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TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 401k Plan overview

Plan NameTEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST
Plan identification number 575

TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST Benefits

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

401k Sponsoring company profile

TEAMSTERS LOCAL 922 - EMPLOYERS HEALTH TRUST has sponsored the creation of one or more 401k plans.

Company Name:TEAMSTERS LOCAL 922 - EMPLOYERS HEALTH TRUST
Employer identification number (EIN):521158708
NAIC Classification:525920
NAIC Description:Trusts, Estates, and Agency Accounts

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5752021-10-01RUDOLPH GARDNER2023-06-20 MICHAEL GOBLE2023-06-20
5752020-10-01RUDOLPH GARDNER2022-06-28 MICHAEL GOBLE2022-06-28
5752019-10-01RUDOLPH GARDNER2021-06-04 MICHAEL GOBLE2021-06-04
5752018-10-01RUDOLPH GARDNER2020-06-12 MICHAEL DUNCAN2020-06-15
5752017-10-01RUDOLPH GARDNER2019-07-02 BILLYE J. POUNDS2019-07-02
5752016-10-01
5752015-10-01
5752014-10-01
5752013-10-01SAMAMTHA BOWLING
5752012-10-01FERLINE BUIE RUDOLPH GARDNER2014-07-11
5752011-10-01FERLINE BUIE RUDOLPH GARDNER2013-07-11
5752009-10-01FERLINE BUIE RUDOLPH GARDNER2011-07-14
5752009-10-01FERLINE BUIE RUDOPH GARDNER2011-07-14
5752009-10-01FERLINE BUIE RUDOLPH GARDNER2011-07-14
5752009-10-01FERLINE BUIE RUDOLPH GARDNER2011-07-14
5752009-10-01FERLINE BUIE RUDOPH GARDNER2011-07-13
5752009-10-01FERLINE BUIE RUDOLPH GARDNER2011-08-18
5752008-10-01
5752008-10-01

Plan Statistics for TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST

401k plan membership statisitcs for TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST

Measure Date Value
2021: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2021 401k membership
Total participants, beginning-of-year2021-10-01413
Total number of active participants reported on line 7a of the Form 55002021-10-01433
Number of retired or separated participants receiving benefits2021-10-0142
Total of all active and inactive participants2021-10-01475
Number of employers contributing to the scheme2021-10-015
2020: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2020 401k membership
Total participants, beginning-of-year2020-10-01426
Total number of active participants reported on line 7a of the Form 55002020-10-01371
Number of retired or separated participants receiving benefits2020-10-0142
Total of all active and inactive participants2020-10-01413
Number of employers contributing to the scheme2020-10-015
2019: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2019 401k membership
Total participants, beginning-of-year2019-10-01422
Total number of active participants reported on line 7a of the Form 55002019-10-01392
Number of retired or separated participants receiving benefits2019-10-0138
Total of all active and inactive participants2019-10-01430
Number of employers contributing to the scheme2019-10-014
2018: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2018 401k membership
Total participants, beginning-of-year2018-10-01412
Total number of active participants reported on line 7a of the Form 55002018-10-01382
Number of retired or separated participants receiving benefits2018-10-0140
Total of all active and inactive participants2018-10-01422
Number of employers contributing to the scheme2018-10-014
2017: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2017 401k membership
Total participants, beginning-of-year2017-10-01396
Total number of active participants reported on line 7a of the Form 55002017-10-01373
Number of retired or separated participants receiving benefits2017-10-0139
Total of all active and inactive participants2017-10-01412
Number of employers contributing to the scheme2017-10-016
2016: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2016 401k membership
Total participants, beginning-of-year2016-10-01397
Total number of active participants reported on line 7a of the Form 55002016-10-01362
Number of retired or separated participants receiving benefits2016-10-0134
Total of all active and inactive participants2016-10-01396
Number of employers contributing to the scheme2016-10-015
2015: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2015 401k membership
Total participants, beginning-of-year2015-10-01420
Total number of active participants reported on line 7a of the Form 55002015-10-01363
Number of retired or separated participants receiving benefits2015-10-0134
Total of all active and inactive participants2015-10-01397
Number of employers contributing to the scheme2015-10-015
2014: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2014 401k membership
Total participants, beginning-of-year2014-10-01421
Total number of active participants reported on line 7a of the Form 55002014-10-01386
Number of retired or separated participants receiving benefits2014-10-0134
Total of all active and inactive participants2014-10-01420
Number of employers contributing to the scheme2014-10-014
2013: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2013 401k membership
Total participants, beginning-of-year2013-10-01461
Total number of active participants reported on line 7a of the Form 55002013-10-01421
Total of all active and inactive participants2013-10-01421
Total participants2013-10-010
Number of employers contributing to the scheme2013-10-014
2012: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2012 401k membership
Total participants, beginning-of-year2012-10-01513
Total number of active participants reported on line 7a of the Form 55002012-10-01461
Number of retired or separated participants receiving benefits2012-10-010
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01461
Number of employers contributing to the scheme2012-10-014
2011: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2011 401k membership
Total participants, beginning-of-year2011-10-01471
Total number of active participants reported on line 7a of the Form 55002011-10-01513
Number of retired or separated participants receiving benefits2011-10-010
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01513
2009: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2009 401k membership
Total participants, beginning-of-year2009-10-01628
Total number of active participants reported on line 7a of the Form 55002009-10-01539
Number of retired or separated participants receiving benefits2009-10-010
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-01539
Number of employers contributing to the scheme2009-10-015

Financial Data on TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST

Measure Date Value
2022 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets2022-09-30$4,908
Total unrealized appreciation/depreciation of assets2022-09-30$4,908
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$710,465
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$546,100
Total income from all sources (including contributions)2022-09-30$9,392,894
Total loss/gain on sale of assets2022-09-30$-116,668
Total of all expenses incurred2022-09-30$8,922,827
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-09-30$8,578,777
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-09-30$7,711,762
Value of total assets at end of year2022-09-30$5,590,724
Value of total assets at beginning of year2022-09-30$4,956,292
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-09-30$344,050
Total interest from all sources2022-09-30$4,345
