MASSACHUSETTS INSTITUTE OF TECHNOLOGY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan MASSACHUSETTS INSTITUTE OF TECHNOLOGY RETIREE WELFARE BENEFIT PLAN
401k plan membership statisitcs for MASSACHUSETTS INSTITUTE OF TECHNOLOGY RETIREE WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2023 : MASSACHUSETTS INSTITUTE OF TECHNOLOGY RETIREE WELFARE BENEFIT PLAN 2023 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2023-06-30 | $-7,757,892 |
| Total unrealized appreciation/depreciation of assets | 2023-06-30 | $-7,757,892 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-06-30 | $22,973,506 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-06-30 | $4,692,948 |
| Total income from all sources (including contributions) | 2023-06-30 | $13,322,252 |
| Total loss/gain on sale of assets | 2023-06-30 | $-6,092,193 |
| Total of all expenses incurred | 2023-06-30 | $50,983,539 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-06-30 | $48,478,612 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-06-30 | $23,285,931 |
| Value of total assets at end of year | 2023-06-30 | $937,722,788 |
| Value of total assets at beginning of year | 2023-06-30 | $957,103,517 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-06-30 | $2,504,927 |
| Total interest from all sources | 2023-06-30 | $539,350 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-06-30 | $3,347,056 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-06-30 | No |
| Administrative expenses professional fees incurred | 2023-06-30 | $154,898 |
| Was this plan covered by a fidelity bond | 2023-06-30 | Yes |
| Value of fidelity bond cover | 2023-06-30 | $25,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2023-06-30 | No |
| Contributions received from participants | 2023-06-30 | $11,065,173 |
| Assets. Other investments not covered elsewhere at end of year | 2023-06-30 | $1,792,229 |
| Assets. Other investments not covered elsewhere at beginning of year | 2023-06-30 | $1,253,264 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2023-06-30 | $12,220,758 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-06-30 | $7,779,589 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-06-30 | $7,769,264 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-06-30 | $22,973,506 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-06-30 | $4,692,948 |
| Administrative expenses (other) incurred | 2023-06-30 | $69,975 |
| Total non interest bearing cash at end of year | 2023-06-30 | $30,704,431 |
| Total non interest bearing cash at beginning of year | 2023-06-30 | $18,595,563 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-06-30 | No |
| Value of net income/loss | 2023-06-30 | $-37,661,287 |
| Value of net assets at end of year (total assets less liabilities) | 2023-06-30 | $914,749,282 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-06-30 | $952,410,569 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2023-06-30 | $648,151,431 |
| Assets. partnership/joint venture interests at beginning of year | 2023-06-30 | $697,729,263 |
| Investment advisory and management fees | 2023-06-30 | $391,670 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-06-30 | $539,350 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-06-30 | $1,381,802 |
| Asset value of US Government securities at end of year | 2023-06-30 | $145,078,764 |
| Asset value of US Government securities at beginning of year | 2023-06-30 | $162,227,224 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-06-30 | No |
| Income. Dividends from common stock | 2023-06-30 | $3,347,056 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-06-30 | $47,096,810 |
| Asset. Corporate debt instrument debt (other) at end of year | 2023-06-30 | $15,408 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2023-06-30 | $1,664 |
| Contract administrator fees | 2023-06-30 | $1,888,384 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2023-06-30 | $104,200,936 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2023-06-30 | $69,527,275 |
| Did the plan have assets held for investment | 2023-06-30 | 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 | 2023-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-06-30 | No |
| Aggregate proceeds on sale of assets | 2023-06-30 | $228,758,226 |
| Aggregate carrying amount (costs) on sale of assets | 2023-06-30 | $234,850,419 |
| Opinion of an independent qualified public accountant for this plan | 2023-06-30 | Unqualified |
| Accountancy firm name | 2023-06-30 | PRICEWATERHOUSECOOPERS |
| Accountancy firm EIN | 2023-06-30 | 134008324 |
| 2022 : MASSACHUSETTS INSTITUTE OF TECHNOLOGY RETIREE WELFARE BENEFIT PLAN 2022 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2022-06-30 | $-95,525,378 |
| Total unrealized appreciation/depreciation of assets | 2022-06-30 | $-95,525,378 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $4,692,948 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $10,226,397 |
| Total income from all sources (including contributions) | 2022-06-30 | $-107,219,935 |
| Total loss/gain on sale of assets | 2022-06-30 | $-32,622,427 |
| Total of all expenses incurred | 2022-06-30 | $42,698,307 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-06-30 | $39,969,670 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-06-30 | $20,222,014 |
| Value of total assets at end of year | 2022-06-30 | $957,103,517 |
