778 |
| Value of fidelity bond covering the plan | 2022-11-30 | $600,000 |
| Total contributions received or receivable from participants | 2022-11-30 | $237,719 |
| Expenses. Other expenses not covered elsewhere | 2022-11-30 | $410,298 |
| Contributions received from other sources (not participants or employers) | 2022-11-30 | $0 |
| Other income received | 2022-11-30 | $35 |
| Net income (gross income less expenses) | 2022-11-30 | $37,816 |
| Net plan assets at end of year (total assets less liabilities) | 2022-11-30 | $-7,758 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-11-30 | $-45,574 |
| Total contributions received or receivable from employer(s) | 2022-11-30 | $910,512 |
| Value of corrective distributions | 2022-11-30 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-11-30 | $44,836 |
| 2021 : MEDICAL INSURANCE PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-11-30 | $155,352 |
| Total plan liabilities at beginning of year | 2021-11-30 | $70,926 |
| Total income from all sources | 2021-11-30 | $1,028,494 |
| Expenses. Total of all expenses incurred | 2021-11-30 | $1,040,895 |
| Benefits paid (including direct rollovers) | 2021-11-30 | $555,071 |
| Total plan assets at end of year | 2021-11-30 | $109,778 |
| Total plan assets at beginning of year | 2021-11-30 | $37,753 |
| Value of fidelity bond covering the plan | 2021-11-30 | $600,000 |
| Total contributions received or receivable from participants | 2021-11-30 | $219,380 |
| Expenses. Other expenses not covered elsewhere | 2021-11-30 | $369,891 |
| Other income received | 2021-11-30 | $98 |
| Net income (gross income less expenses) | 2021-11-30 | $-12,401 |
| Net plan assets at end of year (total assets less liabilities) | 2021-11-30 | $-45,574 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-11-30 | $-33,173 |
| Total contributions received or receivable from employer(s) | 2021-11-30 | $809,016 |
| Value of corrective distributions | 2021-11-30 | $85,243 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-11-30 | $30,690 |
| 2020 : MEDICAL INSURANCE PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-11-30 | $70,926 |
| Total plan liabilities at beginning of year | 2020-11-30 | $62,195 |
| Total income from all sources | 2020-11-30 | $1,155,388 |
| Expenses. Total of all expenses incurred | 2020-11-30 | $1,487,563 |
| Benefits paid (including direct rollovers) | 2020-11-30 | $858,947 |
| Total plan assets at end of year | 2020-11-30 | $37,753 |
| Total plan assets at beginning of year | 2020-11-30 | $361,197 |
| Value of fidelity bond covering the plan | 2020-11-30 | $600,000 |
| Total contributions received or receivable from participants | 2020-11-30 | $251,305 |
| Expenses. Other expenses not covered elsewhere | 2020-11-30 | $392,092 |
| Contributions received from other sources (not participants or employers) | 2020-11-30 | $5,782 |
| Other income received | 2020-11-30 | $520 |
| Net income (gross income less expenses) | 2020-11-30 | $-332,175 |
| Net plan assets at end of year (total assets less liabilities) | 2020-11-30 | $-33,173 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-11-30 | $299,002 |
| Total contributions received or receivable from employer(s) | 2020-11-30 | $897,781 |
| Value of corrective distributions | 2020-11-30 | $201,764 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-11-30 | $34,760 |
| 2019 : MEDICAL INSURANCE PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-11-30 | $62,195 |
| Total plan liabilities at beginning of year | 2019-11-30 | $79,063 |
| Total income from all sources | 2019-11-30 | $1,162,364 |
| Expenses. Total of all expenses incurred | 2019-11-30 | $1,124,288 |
| Benefits paid (including direct rollovers) | 2019-11-30 | $482,506 |
| Total plan assets at end of year | 2019-11-30 | $361,197 |
| Total plan assets at beginning of year | 2019-11-30 | $339,989 |
| Value of fidelity bond covering the plan | 2019-11-30 | $600,000 |
| Total contributions received or receivable from participants | 2019-11-30 | $193,626 |
| Expenses. Other expenses not covered elsewhere | 2019-11-30 | $352,140 |
| Contributions received from other sources (not participants or employers) | 2019-11-30 | $0 |
| Other income received | 2019-11-30 | $914 |
| Net income (gross income less expenses) | 2019-11-30 | $38,076 |
| Net plan assets at end of year (total assets less liabilities) | 2019-11-30 | $299,002 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-11-30 | $260,926 |