Total dividends received (eg from common stock, registered investment company shares)2022-09-30$84,206
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-09-30No
Administrative expenses professional fees incurred2022-09-30$91,770
Was this plan covered by a fidelity bond2022-09-30Yes
Value of fidelity bond cover2022-09-30$100,000
If this is an individual account plan, was there a blackout period2022-09-30No
Were there any nonexempt tranactions with any party-in-interest2022-09-30No
Contributions received from participants2022-09-30$2,170,561
Participant contributions at end of year2022-09-30$121,405
Participant contributions at beginning of year2022-09-30$128,737
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-09-30$128,804
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-09-30$104,876
Other income not declared elsewhere2022-09-30$1,704,341
Administrative expenses (other) incurred2022-09-30$63,338
Liabilities. Value of operating payables at end of year2022-09-30$91,465
Liabilities. Value of operating payables at beginning of year2022-09-30$22,254
Total non interest bearing cash at end of year2022-09-30$2,155,529
Total non interest bearing cash at beginning of year2022-09-30$1,418,781
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Value of net income/loss2022-09-30$470,067
Value of net assets at end of year (total assets less liabilities)2022-09-30$4,880,259
Value of net assets at beginning of year (total assets less liabilities)2022-09-30$4,410,192
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-09-30No
Were any leases to which the plan was party in default or uncollectible2022-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-09-30$2,891,670
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-09-30$2,953,035
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-09-30$2,953,035
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-09-30$4,345
Expenses. Payments to insurance carriers foe the provision of benefits2022-09-30$8,559,277
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-09-30Yes
Was there a failure to transmit to the plan any participant contributions2022-09-30No
Has the plan failed to provide any benefit when due under the plan2022-09-30No
Contributions received in cash from employer2022-09-30$5,541,201
Employer contributions (assets) at end of year2022-09-30$293,316
Employer contributions (assets) at beginning of year2022-09-30$350,863
Income. Dividends from common stock2022-09-30$84,206
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-09-30$19,500
Contract administrator fees2022-09-30$188,942
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32022-09-30No
Liabilities. Value of benefit claims payable at end of year2022-09-30$619,000
Liabilities. Value of benefit claims payable at beginning of year2022-09-30$523,846
Did the plan have assets held for investment2022-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-09-30No
Aggregate proceeds on sale of assets2022-09-30$2,843,098
Aggregate carrying amount (costs) on sale of assets2022-09-30$2,959,766
Opinion of an independent qualified public accountant for this plan2022-09-30Unqualified
Accountancy firm name2022-09-30CALIBRE CPA GROUP, PLLC
Accountancy firm EIN2022-09-30470900880
2021 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2021 401k financial data
Unrealized appreciation/depreciation of real estate assets2021-09-30$-29,350
Total unrealized appreciation/depreciation of assets2021-09-30$-29,350
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$546,100
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$317,924
Total income from all sources (including contributions)2021-09-30$7,257,922
Total of all expenses incurred2021-09-30$6,695,163
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-09-30$6,357,263
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-09-30$6,874,537
Value of total assets at end of year2021-09-30$4,956,292
Value of total assets at beginning of year2021-09-30$4,165,357
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-09-30$337,900
Total interest from all sources2021-09-30$811
Total dividends received (eg from common stock, registered investment company shares)2021-09-30$23,181
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-09-30No
Administrative expenses professional fees incurred2021-09-30$88,457
Was this plan covered by a fidelity bond2021-09-30Yes
Value of fidelity bond cover2021-09-30$100,000
If this is an individual account plan, was there a blackout period2021-09-30No
Were there any nonexempt tranactions with any party-in-interest2021-09-30No
Contributions received from participants2021-09-30$1,946,266
Participant contributions at end of year2021-09-30$128,737
Participant contributions at beginning of year2021-09-30$145,325
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-09-30$104,876
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-09-30$38,734
Other income not declared elsewhere2021-09-30$388,743
Administrative expenses (other) incurred2021-09-30$61,961
Liabilities. Value of operating payables at end of year2021-09-30$22,254
Liabilities. Value of operating payables at beginning of year2021-09-30$98,439
Total non interest bearing cash at end of year2021-09-30$1,418,781
Total non interest bearing cash at beginning of year2021-09-30$2,806,548
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Value of net income/loss2021-09-30$562,759
Value of net assets at end of year (total assets less liabilities)2021-09-30$4,410,192
Value of net assets at beginning of year (total assets less liabilities)2021-09-30$3,847,433
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-09-30No
Were any leases to which the plan was party in default or uncollectible2021-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-09-30$2,953,035
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-09-30$809,060
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-09-30$809,060
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-09-30$811
Expenses. Payments to insurance carriers foe the provision of benefits2021-09-30$6,325,328
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-09-30Yes
Was there a failure to transmit to the plan any participant contributions2021-09-30No
Has the plan failed to provide any benefit when due under the plan2021-09-30No
Contributions received in cash from employer2021-09-30$4,928,271
Employer contributions (assets) at end of year2021-09-30$350,863
Employer contributions (assets) at beginning of year2021-09-30$365,690
Income. Dividends from common stock2021-09-30$23,181
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-09-30$31,935
Contract administrator fees2021-09-30$187,482
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-09-30No
Liabilities. Value of benefit claims payable at end of year2021-09-30$523,846
Liabilities. Value of benefit claims payable at beginning of year2021-09-30$219,485
Did the plan have assets held for investment2021-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-09-30No
Opinion of an independent qualified public accountant for this plan2021-09-30Unqualified
Accountancy firm name2021-09-30CALIBRE CPA GROUP, PLLC
Accountancy firm EIN2021-09-30470900880
2020 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2020 401k financial data
Unrealized appreciation/depreciation of real estate assets2020-09-30$-160
Total unrealized appreciation/depreciation of assets2020-09-30$-160
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$317,924
