I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 401k Plan overview

Plan Name	I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND
Plan identification number	501

I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Other welfare benefit cover

401k Sponsoring company profile

I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND has sponsored the creation of one or more 401k plans.

Company Name:	I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND
Employer identification number (EIN):	351500522
NAIC Classification:	713900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-01-01
501	2021-01-01
501	2020-01-01
501	2019-01-01
501	2018-01-01	THOMAS E. MULRY
501	2017-01-01	THOMAS E. MULRY
501	2016-01-01	THOMAS E. MULRY
501	2015-01-01	MICHAEL WILLIAMS
501	2014-01-01	THOMAS HARVEY
501	2013-01-01	JOHN ROYER
501	2012-01-01	JOHN ROYER
501	2011-01-01	JOHN ROYER
501	2010-01-01	JOHN ROYER		JOHN ROYER	2011-10-14
501	2009-01-01	JOHN ROYER		JOHN ROYER	2010-10-25
501	2009-01-01	JOHN ROYER		JOHN ROYER	2010-10-15

Plan Statistics for I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND

401k plan membership statisitcs for I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND

Measure	Date	Value
2022: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2022 401k membership
Total participants, beginning-of-year	2022-01-01	105
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	117
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	0
Total of all active and inactive participants	2022-01-01	117
2021: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2021 401k membership
Total participants, beginning-of-year	2021-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	105
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	0
Total of all active and inactive participants	2021-01-01	105
2020: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2020 401k membership
Total participants, beginning-of-year	2020-01-01	79
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	106
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	0
Total of all active and inactive participants	2020-01-01	106
2019: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2019 401k membership
Total participants, beginning-of-year	2019-01-01	149
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	79
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	79
2018: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2018 401k membership
Total participants, beginning-of-year	2018-01-01	131
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	149
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	149
2017: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2017 401k membership
Total participants, beginning-of-year	2017-01-01	86
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	86
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	86
2016: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2016 401k membership
Total participants, beginning-of-year	2016-01-01	64
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	63
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	1
Total of all active and inactive participants	2016-01-01	64
2015: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2015 401k membership
Total participants, beginning-of-year	2015-01-01	81
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	62
Number of retired or separated participants receiving benefits	2015-01-01	1
Number of other retired or separated participants entitled to future benefits	2015-01-01	1
Total of all active and inactive participants	2015-01-01	64
2014: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2014 401k membership
Total participants, beginning-of-year	2014-01-01	84
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	80
Number of retired or separated participants receiving benefits	2014-01-01	0
Number of other retired or separated participants entitled to future benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	81
2013: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2013 401k membership
Total participants, beginning-of-year	2013-01-01	66
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	84
Number of retired or separated participants receiving benefits	2013-01-01	0
Number of other retired or separated participants entitled to future benefits	2013-01-01	0
Total of all active and inactive participants	2013-01-01	84
2012: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2012 401k membership
Total participants, beginning-of-year	2012-01-01	69
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	68
Number of retired or separated participants receiving benefits	2012-01-01	1
Number of other retired or separated participants entitled to future benefits	2012-01-01	0
Total of all active and inactive participants	2012-01-01	69
2011: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2011 401k membership
Total participants, beginning-of-year	2011-01-01	76
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	69
Number of retired or separated participants receiving benefits	2011-01-01	0
Number of other retired or separated participants entitled to future benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	69
2010: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2010 401k membership
Total participants, beginning-of-year	2010-01-01	179
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	2
Total of all active and inactive participants	2010-01-01	76
Number of employers contributing to the scheme	2010-01-01	0
2009: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2009 401k membership
Total participants, beginning-of-year	2009-01-01	179
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	176
Number of retired or separated participants receiving benefits	2009-01-01	0
Number of other retired or separated participants entitled to future benefits	2009-01-01	3
Total of all active and inactive participants	2009-01-01	179
Total participants	2009-01-01	0
Number of employers contributing to the scheme	2009-01-01	0

Financial Data on I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND

Measure	Date	Value
2022 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2022 401k financial data
Total unrealized appreciation/depreciation of assets	2022-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$166,059
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-12-31	$113,696
Total income from all sources (including contributions)	2022-12-31	$1,149,744
Total loss/gain on sale of assets	2022-12-31	$0
Total of all expenses incurred	2022-12-31	$370,478
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-12-31	$333,133
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-12-31	$1,149,049
Value of total assets at end of year	2022-12-31	$1,675,669
Value of total assets at beginning of year	2022-12-31	$844,040
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-12-31	$37,345
Total interest from all sources	2022-12-31	$695
Total dividends received (eg from common stock, registered investment company shares)	2022-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-12-31	No
Administrative expenses professional fees incurred	2022-12-31	$17,236
Was this plan covered by a fidelity bond	2022-12-31	Yes
Value of fidelity bond cover	2022-12-31	$150,000
Were there any nonexempt tranactions with any party-in-interest	2022-12-31	No
Contributions received from participants	2022-12-31	$95,959
Participant contributions at end of year	2022-12-31	$28,455
Participant contributions at beginning of year	2022-12-31	$20,061
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-12-31	$140,390
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-12-31	$93,837
Administrative expenses (other) incurred	2022-12-31	$20,109
Liabilities. Value of operating payables at end of year	2022-12-31	$25,669
Liabilities. Value of operating payables at beginning of year	2022-12-31	$19,859
Total non interest bearing cash at end of year	2022-12-31	$394,517
Total non interest bearing cash at beginning of year	2022-12-31	$222,613
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Value of net income/loss	2022-12-31	$779,266
Value of net assets at end of year (total assets less liabilities)	2022-12-31	$1,509,610
Value of net assets at beginning of year (total assets less liabilities)	2022-12-31	$730,344
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-12-31	No
Were any leases to which the plan was party in default or uncollectible	2022-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-12-31	$1,061,731
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-12-31	$461,036
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-12-31	$461,036
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-12-31	$695
Expenses. Payments to insurance carriers foe the provision of benefits	2022-12-31	$333,133
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2022-12-31	No
Has the plan failed to provide any benefit when due under the plan	2022-12-31	No
Contributions received in cash from employer	2022-12-31	$1,053,090
Employer contributions (assets) at end of year	2022-12-31	$190,966
