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GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 401k Plan overview

Plan NameGORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST
Plan identification number 501

GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Supplemental unemployment
  • Apprenticeship and training

401k Sponsoring company profile

GORMAN BROS., INC. has sponsored the creation of one or more 401k plans.

Company Name:GORMAN BROS., INC.
Employer identification number (EIN):140704840
NAIC Classification:237310
NAIC Description:Highway, Street, and Bridge Construction

Additional information about GORMAN BROS., INC.

Jurisdiction of Incorporation: New York Department of State
Incorporation Date: 1933-04-13
Company Identification Number: 44629
Legal Registered Office Address: 200 CHURCH STREET
Albany
ALBANY
United States of America (USA)
12202

More information about GORMAN BROS., INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01ALBERT M. GORMAN2019-10-11 ALBERT M. GORMAN2019-10-11
5012017-01-01ALBERT M. GORMAN2018-07-24 ALBERT M. GORMAN2018-07-24
5012016-01-01ALBERT M. GORMAN2017-10-03 ALBERT M. GORMAN2017-10-03
5012015-01-01ALBERT M. GORMAN2016-06-23 ALBERT M. GORMAN2016-06-23
5012014-01-01ALBERT M. GORMAN2015-07-23 ALBERT M. GORMAN2015-07-23
5012013-01-01ALBERT M. GORMAN2014-10-10 ALBERT M. GORMAN2014-10-10
5012012-01-01ALBERT M. GORMAN2013-07-22 ALBERT M. GORMAN2013-07-22
5012011-01-01ALBERT M. GORMAN2012-07-24 ALBERT M. GORMAN2012-07-24
5012010-01-01ALBERT M. GORMAN2011-07-15 ALBERT M. GORMAN2011-07-15

Plan Statistics for GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST

401k plan membership statisitcs for GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST

Measure Date Value
2022: GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2022 401k membership
Total participants, beginning-of-year2022-01-01134
Total number of active participants reported on line 7a of the Form 55002022-01-01166
Total of all active and inactive participants2022-01-01166
2021: GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2021 401k membership
Total participants, beginning-of-year2021-01-01126
Total number of active participants reported on line 7a of the Form 55002021-01-01116
Number of retired or separated participants receiving benefits2021-01-0118
Total of all active and inactive participants2021-01-01134
2020: GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2020 401k membership
Total participants, beginning-of-year2020-01-01118
Total number of active participants reported on line 7a of the Form 55002020-01-01123
Number of retired or separated participants receiving benefits2020-01-013
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01126
2019: GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2019 401k membership
Total participants, beginning-of-year2019-01-01129
Total number of active participants reported on line 7a of the Form 55002019-01-01118
Number of retired or separated participants receiving benefits2019-01-010
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01118

Financial Data on GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST

Measure Date Value
2022 : GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$648,191
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$715,622
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$715,622
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$648,191
Value of total assets at end of year2022-12-31$73,136
Value of total assets at beginning of year2022-12-31$140,567
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$0
Total interest from all sources2022-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Total non interest bearing cash at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-67,431
Value of net assets at end of year (total assets less liabilities)2022-12-31$73,136
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$140,567
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$454,497
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$648,191
Employer contributions (assets) at end of year2022-12-31$73,136
Employer contributions (assets) at beginning of year2022-12-31$140,567
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$261,125
Did the plan have assets held for investment2022-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31BROWN & FITZGERALD, P.C
Accountancy firm EIN2022-12-31141630137
2021 : GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$609,391
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$650,402
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$650,402
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$609,391
Value of total assets at end of year2021-12-31$140,567
Value of total assets at beginning of year2021-12-31$181,578
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$0
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Total non interest bearing cash at end of year2021-12-31$0
Total non interest bearing cash at beginning of year2021-12-31$129,219
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-41,011
Value of net assets at end of year (total assets less liabilities)2021-12-31$140,567
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$181,578
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$609,391
Employer contributions (assets) at end of year2021-12-31$140,567
Employer contributions (assets) at beginning of year2021-12-31$52,359
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$650,402
Did the plan have assets held for investment2021-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31BROWN AND FITZGERALD, P.C.
Accountancy firm EIN2021-12-31141630137
2020 : GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$564,587
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$611,033
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$611,033
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$564,587
Value of total assets at end of year2020-12-31$181,578
Value of total assets at beginning of year2020-12-31$228,024
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$0
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Total non interest bearing cash at end of year2020-12-31$129,219
Total non interest bearing cash at beginning of year2020-12-31$181,631
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-46,446
Value of net assets at end of year (total assets less liabilities)2020-12-31$181,578
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$228,024
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$564,587
Employer contributions (assets) at end of year2020-12-31$52,359
Employer contributions (assets) at beginning of year2020-12-31$46,393
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$611,033
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31BROWN AND FITZGERALD, P.C.
Accountancy firm EIN2020-12-31141630137
2019 : GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$614,242
Total income from all sources (including contributions)2019-12-31$614,242
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$637,132
Total of all expenses incurred2019-12-31$637,132
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$637,132
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$637,132
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$614,242
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$614,242
Value of total assets at end of year2019-12-31$228,024
Value of total assets at end of year2019-12-31$228,024
Value of total assets at beginning of year2019-12-31$250,914
Value of total assets at beginning of year2019-12-31$250,914
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$0
Total interest from all sources2019-12-31$0
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Total non interest bearing cash at end of year2019-12-31$181,631
Total non interest bearing cash at end of year2019-12-31$181,631
Total non interest bearing cash at beginning of year2019-12-31$135,197
Total non interest bearing cash at beginning of year2019-12-31$135,197
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-22,890
Value of net income/loss2019-12-31$-22,890
Value of net assets at end of year (total assets less liabilities)2019-12-31$228,024
Value of net assets at end of year (total assets less liabilities)2019-12-31$228,024
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$250,914
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$250,914
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$614,242
Contributions received in cash from employer2019-12-31$614,242
Employer contributions (assets) at end of year2019-12-31$46,393
Employer contributions (assets) at end of year2019-12-31$46,393
Employer contributions (assets) at beginning of year2019-12-31$115,717
Employer contributions (assets) at beginning of year2019-12-31$115,717
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$637,132
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$637,132
Did the plan have assets held for investment2019-12-31No
Did the plan have assets held for investment2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31BROWN AND FITZGERALD, P.C.
Accountancy firm name2019-12-31BROWN AND FITZGERALD, P.C.
Accountancy firm EIN2019-12-31141630137
Accountancy firm EIN2019-12-31141630137

Form 5500 Responses for GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST

2022: GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: GORMAN BROTHERS, INC. GOVERNMENT CONTRACTORS BENEFIT TRUST 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 )
Policy contract number10003676
Policy instance 1
Insurance contract or identification number10003676
Number of Individuals Covered278
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $75,335
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,418,416
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $75,335
Insurance broker organization code?3
CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 )
Policy contract number10003676
Policy instance 1
Insurance contract or identification number10003676
Number of Individuals Covered296
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $70,620
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,352,019
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $70,620
Insurance broker organization code?3
CAPITAL DISTRICT PHYSICIANS HEALTH PLAN INC (National Association of Insurance Commissioners NAIC id number: 95491 )
Policy contract number10003676
Policy instance 1
Insurance contract or identification number10003676
Number of Individuals Covered289
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $71,312
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $2,391,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $71,312
Insurance broker organization code?3

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