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$459,369
Total income from all sources (including contributions)2020-09-30$6,851,754
Total of all expenses incurred2020-09-30$4,454,203
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-09-30$4,122,047
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-09-30$6,650,520
Value of total assets at end of year2020-09-30$4,165,357
Value of total assets at beginning of year2020-09-30$1,909,251
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-09-30$332,156
Total interest from all sources2020-09-30$1,972
Total dividends received (eg from common stock, registered investment company shares)2020-09-30$3,722
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-09-30No
Administrative expenses professional fees incurred2020-09-30$68,774
Was this plan covered by a fidelity bond2020-09-30Yes
Value of fidelity bond cover2020-09-30$1,000,000
If this is an individual account plan, was there a blackout period2020-09-30No
Were there any nonexempt tranactions with any party-in-interest2020-09-30No
Contributions received from participants2020-09-30$2,068,274
Participant contributions at end of year2020-09-30$145,325
Participant contributions at beginning of year2020-09-30$113,701
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-09-30$38,734
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-09-30$6,159
Other income not declared elsewhere2020-09-30$195,700
Administrative expenses (other) incurred2020-09-30$47,637
Liabilities. Value of operating payables at end of year2020-09-30$98,439
Liabilities. Value of operating payables at beginning of year2020-09-30$46,343
Total non interest bearing cash at end of year2020-09-30$2,806,548
Total non interest bearing cash at beginning of year2020-09-30$1,026,844
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Value of net income/loss2020-09-30$2,397,551
Value of net assets at end of year (total assets less liabilities)2020-09-30$3,847,433
Value of net assets at beginning of year (total assets less liabilities)2020-09-30$1,449,882
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-09-30No
Were any leases to which the plan was party in default or uncollectible2020-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-09-30$809,060
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-09-30$404,180
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-09-30$404,180
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-09-30$1,972
Expenses. Payments to insurance carriers foe the provision of benefits2020-09-30$4,108,022
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-09-30Yes
Was there a failure to transmit to the plan any participant contributions2020-09-30No
Has the plan failed to provide any benefit when due under the plan2020-09-30No
Contributions received in cash from employer2020-09-30$4,582,246
Employer contributions (assets) at end of year2020-09-30$365,690
Employer contributions (assets) at beginning of year2020-09-30$358,367
Income. Dividends from common stock2020-09-30$3,722
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-09-30$14,025
Contract administrator fees2020-09-30$215,745
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-09-30No
Liabilities. Value of benefit claims payable at end of year2020-09-30$219,485
Liabilities. Value of benefit claims payable at beginning of year2020-09-30$413,026
Did the plan have assets held for investment2020-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-09-30No
Opinion of an independent qualified public accountant for this plan2020-09-30Unqualified
Accountancy firm name2020-09-30CALIBRE CPA GROUP, PLLC
Accountancy firm EIN2020-09-30470900880
2019 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$459,369
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$824,392
Total income from all sources (including contributions)2019-09-30$6,549,227
Total of all expenses incurred2019-09-30$5,723,412
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-09-30$5,410,757
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-09-30$6,266,691
Value of total assets at end of year2019-09-30$1,909,251
Value of total assets at beginning of year2019-09-30$1,448,459
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-09-30$312,655
Total interest from all sources2019-09-30$1,885
Total dividends received (eg from common stock, registered investment company shares)2019-09-30$377
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-09-30No
Administrative expenses professional fees incurred2019-09-30$77,401
Was this plan covered by a fidelity bond2019-09-30Yes
Value of fidelity bond cover2019-09-30$1,000,000
If this is an individual account plan, was there a blackout period2019-09-30No
Were there any nonexempt tranactions with any party-in-interest2019-09-30No
Contributions received from participants2019-09-30$2,047,201
Participant contributions at end of year2019-09-30$113,701
Participant contributions at beginning of year2019-09-30$114,911
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-09-30$6,159
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-09-30$2,211
Other income not declared elsewhere2019-09-30$280,274
Administrative expenses (other) incurred2019-09-30$44,371
Liabilities. Value of operating payables at end of year2019-09-30$46,343
Liabilities. Value of operating payables at beginning of year2019-09-30$48,187
Total non interest bearing cash at end of year2019-09-30$1,026,844
Total non interest bearing cash at beginning of year2019-09-30$592,174
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Value of net income/loss2019-09-30$825,815
Value of net assets at end of year (total assets less liabilities)2019-09-30$1,449,882
Value of net assets at beginning of year (total assets less liabilities)2019-09-30$624,067
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-09-30No
Were any leases to which the plan was party in default or uncollectible2019-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-09-30$404,180
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-09-30$401,930
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-09-30$401,930
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-09-30$1,885
Expenses. Payments to insurance carriers foe the provision of benefits2019-09-30$5,398,457
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-09-30Yes
Was there a failure to transmit to the plan any participant contributions2019-09-30No
Has the plan failed to provide any benefit when due under the plan2019-09-30No
Contributions received in cash from employer2019-09-30$4,219,490
Employer contributions (assets) at end of year2019-09-30$358,367
Employer contributions (assets) at beginning of year2019-09-30$337,233
Income. Dividends from common stock2019-09-30$377
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-09-30$12,300
Contract administrator fees2019-09-30$190,883
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-09-30No
Liabilities. Value of benefit claims payable at end of year2019-09-30$413,026
Liabilities. Value of benefit claims payable at beginning of year2019-09-30$776,205
Did the plan have assets held for investment2019-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-09-30No
Opinion of an independent qualified public accountant for this plan2019-09-30Unqualified
Accountancy firm name2019-09-30CALIBRE CPA GROUP, PLLC
Accountancy firm EIN2019-09-30470900880
2018 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$824,392