| Value of total assets at beginning of year | 2022-06-30 | $1,112,555,208 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-06-30 | $2,728,637 |
| Total interest from all sources | 2022-06-30 | $7,459 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-06-30 | $698,397 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-06-30 | No |
| Administrative expenses professional fees incurred | 2022-06-30 | $184,973 |
| Was this plan covered by a fidelity bond | 2022-06-30 | Yes |
| Value of fidelity bond cover | 2022-06-30 | $20,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-06-30 | No |
| Contributions received from participants | 2022-06-30 | $9,963,581 |
| Assets. Other investments not covered elsewhere at end of year | 2022-06-30 | $1,253,264 |
| Assets. Other investments not covered elsewhere at beginning of year | 2022-06-30 | $557,591 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2022-06-30 | $10,258,433 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-06-30 | $7,769,264 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-06-30 | $6,024,031 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-06-30 | $4,692,948 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-06-30 | $10,226,397 |
| Administrative expenses (other) incurred | 2022-06-30 | $15,279 |
| Total non interest bearing cash at end of year | 2022-06-30 | $18,595,563 |
| Total non interest bearing cash at beginning of year | 2022-06-30 | $44,037,141 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-06-30 | No |
| Value of net income/loss | 2022-06-30 | $-149,918,242 |
| Value of net assets at end of year (total assets less liabilities) | 2022-06-30 | $952,410,569 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-06-30 | $1,102,328,811 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2022-06-30 | $697,729,263 |
| Assets. partnership/joint venture interests at beginning of year | 2022-06-30 | $854,881,624 |
| Investment advisory and management fees | 2022-06-30 | $691,136 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-06-30 | $7,459 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-06-30 | $1,638,877 |
| Asset value of US Government securities at end of year | 2022-06-30 | $162,227,224 |
| Asset value of US Government securities at beginning of year | 2022-06-30 | $148,134,527 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-06-30 | No |
| Income. Dividends from common stock | 2022-06-30 | $698,397 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-06-30 | $38,330,793 |
| Asset. Corporate debt instrument debt (other) at end of year | 2022-06-30 | $1,664 |
| Contract administrator fees | 2022-06-30 | $1,837,249 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2022-06-30 | $69,527,275 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2022-06-30 | $58,920,294 |
| Did the plan have assets held for investment | 2022-06-30 | 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 | 2022-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-06-30 | No |
| Aggregate proceeds on sale of assets | 2022-06-30 | $316,286,623 |
| Aggregate carrying amount (costs) on sale of assets | 2022-06-30 | $348,909,050 |
| Opinion of an independent qualified public accountant for this plan | 2022-06-30 | Unqualified |
| Accountancy firm name | 2022-06-30 | PRICEWATERHOUSECOOPERS |
| Accountancy firm EIN | 2022-06-30 | 134008324 |
| 2021 : MASSACHUSETTS INSTITUTE OF TECHNOLOGY RETIREE WELFARE BENEFIT PLAN 2021 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2021-06-30 | $341,706,049 |
| Total unrealized appreciation/depreciation of assets | 2021-06-30 | $341,706,049 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $10,226,397 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $2,027,616 |
| Expenses. Interest paid | 2021-06-30 | $39,624 |
| Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-102 | 2021-06-30 | $39,624 |
| Total income from all sources (including contributions) | 2021-06-30 | $380,752,455 |
| Total loss/gain on sale of assets | 2021-06-30 | $18,529,864 |
| Total of all expenses incurred | 2021-06-30 | $39,007,111 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-06-30 | $36,670,819 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-06-30 | $20,506,356 |
| Value of total assets at end of year | 2021-06-30 | $1,112,555,208 |
| Value of total assets at beginning of year | 2021-06-30 | $762,611,083 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-06-30 | $2,296,668 |
| Total interest from all sources | 2021-06-30 | $10,186 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-06-30 | No |
| Administrative expenses professional fees incurred | 2021-06-30 | $114,139 |
| Was this plan covered by a fidelity bond | 2021-06-30 | Yes |
| Value of fidelity bond cover | 2021-06-30 | $20,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-06-30 | No |
| Contributions received from participants | 2021-06-30 | $8,948,883 |
| Assets. Other investments not covered elsewhere at end of year | 2021-06-30 | $557,591 |
| Assets. Other investments not covered elsewhere at beginning of year | 2021-06-30 | $1,264,261 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2021-06-30 | $9,176,475 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-06-30 | $6,024,031 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-06-30 | $5,204,589 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-06-30 | $10,226,397 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-06-30 | $2,027,616 |