Employer contributions (assets) at beginning of year	2022-12-31	$140,330
Did the plan have assets held for investment	2022-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-12-31	No
Opinion of an independent qualified public accountant for this plan	2022-12-31	Unqualified
Accountancy firm name	2022-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2022-12-31	410746749
2021 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2021 401k financial data
Total unrealized appreciation/depreciation of assets	2021-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$113,696
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-12-31	$82,480
Total income from all sources (including contributions)	2021-12-31	$720,276
Total loss/gain on sale of assets	2021-12-31	$0
Total of all expenses incurred	2021-12-31	$201,306
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-12-31	$167,073
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-12-31	$720,243
Value of total assets at end of year	2021-12-31	$844,040
Value of total assets at beginning of year	2021-12-31	$293,854
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-12-31	$34,233
Total interest from all sources	2021-12-31	$28
Total dividends received (eg from common stock, registered investment company shares)	2021-12-31	$5
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-12-31	$5
Administrative expenses professional fees incurred	2021-12-31	$16,364
Was this plan covered by a fidelity bond	2021-12-31	Yes
Value of fidelity bond cover	2021-12-31	$150,000
Were there any nonexempt tranactions with any party-in-interest	2021-12-31	No
Contributions received from participants	2021-12-31	$101,652
Participant contributions at end of year	2021-12-31	$20,061
Participant contributions at beginning of year	2021-12-31	$42,960
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-12-31	$93,837
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-12-31	$62,125
Administrative expenses (other) incurred	2021-12-31	$17,869
Liabilities. Value of operating payables at end of year	2021-12-31	$19,859
Liabilities. Value of operating payables at beginning of year	2021-12-31	$20,355
Total non interest bearing cash at end of year	2021-12-31	$222,613
Total non interest bearing cash at beginning of year	2021-12-31	$205,823
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Value of net income/loss	2021-12-31	$518,970
Value of net assets at end of year (total assets less liabilities)	2021-12-31	$730,344
Value of net assets at beginning of year (total assets less liabilities)	2021-12-31	$211,374
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-12-31	No
Were any leases to which the plan was party in default or uncollectible	2021-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-12-31	$461,036
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-12-31	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-12-31	$28
Expenses. Payments to insurance carriers foe the provision of benefits	2021-12-31	$167,073
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2021-12-31	No
Has the plan failed to provide any benefit when due under the plan	2021-12-31	No
Contributions received in cash from employer	2021-12-31	$618,591
Employer contributions (assets) at end of year	2021-12-31	$140,330
Employer contributions (assets) at beginning of year	2021-12-31	$45,071
Did the plan have assets held for investment	2021-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-12-31	No
Opinion of an independent qualified public accountant for this plan	2021-12-31	Unqualified
Accountancy firm name	2021-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2021-12-31	410746749
2020 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2020 401k financial data
Total unrealized appreciation/depreciation of assets	2020-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$82,480
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-12-31	$178,124
Total income from all sources (including contributions)	2020-12-31	$539,284
Total loss/gain on sale of assets	2020-12-31	$0
Total of all expenses incurred	2020-12-31	$1,097,731
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-12-31	$1,063,896
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-12-31	$522,730
Value of total assets at end of year	2020-12-31	$293,854
Value of total assets at beginning of year	2020-12-31	$947,945
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-12-31	$33,835
Total interest from all sources	2020-12-31	$53
Total dividends received (eg from common stock, registered investment company shares)	2020-12-31	$3,144
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-12-31	$3,144
Administrative expenses professional fees incurred	2020-12-31	$16,260
Was this plan covered by a fidelity bond	2020-12-31	Yes
Value of fidelity bond cover	2020-12-31	$150,000
Were there any nonexempt tranactions with any party-in-interest	2020-12-31	No
Contributions received from participants	2020-12-31	$276,450
Participant contributions at end of year	2020-12-31	$42,960
Participant contributions at beginning of year	2020-12-31	$88,704
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-12-31	$2,738
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-12-31	$62,125
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-12-31	$159,579
Administrative expenses (other) incurred	2020-12-31	$17,575
Liabilities. Value of operating payables at end of year	2020-12-31	$20,355
Liabilities. Value of operating payables at beginning of year	2020-12-31	$18,545
Total non interest bearing cash at end of year	2020-12-31	$205,823
Total non interest bearing cash at beginning of year	2020-12-31	$244,375
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Value of net income/loss	2020-12-31	$-558,447
Value of net assets at end of year (total assets less liabilities)	2020-12-31	$211,374
Value of net assets at beginning of year (total assets less liabilities)	2020-12-31	$769,821
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-12-31	No
Were any leases to which the plan was party in default or uncollectible	2020-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-12-31	$400,758
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-12-31	$53
Expenses. Payments to insurance carriers foe the provision of benefits	2020-12-31	$1,063,896
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-12-31	$13,357
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2020-12-31	No
Has the plan failed to provide any benefit when due under the plan	2020-12-31	No
Contributions received in cash from employer	2020-12-31	$246,280
Employer contributions (assets) at end of year	2020-12-31	$45,071
Employer contributions (assets) at beginning of year	2020-12-31	$211,370
Did the plan have assets held for investment	2020-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-12-31	No
Opinion of an independent qualified public accountant for this plan	2020-12-31	Unqualified
Accountancy firm name	2020-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2020-12-31	410746749
2019 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2019 401k financial data
Total unrealized appreciation/depreciation of assets	2019-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$178,124
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$178,124
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$159,779
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-12-31	$159,779
Total income from all sources (including contributions)	2019-12-31	$1,408,851
Total loss/gain on sale of assets	2019-12-31	$0
Total of all expenses incurred	2019-12-31	$1,432,482
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-12-31	$1,393,943
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,306,723
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-12-31	$1,306,723
Value of total assets at end of year	2019-12-31	$947,945
Value of total assets at end of year	2019-12-31	$947,945
Value of total assets at beginning of year	2019-12-31	$953,231
Value of total assets at beginning of year	2019-12-31	$953,231
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-12-31	$38,539
Total interest from all sources	2019-12-31	$194
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$4,576
Total dividends received (eg from common stock, registered investment company shares)	2019-12-31	$4,576
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-12-31	$4,576
Administrative expenses professional fees incurred	2019-12-31	$17,250
Was this plan covered by a fidelity bond	2019-12-31	Yes
Value of fidelity bond cover	2019-12-31	$150,000
Value of fidelity bond cover	2019-12-31	$150,000
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2019-12-31	No
Contributions received from participants	2019-12-31	$334,412
Contributions received from participants	2019-12-31	$334,412
Participant contributions at end of year	2019-12-31	$88,704
Participant contributions at end of year	2019-12-31	$88,704
Participant contributions at beginning of year	2019-12-31	$69,966
Participant contributions at beginning of year	2019-12-31	$69,966
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$2,738