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$1,382,978
Total income from all sources (including contributions)2018-09-30$6,201,141
Total of all expenses incurred2018-09-30$6,744,835
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-09-30$6,431,523
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-09-30$6,013,774
Value of total assets at end of year2018-09-30$1,448,459
Value of total assets at beginning of year2018-09-30$2,550,739
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-09-30$313,312
Total interest from all sources2018-09-30$10,393
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-09-30No
Administrative expenses professional fees incurred2018-09-30$80,283
Was this plan covered by a fidelity bond2018-09-30Yes
Value of fidelity bond cover2018-09-30$1,000,000
If this is an individual account plan, was there a blackout period2018-09-30No
Were there any nonexempt tranactions with any party-in-interest2018-09-30No
Contributions received from participants2018-09-30$2,038,480
Participant contributions at end of year2018-09-30$114,911
Participant contributions at beginning of year2018-09-30$124,889
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-09-30$2,211
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-09-30$6,039
Other income not declared elsewhere2018-09-30$176,974
Administrative expenses (other) incurred2018-09-30$42,229
Liabilities. Value of operating payables at end of year2018-09-30$48,187
Liabilities. Value of operating payables at beginning of year2018-09-30$19,925
Total non interest bearing cash at end of year2018-09-30$592,174
Total non interest bearing cash at beginning of year2018-09-30$1,076,660
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Value of net income/loss2018-09-30$-543,694
Value of net assets at end of year (total assets less liabilities)2018-09-30$624,067
Value of net assets at beginning of year (total assets less liabilities)2018-09-30$1,167,761
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-09-30No
Were any leases to which the plan was party in default or uncollectible2018-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-09-30$401,930
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-09-30$1,000,983
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-09-30$1,000,983
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-09-30$10,393
Expenses. Payments to insurance carriers foe the provision of benefits2018-09-30$6,390,422
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-09-30Yes
Was there a failure to transmit to the plan any participant contributions2018-09-30No
Has the plan failed to provide any benefit when due under the plan2018-09-30No
Contributions received in cash from employer2018-09-30$3,975,294
Employer contributions (assets) at end of year2018-09-30$337,233
Employer contributions (assets) at beginning of year2018-09-30$342,168
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-09-30$41,101
Contract administrator fees2018-09-30$190,800
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-09-30No
Liabilities. Value of benefit claims payable at end of year2018-09-30$776,205
Liabilities. Value of benefit claims payable at beginning of year2018-09-30$1,363,053
Did the plan have assets held for investment2018-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-09-30No
Opinion of an independent qualified public accountant for this plan2018-09-30Unqualified
Accountancy firm name2018-09-30CALIBRE CPA GROUP, PLLC
Accountancy firm EIN2018-09-30470900880
2017 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$1,382,978
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$36,176
Total income from all sources (including contributions)2017-09-30$6,163,609
Total of all expenses incurred2017-09-30$5,920,573
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-09-30$5,625,545
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-09-30$6,109,395
Value of total assets at end of year2017-09-30$2,550,739
Value of total assets at beginning of year2017-09-30$960,901
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-09-30$295,028
Total interest from all sources2017-09-30$4,913
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-09-30No
Administrative expenses professional fees incurred2017-09-30$57,058
Was this plan covered by a fidelity bond2017-09-30Yes
Value of fidelity bond cover2017-09-30$1,000,000
If this is an individual account plan, was there a blackout period2017-09-30No
Were there any nonexempt tranactions with any party-in-interest2017-09-30No
Contributions received from participants2017-09-30$1,952,670
Participant contributions at end of year2017-09-30$124,889
Participant contributions at beginning of year2017-09-30$124,156
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-09-30$6,039
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-09-30$5,156
Other income not declared elsewhere2017-09-30$49,301
Administrative expenses (other) incurred2017-09-30$47,170
Liabilities. Value of operating payables at end of year2017-09-30$19,925
Liabilities. Value of operating payables at beginning of year2017-09-30$36,176
Total non interest bearing cash at end of year2017-09-30$1,076,660
Total non interest bearing cash at beginning of year2017-09-30$36,180
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Value of net income/loss2017-09-30$243,036
Value of net assets at end of year (total assets less liabilities)2017-09-30$1,167,761
Value of net assets at beginning of year (total assets less liabilities)2017-09-30$924,725
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-09-30No
Were any leases to which the plan was party in default or uncollectible2017-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-09-30$1,000,983
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-09-30$436,688
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-09-30$436,688
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-09-30$4,913
Expenses. Payments to insurance carriers foe the provision of benefits2017-09-30$5,589,616
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-09-30Yes
Was there a failure to transmit to the plan any participant contributions2017-09-30No
Has the plan failed to provide any benefit when due under the plan2017-09-30No
Contributions received in cash from employer2017-09-30$4,156,725
Employer contributions (assets) at end of year2017-09-30$342,168
Employer contributions (assets) at beginning of year2017-09-30$358,721
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-09-30$35,929
Contract administrator fees2017-09-30$190,800
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-09-30No
Liabilities. Value of benefit claims payable at end of year2017-09-30$1,363,053
Did the plan have assets held for investment2017-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-09-30No
Opinion of an independent qualified public accountant for this plan2017-09-30Unqualified
Accountancy firm name2017-09-30SALTER & COMPANY, LLC
Accountancy firm EIN2017-09-30208078757
2016 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$36,176
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$549,089
Total income from all sources (including contributions)2016-09-30$6,153,202
Total loss/gain on sale of assets2016-09-30$-1,541
Total of all expenses incurred2016-09-30$6,505,791
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-09-30$6,245,691
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-09-30$6,150,980