| Administrative expenses (other) incurred | 2021-06-30 | $42,358 |
| Total non interest bearing cash at end of year | 2021-06-30 | $44,037,141 |
| Total non interest bearing cash at beginning of year | 2021-06-30 | $35,694,460 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-06-30 | No |
| Value of net income/loss | 2021-06-30 | $341,745,344 |
| Value of net assets at end of year (total assets less liabilities) | 2021-06-30 | $1,102,328,811 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-06-30 | $760,583,467 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2021-06-30 | $854,881,624 |
| Assets. partnership/joint venture interests at beginning of year | 2021-06-30 | $631,434,367 |
| Investment advisory and management fees | 2021-06-30 | $361,402 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-06-30 | $10,186 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-06-30 | $1,687,624 |
| Asset value of US Government securities at end of year | 2021-06-30 | $148,134,527 |
| Asset value of US Government securities at beginning of year | 2021-06-30 | $66,914,841 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-06-30 | No |
| Contributions received in cash from employer | 2021-06-30 | $2,380,998 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-06-30 | $34,983,195 |
| Contract administrator fees | 2021-06-30 | $1,778,769 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2021-06-30 | $58,920,294 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2021-06-30 | $22,098,565 |
| Did the plan have assets held for investment | 2021-06-30 | 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 | 2021-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-06-30 | No |
| Aggregate proceeds on sale of assets | 2021-06-30 | $-195,905,006 |
| Aggregate carrying amount (costs) on sale of assets | 2021-06-30 | $-214,434,870 |
| Opinion of an independent qualified public accountant for this plan | 2021-06-30 | Disclaimer |
| Accountancy firm name | 2021-06-30 | PRICEWATERHOUSECOOPERS |
| Accountancy firm EIN | 2021-06-30 | 134008324 |
| 2020 : MASSACHUSETTS INSTITUTE OF TECHNOLOGY RETIREE WELFARE BENEFIT PLAN 2020 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2020-06-30 | $64,985,356 |
| Total unrealized appreciation/depreciation of assets | 2020-06-30 | $64,985,356 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $2,027,616 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $1,057,372 |
| Total income from all sources (including contributions) | 2020-06-30 | $84,511,820 |
| Total loss/gain on sale of assets | 2020-06-30 | $516,956 |
| Total of all expenses incurred | 2020-06-30 | $35,084,681 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-06-30 | $32,753,193 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-06-30 | $18,861,447 |
| Value of total assets at end of year | 2020-06-30 | $762,611,083 |
| Value of total assets at beginning of year | 2020-06-30 | $712,213,700 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-06-30 | $2,331,488 |
| Total interest from all sources | 2020-06-30 | $118,737 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-06-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-06-30 | No |
| Administrative expenses professional fees incurred | 2020-06-30 | $174,056 |
| Was this plan covered by a fidelity bond | 2020-06-30 | Yes |
| Value of fidelity bond cover | 2020-06-30 | $20,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-06-30 | No |
| Contributions received from participants | 2020-06-30 | $8,158,636 |
| Assets. Other investments not covered elsewhere at end of year | 2020-06-30 | $1,264,261 |
| Assets. Other investments not covered elsewhere at beginning of year | 2020-06-30 | $1,709,408 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-06-30 | $9,223,269 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-06-30 | $5,204,589 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-06-30 | $1,259,360 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-06-30 | $2,027,616 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-06-30 | $1,057,372 |
| Other income not declared elsewhere | 2020-06-30 | $29,324 |
| Administrative expenses (other) incurred | 2020-06-30 | $52,082 |
| Total non interest bearing cash at end of year | 2020-06-30 | $35,694,460 |
| Total non interest bearing cash at beginning of year | 2020-06-30 | $17,168,389 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-06-30 | No |
| Value of net income/loss | 2020-06-30 | $49,427,139 |
| Value of net assets at end of year (total assets less liabilities) | 2020-06-30 | $760,583,467 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-06-30 | $711,156,328 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2020-06-30 | $631,434,367 |
| Assets. partnership/joint venture interests at beginning of year | 2020-06-30 | $588,493,273 |
| Investment advisory and management fees | 2020-06-30 | $361,630 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-06-30 | $118,737 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-06-30 | $1,648,370 |
| Asset value of US Government securities at end of year | 2020-06-30 | $66,914,841 |
| Asset value of US Government securities at beginning of year | 2020-06-30 | $89,888,095 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-06-30 | No |