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-12-31	$2,738
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$3,466
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-12-31	$3,466
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$159,579
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-12-31	$159,579
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$142,219
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-12-31	$142,219
Administrative expenses (other) incurred	2019-12-31	$21,289
Liabilities. Value of operating payables at end of year	2019-12-31	$18,545
Liabilities. Value of operating payables at end of year	2019-12-31	$18,545
Liabilities. Value of operating payables at beginning of year	2019-12-31	$17,560
Liabilities. Value of operating payables at beginning of year	2019-12-31	$17,560
Total non interest bearing cash at end of year	2019-12-31	$244,375
Total non interest bearing cash at end of year	2019-12-31	$244,375
Total non interest bearing cash at beginning of year	2019-12-31	$430,434
Total non interest bearing cash at beginning of year	2019-12-31	$430,434
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Value of net income/loss	2019-12-31	$-23,631
Value of net income/loss	2019-12-31	$-23,631
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$769,821
Value of net assets at end of year (total assets less liabilities)	2019-12-31	$769,821
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$793,452
Value of net assets at beginning of year (total assets less liabilities)	2019-12-31	$793,452
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Were any leases to which the plan was party in default or uncollectible	2019-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$400,758
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-12-31	$400,758
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$302,342
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-12-31	$302,342
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$194
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-12-31	$194
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$1,393,943
Expenses. Payments to insurance carriers foe the provision of benefits	2019-12-31	$1,393,943
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-12-31	$97,358
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Was there a failure to transmit to the plan any participant contributions	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Has the plan failed to provide any benefit when due under the plan	2019-12-31	No
Contributions received in cash from employer	2019-12-31	$972,311
Contributions received in cash from employer	2019-12-31	$972,311
Employer contributions (assets) at end of year	2019-12-31	$211,370
Employer contributions (assets) at end of year	2019-12-31	$211,370
Employer contributions (assets) at beginning of year	2019-12-31	$147,023
Employer contributions (assets) at beginning of year	2019-12-31	$147,023
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan have assets held for investment	2019-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-12-31	No
Opinion of an independent qualified public accountant for this plan	2019-12-31	Qualified
Opinion of an independent qualified public accountant for this plan	2019-12-31	Qualified
Accountancy firm name	2019-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm name	2019-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2019-12-31	410746749
Accountancy firm EIN	2019-12-31	410746749
2018 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$159,779
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$124,712
Total income from all sources (including contributions)	2018-12-31	$1,146,250
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$1,363,227
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$1,330,607
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$1,162,399
Value of total assets at end of year	2018-12-31	$953,231
Value of total assets at beginning of year	2018-12-31	$1,135,141
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$32,620
Total interest from all sources	2018-12-31	$159
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$4,882
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$4,882
Administrative expenses professional fees incurred	2018-12-31	$13,525
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$150,000
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Contributions received from participants	2018-12-31	$333,884
Participant contributions at end of year	2018-12-31	$69,966
Participant contributions at beginning of year	2018-12-31	$65,461
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-12-31	$3,466
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-12-31	$2,508
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-12-31	$142,219
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-12-31	$120,269
Administrative expenses (other) incurred	2018-12-31	$19,095
Liabilities. Value of operating payables at end of year	2018-12-31	$17,560
Liabilities. Value of operating payables at beginning of year	2018-12-31	$4,443
Total non interest bearing cash at end of year	2018-12-31	$430,434
Total non interest bearing cash at beginning of year	2018-12-31	$550,238
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$-216,977
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$793,452
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,010,429
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$302,342
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$323,416
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$159
Expenses. Payments to insurance carriers foe the provision of benefits	2018-12-31	$1,330,607
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$-21,190
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	No
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contributions received in cash from employer	2018-12-31	$828,515
Employer contributions (assets) at end of year	2018-12-31	$147,023
Employer contributions (assets) at beginning of year	2018-12-31	$193,518
Did the plan have assets held for investment	2018-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Qualified
Accountancy firm name	2018-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2018-12-31	410746749
2017 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$124,712
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$112,428
Total income from all sources (including contributions)	2017-12-31	$1,184,707
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$1,033,493
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$1,002,363
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$1,126,578
Value of total assets at end of year	2017-12-31	$1,135,141
Value of total assets at beginning of year	2017-12-31	$971,643
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$31,130
Total interest from all sources	2017-12-31	$144
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$3,569
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$3,569
Administrative expenses professional fees incurred	2017-12-31	$13,100
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$100,000
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Contributions received from participants	2017-12-31	$307,298
Participant contributions at end of year	2017-12-31	$65,461
Participant contributions at beginning of year	2017-12-31	$57,713
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-12-31	$2,508
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-12-31	$186
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-12-31	$120,269
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-12-31	$95,141
Administrative expenses (other) incurred	2017-12-31	$18,030
Liabilities. Value of operating payables at end of year	2017-12-31	$4,443
Liabilities. Value of operating payables at beginning of year	2017-12-31	$17,287
Total non interest bearing cash at end of year	2017-12-31	$550,238
Total non interest bearing cash at beginning of year	2017-12-31	$452,926
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$151,214
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,010,429
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$859,215
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$323,416
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$268,909
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-12-31	$144
Expenses. Payments to insurance carriers foe the provision of benefits	2017-12-31	$1,002,363
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$54,416
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Contributions received in cash from employer	2017-12-31	$819,280
Employer contributions (assets) at end of year	2017-12-31	$193,518
Employer contributions (assets) at beginning of year	2017-12-31	$191,909
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Qualified
Accountancy firm name	2017-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2017-12-31	410746749
2016 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$112,428
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$90,591