Value of total assets at end of year2016-09-30$960,901
Value of total assets at beginning of year2016-09-30$1,826,403
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-09-30$260,100
Total interest from all sources2016-09-30$3,763
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-09-30No
Administrative expenses professional fees incurred2016-09-30$37,204
Was this plan covered by a fidelity bond2016-09-30Yes
Value of fidelity bond cover2016-09-30$1,000,000
If this is an individual account plan, was there a blackout period2016-09-30No
Were there any nonexempt tranactions with any party-in-interest2016-09-30No
Contributions received from participants2016-09-30$1,994,971
Participant contributions at end of year2016-09-30$124,156
Participant contributions at beginning of year2016-09-30$165,191
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-09-30$5,156
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-09-30$15,322
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-09-30$528,886
Administrative expenses (other) incurred2016-09-30$32,096
Liabilities. Value of operating payables at end of year2016-09-30$36,176
Liabilities. Value of operating payables at beginning of year2016-09-30$20,203
Total non interest bearing cash at end of year2016-09-30$36,180
Total non interest bearing cash at beginning of year2016-09-30$772,916
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Value of net income/loss2016-09-30$-352,589
Value of net assets at end of year (total assets less liabilities)2016-09-30$924,725
Value of net assets at beginning of year (total assets less liabilities)2016-09-30$1,277,314
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-09-30No
Were any leases to which the plan was party in default or uncollectible2016-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-09-30$436,688
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-09-30$433,221
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-09-30$433,221
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-09-30$3,763
Expenses. Payments to insurance carriers foe the provision of benefits2016-09-30$6,196,779
Asset value of US Government securities at beginning of year2016-09-30$99,993
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-09-30Yes
Was there a failure to transmit to the plan any participant contributions2016-09-30No
Has the plan failed to provide any benefit when due under the plan2016-09-30No
Contributions received in cash from employer2016-09-30$4,156,009
Employer contributions (assets) at end of year2016-09-30$358,721
Employer contributions (assets) at beginning of year2016-09-30$339,760
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-09-30$48,912
Contract administrator fees2016-09-30$190,800
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-09-30No
Did the plan have assets held for investment2016-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-09-30No
Aggregate proceeds on sale of assets2016-09-30$200,000
Aggregate carrying amount (costs) on sale of assets2016-09-30$201,541
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-09-30No
Opinion of an independent qualified public accountant for this plan2016-09-30Unqualified
Accountancy firm name2016-09-30SALTER & COMPANY, LLC
Accountancy firm EIN2016-09-30208078757
2015 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-09-30$5,235
Total unrealized appreciation/depreciation of assets2015-09-30$5,235
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$549,089
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$23,920
Total income from all sources (including contributions)2015-09-30$6,044,285
Total loss/gain on sale of assets2015-09-30$0
Total of all expenses incurred2015-09-30$6,545,796
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-09-30$6,285,791
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-09-30$6,030,382
Value of total assets at end of year2015-09-30$1,826,403
Value of total assets at beginning of year2015-09-30$1,802,745
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-09-30$260,005
Total interest from all sources2015-09-30$8,668
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-09-30No
Administrative expenses professional fees incurred2015-09-30$47,132
Was this plan covered by a fidelity bond2015-09-30Yes
Value of fidelity bond cover2015-09-30$1,000,000
If this is an individual account plan, was there a blackout period2015-09-30No
Were there any nonexempt tranactions with any party-in-interest2015-09-30No
Contributions received from participants2015-09-30$1,793,858
Participant contributions at end of year2015-09-30$165,191
Participant contributions at beginning of year2015-09-30$165,042
Assets. Other investments not covered elsewhere at beginning of year2015-09-30$12,061
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-09-30$15,322
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-09-30$1,277
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-09-30$528,886
Administrative expenses (other) incurred2015-09-30$17,528
Liabilities. Value of operating payables at end of year2015-09-30$20,203
Liabilities. Value of operating payables at beginning of year2015-09-30$23,920
Total non interest bearing cash at end of year2015-09-30$772,916
Total non interest bearing cash at beginning of year2015-09-30$752,660
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Value of net income/loss2015-09-30$-501,511
Value of net assets at end of year (total assets less liabilities)2015-09-30$1,277,314
Value of net assets at beginning of year (total assets less liabilities)2015-09-30$1,778,825
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-09-30No
Were any leases to which the plan was party in default or uncollectible2015-09-30No
Interest earned on other investments2015-09-30$4,620
Income. Interest from US Government securities2015-09-30$2,788
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-09-30$433,221
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-09-30$428,916
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-09-30$428,916
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-09-30$1,260
Expenses. Payments to insurance carriers foe the provision of benefits2015-09-30$6,241,329
Asset value of US Government securities at end of year2015-09-30$99,993
Asset value of US Government securities at beginning of year2015-09-30$95,974
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-09-30Yes
Was there a failure to transmit to the plan any participant contributions2015-09-30No
Has the plan failed to provide any benefit when due under the plan2015-09-30No
Contributions received in cash from employer2015-09-30$4,236,524
Employer contributions (assets) at end of year2015-09-30$339,760
Employer contributions (assets) at beginning of year2015-09-30$346,815
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-09-30$44,462
Contract administrator fees2015-09-30$195,345
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-09-30No
Did the plan have assets held for investment2015-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-09-30No
Aggregate proceeds on sale of assets2015-09-30$200,000
Aggregate carrying amount (costs) on sale of assets2015-09-30$200,000
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-09-30No
Opinion of an independent qualified public accountant for this plan2015-09-30Unqualified
Accountancy firm name2015-09-30SALTER & COMPANY,LLC
Accountancy firm EIN2015-09-30208078757
2014 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-09-30$5,277