| Contributions received in cash from employer | 2020-06-30 | $1,479,542 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-06-30 | $31,104,823 |
| Contract administrator fees | 2020-06-30 | $1,743,720 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2020-06-30 | $22,098,565 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2020-06-30 | $13,695,175 |
| Did the plan have assets held for investment | 2020-06-30 | 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 | 2020-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-06-30 | No |
| Aggregate proceeds on sale of assets | 2020-06-30 | $-5,301,712 |
| Aggregate carrying amount (costs) on sale of assets | 2020-06-30 | $-5,818,668 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-06-30 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2020-06-30 | Disclaimer |
| Accountancy firm name | 2020-06-30 | PRICEWATERHOUSECOOPERS |
| Accountancy firm EIN | 2020-06-30 | 134008324 |
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0112757 |
| Policy instance | 4 |
| Insurance contract or identification number | 0112757 | | Number of Individuals Covered | 1124 | | 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 | Yes | | 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 $481,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 1824 |
| Policy instance | 3 |
| Insurance contract or identification number | 1824 | | Number of Individuals Covered | 265 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $536,665 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 79397065 |
| Policy instance | 2 |
| Insurance contract or identification number | 79397065 | | Number of Individuals Covered | 93 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $298,156 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0009191 |
| Policy instance | 1 |
| Insurance contract or identification number | 0009191 | | Number of Individuals Covered | 130 | | 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 | | 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 $260,372 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0112757 |
| Policy instance | 4 |
| Insurance contract or identification number | 0112757 | | Number of Individuals Covered | 1095 | | 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 | Yes | | 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 $450,633 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 1824 |
| Policy instance | 3 |
| Insurance contract or identification number | 1824 | | Number of Individuals Covered | 292 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $603,278 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 79397065 |
| Policy instance | 2 |
| Insurance contract or identification number | 79397065 | | Number of Individuals Covered | 106 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $333,788 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0009191 |
| Policy instance | 1 |
| Insurance contract or identification number | 0009191 | | Number of Individuals Covered | 153 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $287,588 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0112757 |
| Policy instance | 4 |
| Insurance contract or identification number | 0112757 | | Number of Individuals Covered | 1085 | | 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 | Yes | | 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 $422,117 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 1824 |
| Policy instance | 3 |
| Insurance contract or identification number | 1824 | | Number of Individuals Covered | 295 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $634,837 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 00475065 |
| Policy instance | 2 |
| Insurance contract or identification number | 00475065 | | Number of Individuals Covered | 110 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $303,268 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0009191 |
| Policy instance | 1 |
| Insurance contract or identification number | 0009191 | | Number of Individuals Covered | 158 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $300,164 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0112757 |
| Policy instance | 4 |
| Insurance contract or identification number | 0112757 | | Number of Individuals Covered | 1093 | | 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 | Yes | | 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 $419,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 1824 |
| Policy instance | 3 |
| Insurance contract or identification number | 1824 | | Number of Individuals Covered | 313 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $640,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 ) |
| Policy contract number | 00475065 |
| Policy instance | 2 |
| Insurance contract or identification number | 00475065 | | Number of Individuals Covered | 116 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $364,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 ) |
| Policy contract number | 0009191 |
| Policy instance | 1 |
| Insurance contract or identification number | 0009191 | | Number of Individuals Covered | 169 | | 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 | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $308,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