Total income from all sources (including contributions)	2016-12-31	$948,718
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$877,084
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$844,317
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$938,981
Value of total assets at end of year	2016-12-31	$971,643
Value of total assets at beginning of year	2016-12-31	$878,172
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$32,767
Total interest from all sources	2016-12-31	$112
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$4,852
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$4,852
Administrative expenses professional fees incurred	2016-12-31	$14,450
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$100,000
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$260,043
Participant contributions at end of year	2016-12-31	$57,713
Participant contributions at beginning of year	2016-12-31	$66,755
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$186
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$1,842
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$95,141
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$73,432
Administrative expenses (other) incurred	2016-12-31	$18,317
Liabilities. Value of operating payables at end of year	2016-12-31	$17,287
Liabilities. Value of operating payables at beginning of year	2016-12-31	$17,159
Total non interest bearing cash at end of year	2016-12-31	$452,926
Total non interest bearing cash at beginning of year	2016-12-31	$351,631
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$71,634
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$859,215
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$787,581
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$268,909
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$262,149
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$112
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$844,317
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$4,773
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$678,938
Employer contributions (assets) at end of year	2016-12-31	$191,909
Employer contributions (assets) at beginning of year	2016-12-31	$195,795
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Qualified
Accountancy firm name	2016-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2016-12-31	410746749
2015 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$90,591
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$92,478
Total income from all sources (including contributions)	2015-12-31	$904,416
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$816,004
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$784,732
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$893,679
Value of total assets at end of year	2015-12-31	$878,172
Value of total assets at beginning of year	2015-12-31	$791,647
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$31,272
Total interest from all sources	2015-12-31	$104
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$6,187
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$6,187
Administrative expenses professional fees incurred	2015-12-31	$13,845
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$100,000
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$261,562
Participant contributions at end of year	2015-12-31	$66,755
Participant contributions at beginning of year	2015-12-31	$58,284
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$1,842
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$1,978
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$73,432
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$75,708
Administrative expenses (other) incurred	2015-12-31	$17,427
Liabilities. Value of operating payables at end of year	2015-12-31	$17,159
Liabilities. Value of operating payables at beginning of year	2015-12-31	$16,770
Total non interest bearing cash at end of year	2015-12-31	$351,631
Total non interest bearing cash at beginning of year	2015-12-31	$334,044
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$88,412
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$787,581
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$699,169
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$262,149
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$254,334
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$104
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$784,732
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$4,446
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$632,117
Employer contributions (assets) at end of year	2015-12-31	$195,795
Employer contributions (assets) at beginning of year	2015-12-31	$143,007
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Qualified
Accountancy firm name	2015-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2015-12-31	410746749
2014 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$92,478
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$95,701
Total income from all sources (including contributions)	2014-12-31	$788,136
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$857,155
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$826,423
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$750,167
Value of total assets at end of year	2014-12-31	$791,647
Value of total assets at beginning of year	2014-12-31	$863,889
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$30,732
Total interest from all sources	2014-12-31	$121
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$5,299
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2014-12-31	$5,299
Administrative expenses professional fees incurred	2014-12-31	$13,510
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$100,000
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$278,026
Participant contributions at end of year	2014-12-31	$58,284
Participant contributions at beginning of year	2014-12-31	$43,373
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$1,978
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$1,984
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$75,708
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$78,636
Other income not declared elsewhere	2014-12-31	$3,596
Administrative expenses (other) incurred	2014-12-31	$17,222
Liabilities. Value of operating payables at end of year	2014-12-31	$16,770
Liabilities. Value of operating payables at beginning of year	2014-12-31	$17,065
Total non interest bearing cash at end of year	2014-12-31	$334,044
Total non interest bearing cash at beginning of year	2014-12-31	$486,276
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-69,019
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$699,169
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$768,188
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2014-12-31	$254,334
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2014-12-31	$222,676
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$121
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$826,423
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2014-12-31	$28,953
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$472,141
Employer contributions (assets) at end of year	2014-12-31	$143,007
Employer contributions (assets) at beginning of year	2014-12-31	$109,580
Did the plan have assets held for investment	2014-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Qualified
Accountancy firm name	2014-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2014-12-31	410746749
2013 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$95,701
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$86,639
Total income from all sources (including contributions)	2013-12-31	$789,344
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$546,008
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$515,838
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$731,437
Value of total assets at end of year	2013-12-31	$863,889
Value of total assets at beginning of year	2013-12-31	$611,491
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$30,170
Total interest from all sources	2013-12-31	$106
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$3,063
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2013-12-31	$3,063
Administrative expenses professional fees incurred	2013-12-31	$12,615
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$100,000
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$208,844
Participant contributions at end of year	2013-12-31	$43,373
Participant contributions at beginning of year	2013-12-31	$52,178
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$1,984
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$78,636
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$69,365
Administrative expenses (other) incurred	2013-12-31	$17,555
Liabilities. Value of operating payables at end of year	2013-12-31	$17,065
Liabilities. Value of operating payables at beginning of year	2013-12-31	$17,274
Total non interest bearing cash at end of year	2013-12-31	$486,276
Total non interest bearing cash at beginning of year	2013-12-31	$302,404