Total unrealized appreciation/depreciation of assets2014-09-30$5,277
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$23,920
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$29,334
Total income from all sources (including contributions)2014-09-30$5,649,336
Total loss/gain on sale of assets2014-09-30$-921
Total of all expenses incurred2014-09-30$5,908,545
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-09-30$5,648,978
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-09-30$5,589,294
Value of total assets at end of year2014-09-30$1,802,745
Value of total assets at beginning of year2014-09-30$2,067,368
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-09-30$259,567
Total interest from all sources2014-09-30$8,009
Total dividends received (eg from common stock, registered investment company shares)2014-09-30$1,501
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2014-09-30$1,501
Administrative expenses professional fees incurred2014-09-30$44,716
Was this plan covered by a fidelity bond2014-09-30Yes
Value of fidelity bond cover2014-09-30$1,000,000
If this is an individual account plan, was there a blackout period2014-09-30No
Were there any nonexempt tranactions with any party-in-interest2014-09-30No
Contributions received from participants2014-09-30$1,490,696
Participant contributions at end of year2014-09-30$165,042
Participant contributions at beginning of year2014-09-30$110,778
Assets. Other investments not covered elsewhere at end of year2014-09-30$12,061
Assets. Other investments not covered elsewhere at beginning of year2014-09-30$15,875
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-09-30$28,813
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-09-30$1,277
Other income not declared elsewhere2014-09-30$46,176
Administrative expenses (other) incurred2014-09-30$24,051
Liabilities. Value of operating payables at end of year2014-09-30$23,920
Liabilities. Value of operating payables at beginning of year2014-09-30$29,334
Total non interest bearing cash at end of year2014-09-30$752,660
Total non interest bearing cash at beginning of year2014-09-30$590,026
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Value of net income/loss2014-09-30$-259,209
Value of net assets at end of year (total assets less liabilities)2014-09-30$1,778,825
Value of net assets at beginning of year (total assets less liabilities)2014-09-30$2,038,034
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-09-30No
Were any leases to which the plan was party in default or uncollectible2014-09-30No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-09-30$125,150
Value of interest in common/collective trusts at end of year2014-09-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-09-30$428,916
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-09-30$560,376
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-09-30$560,376
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-09-30$8,009
Expenses. Payments to insurance carriers foe the provision of benefits2014-09-30$5,567,780
Asset value of US Government securities at end of year2014-09-30$95,974
Asset value of US Government securities at beginning of year2014-09-30$92,742
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-09-30Yes
Was there a failure to transmit to the plan any participant contributions2014-09-30No
Has the plan failed to provide any benefit when due under the plan2014-09-30No
Contributions received in cash from employer2014-09-30$4,098,598
Employer contributions (assets) at end of year2014-09-30$346,815
Employer contributions (assets) at beginning of year2014-09-30$339,305
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-09-30$52,385
Asset. Corporate debt instrument debt (other) at beginning of year2014-09-30$233,116
Contract administrator fees2014-09-30$190,800
Did the plan have assets held for investment2014-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-09-30No
Aggregate proceeds on sale of assets2014-09-30$-921
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-09-30No
Opinion of an independent qualified public accountant for this plan2014-09-30Unqualified
Accountancy firm name2014-09-30GARBELMAN WINSLOW CPA
Accountancy firm EIN2014-09-30530261442
2013 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-09-30$-17,093
Total unrealized appreciation/depreciation of assets2013-09-30$-17,093
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$29,334
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$24,018
Total income from all sources (including contributions)2013-09-30$5,484,383
Total of all expenses incurred2013-09-30$6,008,651
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-09-30$5,758,074
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-09-30$5,436,092
Value of total assets at end of year2013-09-30$2,067,368
Value of total assets at beginning of year2013-09-30$2,586,320
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-09-30$250,577
Total interest from all sources2013-09-30$12,868
Total dividends received (eg from common stock, registered investment company shares)2013-09-30$3,459
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2013-09-30$3,459
Was this plan covered by a fidelity bond2013-09-30Yes
Value of fidelity bond cover2013-09-30$1,000,000
If this is an individual account plan, was there a blackout period2013-09-30No
Were there any nonexempt tranactions with any party-in-interest2013-09-30No
Contributions received from participants2013-09-30$1,326,328
Participant contributions at end of year2013-09-30$110,778
Participant contributions at beginning of year2013-09-30$114,024
Assets. Other investments not covered elsewhere at end of year2013-09-30$15,875
Assets. Other investments not covered elsewhere at beginning of year2013-09-30$5,919
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-09-30$36,454
Other income not declared elsewhere2013-09-30$52,257
Administrative expenses (other) incurred2013-09-30$250,577
Liabilities. Value of operating payables at end of year2013-09-30$29,334
Liabilities. Value of operating payables at beginning of year2013-09-30$24,018
Total non interest bearing cash at end of year2013-09-30$590,026
Total non interest bearing cash at beginning of year2013-09-30$610,364
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Value of net income/loss2013-09-30$-524,268
Value of net assets at end of year (total assets less liabilities)2013-09-30$2,038,034
Value of net assets at beginning of year (total assets less liabilities)2013-09-30$2,562,302
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-09-30No
Were any leases to which the plan was party in default or uncollectible2013-09-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-09-30$125,150
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-09-30$560,376
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-09-30$813,086
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-09-30$813,086
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-09-30$12,868
Expenses. Payments to insurance carriers foe the provision of benefits2013-09-30$5,695,571
Asset value of US Government securities at end of year2013-09-30$92,742
Asset value of US Government securities at beginning of year2013-09-30$702,542
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-09-30$-3,200
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-09-30Yes
Was there a failure to transmit to the plan any participant contributions2013-09-30No