| Total contributions received or receivable from employer(s) | 2019-11-30 | $967,824 |
| Value of corrective distributions | 2019-11-30 | $243,128 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-11-30 | $46,514 |
| 2017 : MEDICAL INSURANCE PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-11-30 | $59,994 |
| Total plan liabilities at beginning of year | 2017-11-30 | $62,943 |
| Total income from all sources | 2017-11-30 | $1,037,209 |
| Expenses. Total of all expenses incurred | 2017-11-30 | $856,638 |
| Benefits paid (including direct rollovers) | 2017-11-30 | $446,850 |
| Total plan assets at end of year | 2017-11-30 | $326,079 |
| Total plan assets at beginning of year | 2017-11-30 | $148,457 |
| Value of fidelity bond covering the plan | 2017-11-30 | $600,000 |
| Expenses. Other expenses not covered elsewhere | 2017-11-30 | $274,879 |
| Other income received | 2017-11-30 | $562 |
| Net income (gross income less expenses) | 2017-11-30 | $180,571 |
| Net plan assets at end of year (total assets less liabilities) | 2017-11-30 | $266,085 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-11-30 | $85,514 |
| Total contributions received or receivable from employer(s) | 2017-11-30 | $1,036,647 |
| Value of corrective distributions | 2017-11-30 | $93,801 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-11-30 | $41,108 |
| 2016 : MEDICAL INSURANCE PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-11-30 | $62,943 |
| Total plan liabilities at beginning of year | 2016-11-30 | $0 |
| Total income from all sources | 2016-11-30 | $940,884 |
| Expenses. Total of all expenses incurred | 2016-11-30 | $855,370 |
| Benefits paid (including direct rollovers) | 2016-11-30 | $565,583 |
| Total plan assets at end of year | 2016-11-30 | $148,457 |
| Total plan assets at beginning of year | 2016-11-30 | $0 |
| Value of fidelity bond covering the plan | 2016-11-30 | $600,000 |
| Total contributions received or receivable from participants | 2016-11-30 | $196,027 |
| Expenses. Other expenses not covered elsewhere | 2016-11-30 | $246,961 |
| Contributions received from other sources (not participants or employers) | 2016-11-30 | $6,276 |
| Other income received | 2016-11-30 | $124 |
| Net income (gross income less expenses) | 2016-11-30 | $85,514 |
| Net plan assets at end of year (total assets less liabilities) | 2016-11-30 | $85,514 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-11-30 | $0 |
| Total contributions received or receivable from employer(s) | 2016-11-30 | $738,457 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-11-30 | $42,826 |
| 2021: MEDICAL INSURANCE PLAN 2021 form 5500 responses |
|---|
| 2021-12-01 | Type of plan entity | Single employer plan |
| 2021-12-01 | Submission has been amended | No |
| 2021-12-01 | This submission is the final filing | No |
| 2021-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-12-01 | Plan is a collectively bargained plan | No |
| 2021-12-01 | Plan funding arrangement – Insurance | Yes |
| 2021-12-01 | Plan funding arrangement – Trust | Yes |
| 2021-12-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-12-01 | Plan benefit arrangement - Trust | Yes |
| 2021-12-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: MEDICAL INSURANCE PLAN 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Submission has been amended | No |
| 2020-12-01 | This submission is the final filing | No |
| 2020-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-12-01 | Plan is a collectively bargained plan | No |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan funding arrangement – Trust | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement - Trust | Yes |
| 2019: MEDICAL INSURANCE PLAN 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | Submission has been amended | No |
| 2019-12-01 | This submission is the final filing | No |
| 2019-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-12-01 | Plan is a collectively bargained plan | No |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan funding arrangement – Trust | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement - Trust | Yes |
| 2018: MEDICAL INSURANCE PLAN 2018 form 5500 responses |
|---|
| 2018-12-01 | Type of plan entity | Single employer plan |
| 2018-12-01 | Submission has been amended | No |
| 2018-12-01 | This submission is the final filing | No |
| 2018-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-12-01 | Plan is a collectively bargained plan | No |