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$243,336
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$768,188
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$524,852
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2013-12-31	$222,676
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2013-12-31	$167,470
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$106
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$515,838
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2013-12-31	$54,738
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$522,593
Employer contributions (assets) at end of year	2013-12-31	$109,580
Employer contributions (assets) at beginning of year	2013-12-31	$89,439
Assets. Corporate common stocks other than exployer securities at end of year	2013-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-12-31	$0
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Qualified
Accountancy firm name	2013-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2013-12-31	410746749
2012 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$86,639
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$98,229
Total income from all sources (including contributions)	2012-12-31	$860,979
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$576,163
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$545,957
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$822,161
Value of total assets at end of year	2012-12-31	$611,491
Value of total assets at beginning of year	2012-12-31	$338,265
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$30,206
Total interest from all sources	2012-12-31	$92
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$1,986
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2012-12-31	$1,986
Administrative expenses professional fees incurred	2012-12-31	$12,490
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$100,000
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$211,954
Participant contributions at end of year	2012-12-31	$52,178
Participant contributions at beginning of year	2012-12-31	$39,682
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$69,365
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$70,187
Other income not declared elsewhere	2012-12-31	$13,835
Administrative expenses (other) incurred	2012-12-31	$17,716
Liabilities. Value of operating payables at end of year	2012-12-31	$17,274
Liabilities. Value of operating payables at beginning of year	2012-12-31	$28,042
Total non interest bearing cash at end of year	2012-12-31	$302,404
Total non interest bearing cash at beginning of year	2012-12-31	$64,495
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$284,816
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$524,852
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$240,036
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2012-12-31	$167,470
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2012-12-31	$144,566
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$92
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$545,957
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-12-31	$22,905
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$610,207
Employer contributions (assets) at end of year	2012-12-31	$89,439
Employer contributions (assets) at beginning of year	2012-12-31	$89,522
Assets. Corporate common stocks other than exployer securities at end of year	2012-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-12-31	$0
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Qualified
Accountancy firm name	2012-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2012-12-31	410746749
2011 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2011 401k financial data
Total unrealized appreciation/depreciation of assets	2011-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$98,229
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$70,277
Total income from all sources (including contributions)	2011-12-31	$629,080
Total loss/gain on sale of assets	2011-12-31	$0
Total of all expenses incurred	2011-12-31	$553,541
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$526,130
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$620,646
Value of total assets at end of year	2011-12-31	$338,265
Value of total assets at beginning of year	2011-12-31	$234,774
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$27,411
Total interest from all sources	2011-12-31	$22
Total dividends received (eg from common stock, registered investment company shares)	2011-12-31	$2,135
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Total dividends received from registered investment company shares (eg mutual funds)	2011-12-31	$2,135
Administrative expenses professional fees incurred	2011-12-31	$12,865
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$50,000
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$196,020
Participant contributions at end of year	2011-12-31	$39,682
Participant contributions at beginning of year	2011-12-31	$45,448
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$70,187
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$56,441
Administrative expenses (other) incurred	2011-12-31	$14,546
Liabilities. Value of operating payables at end of year	2011-12-31	$28,042
Liabilities. Value of operating payables at beginning of year	2011-12-31	$13,836
Total non interest bearing cash at end of year	2011-12-31	$64,495
Total non interest bearing cash at beginning of year	2011-12-31	$15,129
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$75,539
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$240,036
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$164,497
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2011-12-31	$144,566
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2011-12-31	$138,288
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$22
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$525,870
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2011-12-31	$6,277
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$424,626
Employer contributions (assets) at end of year	2011-12-31	$89,522
Employer contributions (assets) at beginning of year	2011-12-31	$35,909
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$260
Assets. Corporate common stocks other than exployer securities at end of year	2011-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-12-31	$0
Did the plan have assets held for investment	2011-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Qualified
Accountancy firm name	2011-12-31	CLIFTONLARSONALLEN LLP
Accountancy firm EIN	2011-12-31	410746749
2010 : I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2010-12-31	$1,235
Total unrealized appreciation/depreciation of assets	2010-12-31	$1,235
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$70,277
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$109,400
Total income from all sources (including contributions)	2010-12-31	$633,193
Total loss/gain on sale of assets	2010-12-31	$0
Total of all expenses incurred	2010-12-31	$756,011
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$727,110
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$575,606
Value of total assets at end of year	2010-12-31	$234,774
Value of total assets at beginning of year	2010-12-31	$396,715
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$28,901
Total interest from all sources	2010-12-31	$34
Total dividends received (eg from common stock, registered investment company shares)	2010-12-31	$3,750
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$13,640
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$50,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$225,563
Participant contributions at end of year	2010-12-31	$45,448
Participant contributions at beginning of year	2010-12-31	$41,691
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$56,441
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$72,947
Other income not declared elsewhere	2010-12-31	$31,677
Administrative expenses (other) incurred	2010-12-31	$15,261
Liabilities. Value of operating payables at end of year	2010-12-31	$13,836
Liabilities. Value of operating payables at beginning of year	2010-12-31	$33,853
Total non interest bearing cash at end of year	2010-12-31	$15,129
Total non interest bearing cash at beginning of year	2010-12-31	$38,908
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-122,818
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$164,497
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$287,315
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2010-12-31	$138,288
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2010-12-31	$244,701
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$34
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$723,990
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2010-12-31	$20,891
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$350,043
Employer contributions (assets) at end of year	2010-12-31	$35,909
Employer contributions (assets) at beginning of year	2010-12-31	$46,221