Has the plan failed to provide any benefit when due under the plan2013-09-30No
Contributions received in cash from employer2013-09-30$4,109,764
Employer contributions (assets) at end of year2013-09-30$339,305
Employer contributions (assets) at beginning of year2013-09-30$340,385
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-09-30$26,049
Asset. Corporate debt instrument debt (other) at end of year2013-09-30$233,116
Did the plan have assets held for investment2013-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-09-30No
Opinion of an independent qualified public accountant for this plan2013-09-30Unqualified
Accountancy firm name2013-09-30ARONHALT, STRINGER & COMPANY
Accountancy firm EIN2013-09-30521045345
2012 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-09-30$-1,465
Total unrealized appreciation/depreciation of assets2012-09-30$-1,465
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$24,018
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$21,455
Total income from all sources (including contributions)2012-09-30$6,189,349
Total of all expenses incurred2012-09-30$6,156,944
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-09-30$5,914,297
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-09-30$5,698,260
Value of total assets at end of year2012-09-30$2,586,320
Value of total assets at beginning of year2012-09-30$2,551,352
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-09-30$242,647
Total interest from all sources2012-09-30$20,463
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-09-30No
Administrative expenses professional fees incurred2012-09-30$43,567
Was this plan covered by a fidelity bond2012-09-30Yes
Value of fidelity bond cover2012-09-30$1,000,000
If this is an individual account plan, was there a blackout period2012-09-30No
Were there any nonexempt tranactions with any party-in-interest2012-09-30No
Contributions received from participants2012-09-30$1,404,473
Participant contributions at end of year2012-09-30$114,024
Participant contributions at beginning of year2012-09-30$92,298
Assets. Other investments not covered elsewhere at end of year2012-09-30$5,919
Assets. Other investments not covered elsewhere at beginning of year2012-09-30$4,695
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-09-30$39,300
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-09-30$9,074
Other income not declared elsewhere2012-09-30$472,091
Administrative expenses (other) incurred2012-09-30$12,180
Liabilities. Value of operating payables at end of year2012-09-30$24,018
Liabilities. Value of operating payables at beginning of year2012-09-30$21,455
Total non interest bearing cash at end of year2012-09-30$610,364
Total non interest bearing cash at beginning of year2012-09-30$721,488
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Value of net income/loss2012-09-30$32,405
Value of net assets at end of year (total assets less liabilities)2012-09-30$2,562,302
Value of net assets at beginning of year (total assets less liabilities)2012-09-30$2,529,897
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-09-30No
Were any leases to which the plan was party in default or uncollectible2012-09-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-09-30$813,086
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-09-30$753,160
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-09-30$753,160
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-09-30$20,463
Expenses. Payments to insurance carriers foe the provision of benefits2012-09-30$5,834,729
Asset value of US Government securities at end of year2012-09-30$702,542
Asset value of US Government securities at beginning of year2012-09-30$398,019
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-09-30No
Was there a failure to transmit to the plan any participant contributions2012-09-30No
Has the plan failed to provide any benefit when due under the plan2012-09-30No
Contributions received in cash from employer2012-09-30$4,293,787
Employer contributions (assets) at end of year2012-09-30$340,385
Employer contributions (assets) at beginning of year2012-09-30$572,618
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-09-30$40,268
Contract administrator fees2012-09-30$186,900
Did the plan have assets held for investment2012-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-09-30No
Opinion of an independent qualified public accountant for this plan2012-09-30Unqualified
Accountancy firm name2012-09-30ARONHALT, STRINGER & COMPANY
Accountancy firm EIN2012-09-30521045345
2011 : TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-09-30$-4,566
Total unrealized appreciation/depreciation of assets2011-09-30$-4,566
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-09-30$21,455
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-09-30$24,146
Total income from all sources (including contributions)2011-09-30$5,728,210
Total of all expenses incurred2011-09-30$5,879,840
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-09-30$5,516,629
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-09-30$5,762,592
Value of total assets at end of year2011-09-30$2,551,352
Value of total assets at beginning of year2011-09-30$2,705,673
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-09-30$363,211
Total interest from all sources2011-09-30$-29,816
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-09-30No
Administrative expenses professional fees incurred2011-09-30$37,493
Was this plan covered by a fidelity bond2011-09-30Yes
Value of fidelity bond cover2011-09-30$1,000,000
If this is an individual account plan, was there a blackout period2011-09-30No
Were there any nonexempt tranactions with any party-in-interest2011-09-30No
Contributions received from participants2011-09-30$1,395,251
Participant contributions at end of year2011-09-30$92,298
Participant contributions at beginning of year2011-09-30$73,667
Assets. Other investments not covered elsewhere at end of year2011-09-30$4,695
Assets. Other investments not covered elsewhere at beginning of year2011-09-30$11,168
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-09-30$36,735
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-09-30$9,074
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-09-30$60,526
Administrative expenses (other) incurred2011-09-30$138,818
Liabilities. Value of operating payables at end of year2011-09-30$21,455
Liabilities. Value of operating payables at beginning of year2011-09-30$24,146
Total non interest bearing cash at end of year2011-09-30$721,488
Total non interest bearing cash at beginning of year2011-09-30$800,051
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Value of net income/loss2011-09-30$-151,630
Value of net assets at end of year (total assets less liabilities)2011-09-30$2,529,897
Value of net assets at beginning of year (total assets less liabilities)2011-09-30$2,681,527
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-09-30No
Were any leases to which the plan was party in default or uncollectible2011-09-30No
Interest earned on other investments2011-09-30$-51,449
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-09-30$753,160
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-09-30$736,986
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-09-30$736,986
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-09-30$21,633
Expenses. Payments to insurance carriers foe the provision of benefits2011-09-30$5,456,895