| 2018-12-01 | Plan funding arrangement – Insurance | Yes |
| 2018-12-01 | Plan funding arrangement – Trust | Yes |
| 2018-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-12-01 | Plan benefit arrangement - Trust | Yes |
| 2017: MEDICAL INSURANCE PLAN 2017 form 5500 responses |
|---|
| 2017-12-01 | Type of plan entity | Single employer plan |
| 2017-12-01 | Submission has been amended | No |
| 2017-12-01 | This submission is the final filing | No |
| 2017-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-12-01 | Plan is a collectively bargained plan | No |
| 2017-12-01 | Plan funding arrangement – Insurance | Yes |
| 2017-12-01 | Plan funding arrangement – Trust | Yes |
| 2017-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-12-01 | Plan benefit arrangement - Trust | Yes |
| 2016: MEDICAL INSURANCE PLAN 2016 form 5500 responses |
|---|
| 2016-12-01 | Type of plan entity | Single employer plan |
| 2016-12-01 | Submission has been amended | No |
| 2016-12-01 | This submission is the final filing | No |
| 2016-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-12-01 | Plan is a collectively bargained plan | No |
| 2016-12-01 | Plan funding arrangement – Insurance | Yes |
| 2016-12-01 | Plan funding arrangement – Trust | Yes |
| 2016-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-12-01 | Plan benefit arrangement - Trust | Yes |
| 2015: MEDICAL INSURANCE PLAN 2015 form 5500 responses |
|---|
| 2015-12-01 | Type of plan entity | Single employer plan |
| 2015-12-01 | First time form 5500 has been submitted | Yes |
| 2015-12-01 | Submission has been amended | No |
| 2015-12-01 | This submission is the final filing | No |
| 2015-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-12-01 | Plan is a collectively bargained plan | No |
| 2015-12-01 | Plan funding arrangement – Insurance | Yes |
| 2015-12-01 | Plan funding arrangement – Trust | Yes |
| 2015-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-12-01 | Plan benefit arrangement - Trust | Yes |
| 2010: MEDICAL INSURANCE PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | Submission has been amended | Yes |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: MEDICAL INSURANCE PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Single employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | 203211 |
| Policy instance | 1 |
| Insurance contract or identification number | 203211 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-11-30 | | 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 | | 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 $339,905 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | 30500159 |
| Policy instance | 2 |
| Insurance contract or identification number | 30500159 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2021-12-01 | | Insurance policy end date | 2021-12-31 | | 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 | | 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 $27,654 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500159 |
| Policy instance | 1 |
| Insurance contract or identification number | 30500159 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2020-12-01 | | Insurance policy end date | 2021-11-30 | | 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 | | 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 $327,627 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500159 |
| Policy instance | 1 |
| Insurance contract or identification number | 30500159 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2019-12-01 | | Insurance policy end date | 2020-11-30 | | 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 | | 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 $348,020 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| Insurance contract or identification number | VERIS | | Number of Individuals Covered | 92 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-11-30 | | 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 | | 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 $308,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | VERIS |
| Policy instance | 1 |
| Insurance contract or identification number | VERIS | | Number of Individuals Covered | 73 | | Insurance policy start date | 2017-12-01 | | Insurance policy end date | 2018-11-30 | | 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 | | 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 $276,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