Income. Dividends from common stock	2010-12-31	$3,750
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$3,120
Assets. Corporate common stocks other than exployer securities at end of year	2010-12-31	$0
Assets. Corporate common stocks other than exployer securities at beginning of year	2010-12-31	$25,194
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$2,600
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Qualified
Accountancy firm name	2010-12-31	CLIFTON GUNDERSON LLP
Accountancy firm EIN	2010-12-31	370802863

Form 5500 Responses for I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND

2022: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2022 form 5500 responses
2022-01-01	Type of plan entity	Multi-employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	Yes
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2021 form 5500 responses
2021-01-01	Type of plan entity	Multi-employer plan
2021-01-01	Submission has been amended	No
2021-01-01	This submission is the final filing	No
2021-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2021-01-01	Plan is a collectively bargained plan	Yes
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2020 form 5500 responses
2020-01-01	Type of plan entity	Multi-employer plan
2020-01-01	Submission has been amended	No
2020-01-01	This submission is the final filing	No
2020-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2020-01-01	Plan is a collectively bargained plan	Yes
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2019 form 5500 responses
2019-01-01	Type of plan entity	Multi-employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	Yes
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2018 form 5500 responses
2018-01-01	Type of plan entity	Multi-employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Insurance	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement – Insurance	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2017 form 5500 responses
2017-01-01	Type of plan entity	Multi-employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	Yes
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2016 form 5500 responses
2016-01-01	Type of plan entity	Multi-employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2015 form 5500 responses
2015-01-01	Type of plan entity	Multi-employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2014 form 5500 responses
2014-01-01	Type of plan entity	Multi-employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2013 form 5500 responses
2013-01-01	Type of plan entity	Multi-employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2012 form 5500 responses
2012-01-01	Type of plan entity	Multi-employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2011 form 5500 responses
2011-01-01	Type of plan entity	Multi-employer plan
2011-01-01	Submission has been amended	No
2011-01-01	This submission is the final filing	No
2011-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2010 form 5500 responses
2010-01-01	Type of plan entity	Multi-employer plan
2010-01-01	Submission has been amended	No
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	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: I.A.T.S.E. LOCAL 30 HEALTH & WELFARE FUND 2009 form 5500 responses
2009-01-01	Type of plan entity	Multi-employer plan
2009-01-01	Submission has been amended	Yes
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	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

ANTHEM INSURANCE COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	EAP
Policy instance	4
Insurance contract or identification number EAP Number of Individuals Covered 117 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 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 Other welfare benefits provided EAP 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 $1,752 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	W11126
Policy instance	3
Insurance contract or identification number W11126 Number of Individuals Covered 14 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $1,610 Total amount of fees paid to insurance company USD $0 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 Yes Dental Insurance Welfare Benefit Yes 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 $297,733 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,610 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSION Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12066310
Policy instance	2
Insurance contract or identification number 12066310 Number of Individuals Covered 14 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $264 Total amount of fees paid to insurance company USD $0 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 Yes 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 $2,618 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $264 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548
Policy instance	1
Insurance contract or identification number CL548 Number of Individuals Covered 42 Insurance policy start date 2022-01-01 Insurance policy end date 2022-12-31 Total amount of commissions paid to insurance broker USD $671 Total amount of fees paid to insurance company USD $0 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided 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 $6,036 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $671 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker SALES AND BASE COMMISSION PAID Insurance broker organization code? 3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548
Policy instance	1
Insurance contract or identification number CL548 Number of Individuals Covered 105 Insurance policy start date 2020-06-01 Insurance policy end date 2021-05-31 Total amount of commissions paid to insurance broker USD $1,414 Total amount of fees paid to insurance company USD $0 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided 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 $14,495 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,414 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker SALES AND BASE COMMISSION PAID Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12066310
Policy instance	2
Insurance contract or identification number 12066310 Number of Individuals Covered 8 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $153 Total amount of fees paid to insurance company USD $0 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 Yes 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 $1,589 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $153 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	W11126
Policy instance	3
Insurance contract or identification number W11126 Number of Individuals Covered 15 Insurance policy start date 2021-01-01 Insurance policy end date 2021-12-31 Total amount of commissions paid to insurance broker USD $960 Total amount of fees paid to insurance company USD $0 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 Yes Dental Insurance Welfare Benefit Yes 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 $148,962 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $960 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSION Insurance broker organization code? 3
ANTHEM INSURANCE COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	EAP
Policy instance	4
Insurance contract or identification number EAP Number of Individuals Covered 157 Insurance policy start date 2021-01-01 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 Other welfare benefits provided EAP 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 $2,110 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548
Policy instance	1
Insurance contract or identification number CL548 Number of Individuals Covered 106 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $1,394 Total amount of fees paid to insurance company USD $0 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided 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 $14,551 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,394 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker SALES AND BASE COMMISSION PAID Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12066310
Policy instance	2
Insurance contract or identification number 12066310 Number of Individuals Covered 84 Insurance policy start date 2019-06-01 Insurance policy end date 2020-05-31 Total amount of commissions paid to insurance broker USD $914 Total amount of fees paid to insurance company USD $0 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 Yes 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 $15,801 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $914 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	W11126
Policy instance	3
Insurance contract or identification number W11126 Number of Individuals Covered 16 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 Total amount of commissions paid to insurance broker USD $7,910 Total amount of fees paid to insurance company USD $0 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 Yes Dental Insurance Welfare Benefit Yes 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 $1,035,811 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,910 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSION Insurance broker organization code? 3