Asset value of US Government securities at end of year2011-09-30$398,019
Asset value of US Government securities at beginning of year2011-09-30$401,213
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-09-30No
Was there a failure to transmit to the plan any participant contributions2011-09-30No
Has the plan failed to provide any benefit when due under the plan2011-09-30No
Contributions received in cash from employer2011-09-30$4,367,341
Employer contributions (assets) at end of year2011-09-30$572,618
Employer contributions (assets) at beginning of year2011-09-30$622,062
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-09-30$22,999
Contract administrator fees2011-09-30$186,900
Did the plan have assets held for investment2011-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-09-30No
Opinion of an independent qualified public accountant for this plan2011-09-30Unqualified
Accountancy firm name2011-09-30ARONHALT, STRINGER & COMPANY
Accountancy firm EIN2011-09-30521045345

Form 5500 Responses for TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST

2021: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2021 form 5500 responses
2021-10-01Type of plan entityMulti-employer plan
2021-10-01Plan is a collectively bargained planYes
2021-10-01Plan funding arrangement – InsuranceYes
2021-10-01Plan funding arrangement – TrustYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement - TrustYes
2020: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2020 form 5500 responses
2020-10-01Type of plan entityMulti-employer plan
2020-10-01Plan is a collectively bargained planYes
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – TrustYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement - TrustYes
2019: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2019 form 5500 responses
2019-10-01Type of plan entityMulti-employer plan
2019-10-01Plan is a collectively bargained planYes
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – TrustYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement - TrustYes
2018: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2018 form 5500 responses
2018-10-01Type of plan entityMulti-employer plan
2018-10-01Plan is a collectively bargained planYes
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – TrustYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement - TrustYes
2017: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2017 form 5500 responses
2017-10-01Type of plan entityMulti-employer plan
2017-10-01Plan is a collectively bargained planYes
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – TrustYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement - TrustYes
2016: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2016 form 5500 responses
2016-10-01Type of plan entityMulti-employer plan
2016-10-01Plan is a collectively bargained planYes
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement - TrustYes
2015: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2015 form 5500 responses
2015-10-01Type of plan entityMulti-employer plan
2015-10-01Plan is a collectively bargained planYes
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – TrustYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement - TrustYes
2014: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2014 form 5500 responses
2014-10-01Type of plan entityMulti-employer plan
2014-10-01Plan is a collectively bargained planYes
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – TrustYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement - TrustYes
2013: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2013 form 5500 responses
2013-10-01Type of plan entityMulti-employer plan
2013-10-01Plan is a collectively bargained planYes
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – TrustYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement - TrustYes
2012: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2012 form 5500 responses
2012-10-01Type of plan entityMulti-employer plan
2012-10-01Plan is a collectively bargained planYes
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – TrustYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement - TrustYes
2011: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2011 form 5500 responses
2011-10-01Type of plan entityMulti-employer plan
2011-10-01Plan is a collectively bargained planYes
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – TrustYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement - TrustYes
2009: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2009 form 5500 responses
2009-10-01Type of plan entityMulti-employer plan
2009-10-01Submission has been amendedYes
2009-10-01Plan is a collectively bargained planYes
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan funding arrangement – TrustYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan benefit arrangement - TrustYes
2008: TEAMSTERS LOCAL 922EMPLOYERS HEALTH TRUST 2008 form 5500 responses
2008-10-01Type of plan entityMulti-employer plan
2008-10-01Submission has been amendedNo
2008-10-01This submission is the final filingNo
2008-10-01This return/report is a short plan year return/report (less than 12 months)No
2008-10-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number880370G
Policy instance 2
Insurance contract or identification number880370G
Number of Individuals Covered434
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberTLO-001
Policy instance 1
Insurance contract or identification numberTLO-001
Number of Individuals Covered2056
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number880370G
Policy instance 2
Insurance contract or identification number880370G
Number of Individuals Covered370
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberTLO-001
Policy instance 1
Insurance contract or identification numberTLO-001
Number of Individuals Covered800
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number880370G
Policy instance 2
Insurance contract or identification number880370G
Number of Individuals Covered394
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberTLO-001
Policy instance 1
Insurance contract or identification numberTLO-001
Number of Individuals Covered799
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number880370G
Policy instance 2
Insurance contract or identification number880370G
Number of Individuals Covered91
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $23,774
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberTLO-001
Policy instance 1
Insurance contract or identification numberTLO-001
Number of Individuals Covered422
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05925157
Policy instance 3
Insurance contract or identification numberTM05925157
Number of Individuals Covered457
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $1,883
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number880370G
Policy instance 2
Insurance contract or identification number880370G
Number of Individuals Covered340
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedLONG TERM CARE
Welfare Benefit Premiums Paid to CarrierUSD $28,097
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DAVIS VISION (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract numberTLO-001
Policy instance 1
Insurance contract or identification numberTLO-001
Number of Individuals Covered951
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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