ANTHEM INSURANCE COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	EAP
Policy instance	4
Insurance contract or identification number EAP Number of Individuals Covered 157 Insurance policy start date 2020-01-01 Insurance policy end date 2020-12-31 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 Other welfare benefits provided EAP 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 $1,934 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548
Policy instance	1
Insurance contract or identification number CL548 Number of Individuals Covered 106 Insurance policy start date 2018-06-01 Insurance policy end date 2019-05-31 Total amount of commissions paid to insurance broker USD $1,253 Total amount of fees paid to insurance company USD $0 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided 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 $13,763 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,253 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker SALES AND BASE COMMISSION PAID Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )
Policy contract number	12066310
Policy instance	2
Insurance contract or identification number 12066310 Number of Individuals Covered 82 Insurance policy start date 2018-06-01 Insurance policy end date 2019-05-31 Total amount of commissions paid to insurance broker USD $925 Total amount of fees paid to insurance company USD $0 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 Yes 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 $14,883 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $925 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	W11126
Policy instance	3
Insurance contract or identification number W11126 Number of Individuals Covered 133 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 Total amount of commissions paid to insurance broker USD $8,930 Total amount of fees paid to insurance company USD $0 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 Yes Dental Insurance Welfare Benefit Yes 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 $1,364,832 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,930 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSION Insurance broker organization code? 3
ANTHEM INSURANCE COMPANIES, INC. (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	EAP
Policy instance	4
Insurance contract or identification number EAP Number of Individuals Covered 149 Insurance policy start date 2019-01-01 Insurance policy end date 2019-12-31 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 Other welfare benefits provided EAP 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 $2,002 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: 53031 )
Policy contract number	12066310
Policy instance	3
Insurance contract or identification number 12066310 Number of Individuals Covered 83 Insurance policy start date 2017-02-01 Insurance policy end date 2018-01-31 Total amount of commissions paid to insurance broker USD $904 Total amount of fees paid to insurance company USD $0 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 Yes 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 $14,330 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $904 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548000
Policy instance	2
Insurance contract or identification number CL548000 Number of Individuals Covered 94 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $1,183 Total amount of fees paid to insurance company USD $0 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided 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 $12,918 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,183 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker SALES AND BASE COMMISSION PAID Insurance broker organization code? 3
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	00009936
Policy instance	1
Insurance contract or identification number 00009936 Number of Individuals Covered 127 Insurance policy start date 2018-01-01 Insurance policy end date 2018-12-31 Total amount of commissions paid to insurance broker USD $8,654 Total amount of fees paid to insurance company USD $0 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 Yes Dental Insurance Welfare Benefit Yes 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 $1,302,819 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $8,654 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker SALES AND BASE COMMISSIONS PAID Insurance broker organization code? 3
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 53031 )
Policy contract number	12066310
Policy instance	3
Insurance contract or identification number 12066310 Number of Individuals Covered 76 Insurance policy start date 2016-02-01 Insurance policy end date 2017-01-31 Total amount of commissions paid to insurance broker USD $822 Total amount of fees paid to insurance company USD $0 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 Yes 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 $12,017 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $822 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3 Insurance broker name MICHAEL OWEN
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548000
Policy instance	2
Insurance contract or identification number CL548000 Number of Individuals Covered 52 Insurance policy start date 2016-06-01 Insurance policy end date 2017-05-31 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided 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 $10,557 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	00009936
Policy instance	1
Insurance contract or identification number 00009936 Number of Individuals Covered 124 Insurance policy start date 2017-01-01 Insurance policy end date 2017-12-31 Total amount of commissions paid to insurance broker USD $9,040 Total amount of fees paid to insurance company USD $0 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 Yes Dental Insurance Welfare Benefit Yes 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 $976,055 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $9,040 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker SALES AND BASE COMMISSIONS PAID Insurance broker organization code? 3 Insurance broker name MICHAEL J OWEN
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	00009936
Policy instance	1
Insurance contract or identification number 00009936 Number of Individuals Covered 104 Insurance policy start date 2015-01-01 Insurance policy end date 2015-12-31 Total amount of commissions paid to insurance broker USD $7,550 Total amount of fees paid to insurance company USD $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 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 Yes Dental Insurance Welfare Benefit Yes 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 $739,559 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,550 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3 Insurance broker name MICHAEL J OWEN
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548000
Policy instance	2
Insurance contract or identification number CL548000 Number of Individuals Covered 75 Insurance policy start date 2014-06-01 Insurance policy end date 2015-05-31 Total amount of commissions paid to insurance broker USD $1,131 Total amount of fees paid to insurance company USD $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 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided 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 $11,306 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $1,131 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3 Insurance broker name MICHAEL J OWEN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number	12066310
Policy instance	3
Insurance contract or identification number 12066310 Number of Individuals Covered 66 Insurance policy start date 2014-02-01 Insurance policy end date 2015-01-31 Total amount of commissions paid to insurance broker USD $803 Total amount of fees paid to insurance company USD $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 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 Yes 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 $11,499 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $803 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSIONS Insurance broker organization code? 3 Insurance broker name MICHAEL OWEN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number	12066310
Policy instance	3
Insurance contract or identification number 12066310 Number of Individuals Covered 68 Insurance policy start date 2013-02-01 Insurance policy end date 2014-01-31 Total amount of commissions paid to insurance broker USD $779 Total amount of fees paid to insurance company USD $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 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 Yes 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 $10,804 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $779 Insurance broker organization code? 3 Insurance broker name MICHAEL OWEN
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548000
Policy instance	2
Insurance contract or identification number CL548000 Number of Individuals Covered 80 Insurance policy start date 2013-06-01 Insurance policy end date 2014-05-31 Total amount of commissions paid to insurance broker USD $522 Total amount of fees paid to insurance company USD $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 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided 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 $11,966 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $522 Insurance broker organization code? 3 Insurance broker name MICHAEL J OWEN
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	00009936
Policy instance	1
Insurance contract or identification number 00009936 Number of Individuals Covered 119 Insurance policy start date 2014-01-01 Insurance policy end date 2014-12-31 Total amount of commissions paid to insurance broker USD $7,198 Total amount of fees paid to insurance company USD $174 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 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 Yes Dental Insurance Welfare Benefit Yes 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 $802,920 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,198 Amount paid for insurance broker fees 174 Additional information about fees paid to insurance broker BONUS Insurance broker organization code? 3 Insurance broker name MICHAEL J OWEN
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	00009936
Policy instance	1
Insurance contract or identification number 00009936 Number of Individuals Covered 58 Insurance policy start date 2013-01-01 Insurance policy end date 2013-12-31 Total amount of commissions paid to insurance broker USD $7,060 Total amount of fees paid to insurance company USD $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 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 Yes Dental Insurance Welfare Benefit Yes 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 $535,656 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,060 Insurance broker organization code? 3 Insurance broker name MICHAEL J OWEN
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548000
Policy instance	2
Insurance contract or identification number CL548000 Number of Individuals Covered 66 Insurance policy start date 2012-06-01 Insurance policy end date 2013-05-31 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 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Insurance broker organization code? 3 Insurance broker name MICHAEL J OWEN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number	12066310
Policy instance	3
Insurance contract or identification number 12066310 Number of Individuals Covered 60 Insurance policy start date 2012-02-01 Insurance policy end date 2013-01-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $764 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 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 Yes 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 $10,397 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $0 Amount paid for insurance broker fees 764 Additional information about fees paid to insurance broker COMMISSIONS PAID Insurance broker organization code? 3 Insurance broker name MICHAEL OWEN
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548000
Policy instance	2
Insurance contract or identification number CL548000 Number of Individuals Covered 66 Insurance policy start date 2011-06-01 Insurance policy end date 2012-05-31 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 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided AD&D Were dividends or retroactive rate refunds paid in cash? No Were dividends or retroactive rate refunds paid as a credit? No Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Insurance broker organization code? 3 Insurance broker name MICHAEL J OWEN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number	12066310
Policy instance	3
Insurance contract or identification number 12066310 Number of Individuals Covered 61 Insurance policy start date 2011-02-01 Insurance policy end date 2012-01-31 Total amount of commissions paid to insurance broker USD $727 Total amount of fees paid to insurance company USD $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 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 Yes 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 $9,532 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $727 Amount paid for insurance broker fees 0 Additional information about fees paid to insurance broker COMMISSIONS PAID Insurance broker organization code? 3 Insurance broker name MICHAEL OWEN
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	00009936
Policy instance	1
Insurance contract or identification number 00009936 Number of Individuals Covered 115 Insurance policy start date 2012-01-01 Insurance policy end date 2012-12-31 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 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 Yes Dental Insurance Welfare Benefit Yes 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 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes Insurance broker organization code? 3 Insurance broker name MICHAEL J OWEN
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number	12066310
Policy instance	3
Insurance contract or identification number 12066310 Number of Individuals Covered 64 Insurance policy start date 2010-02-01 Insurance policy end date 2011-01-31 Total amount of commissions paid to insurance broker USD $773 Total amount of fees paid to insurance company USD $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 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 Yes 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 $10,656 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548000
Policy instance	2
Insurance contract or identification number CL548000 Number of Individuals Covered 66 Insurance policy start date 2010-06-01 Insurance policy end date 2011-05-31 Total amount of commissions paid to insurance broker USD $994 Total amount of fees paid to insurance company USD $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 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 Yes Temporary Disability Insurance Welfare Benefit No Long Term Disability Insurance Welfare Benefit No Unemployment Insurance Welfare Benefit No Other welfare benefits provided 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 $9,215 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	00009936
Policy instance	1
Insurance contract or identification number 00009936 Number of Individuals Covered 102 Insurance policy start date 2011-01-01 Insurance policy end date 2011-12-31 Total amount of commissions paid to insurance broker USD $4,930 Total amount of fees paid to insurance company USD $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 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 Yes Dental Insurance Welfare Benefit Yes 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 $504,410 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No
ANTHEM INSURANCE COMPANIES, INC (National Association of Insurance Commissioners NAIC id number: 28207 )
Policy contract number	00009936
Policy instance	1
Insurance contract or identification number 00009936 Number of Individuals Covered 127 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $7,130 Total amount of fees paid to insurance company USD $0 Health Insurance Welfare Benefit Yes Dental Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $705,292 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $7,130 Insurance broker organization code? 3 Insurance broker name MICHAEL OWEN
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number	CL548000
Policy instance	2
Insurance contract or identification number CL548000 Number of Individuals Covered 74 Insurance policy start date 2010-01-01 Insurance policy end date 2010-12-31 Total amount of commissions paid to insurance broker USD $0 Total amount of fees paid to insurance company USD $0 Life Insurance Welfare Benefit Yes Other welfare benefits provided AD&D Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? Yes
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 52050 )
Policy contract number	12066310
Policy instance	3
Insurance contract or identification number 12066310 Number of Individuals Covered 66 Insurance policy start date 2009-02-01 Insurance policy end date 2010-01-31 Total amount of commissions paid to insurance broker USD $770 Total amount of fees paid to insurance company USD $0 Vision Insurance Welfare Benefit Yes Welfare Benefit Premiums Paid to Carrier USD $10,569 Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? No Commission paid to Insurance Broker USD $770 Insurance broker organization code? 3 Insurance broker name MICHAEL OWEN

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