TRUSTEES OF BUFFALO LABORERS' WELFARE FUND has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan BUFFALO LABORERS' WELFARE FUND
| Measure | Date | Value |
|---|
| 2023 : BUFFALO LABORERS' WELFARE FUND 2023 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2023-06-30 | $173 |
| Total unrealized appreciation/depreciation of assets | 2023-06-30 | $173 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-06-30 | $153,673 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-06-30 | $148,847 |
| Total income from all sources (including contributions) | 2023-06-30 | $10,128,048 |
| Total loss/gain on sale of assets | 2023-06-30 | $0 |
| Total of all expenses incurred | 2023-06-30 | $9,148,609 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-06-30 | $8,524,702 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-06-30 | $9,376,137 |
| Value of total assets at end of year | 2023-06-30 | $21,065,269 |
| Value of total assets at beginning of year | 2023-06-30 | $20,081,004 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-06-30 | $623,907 |
| Total interest from all sources | 2023-06-30 | $186,876 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-06-30 | $393,610 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2023-06-30 | $393,610 |
| Administrative expenses professional fees incurred | 2023-06-30 | $165,174 |
| Was this plan covered by a fidelity bond | 2023-06-30 | Yes |
| Value of fidelity bond cover | 2023-06-30 | $3,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2023-06-30 | No |
| Contributions received from participants | 2023-06-30 | $395,797 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2023-06-30 | $20,117 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-06-30 | $42,167 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-06-30 | $141,494 |
| Other income not declared elsewhere | 2023-06-30 | $32,553 |
| Administrative expenses (other) incurred | 2023-06-30 | $450,233 |
| Liabilities. Value of operating payables at end of year | 2023-06-30 | $153,673 |
| Liabilities. Value of operating payables at beginning of year | 2023-06-30 | $148,847 |
| Total non interest bearing cash at end of year | 2023-06-30 | $182,010 |
| Total non interest bearing cash at beginning of year | 2023-06-30 | $153,080 |
| 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 | $979,439 |
| Value of net assets at end of year (total assets less liabilities) | 2023-06-30 | $20,911,596 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-06-30 | $19,932,157 |
| 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 | $0 |
| Assets. partnership/joint venture interests at beginning of year | 2023-06-30 | $775 |
| Investment advisory and management fees | 2023-06-30 | $8,500 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2023-06-30 | $10,938,841 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2023-06-30 | $9,670,757 |
| Interest earned on other investments | 2023-06-30 | $184,577 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-06-30 | $465,003 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-06-30 | $927,731 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-06-30 | $927,731 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-06-30 | $2,299 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2023-06-30 | $7,793,026 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2023-06-30 | $7,608,449 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-06-30 | $4,111,972 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2023-06-30 | $138,699 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-06-30 | Yes |
| 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 |
| Contributions received in cash from employer | 2023-06-30 | $8,980,340 |
| Employer contributions (assets) at end of year | 2023-06-30 | $1,622,000 |
| Employer contributions (assets) at beginning of year | 2023-06-30 | $1,548,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-06-30 | $4,392,613 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2023-06-30 | $22,222 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2023-06-30 | $30,718 |
| 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 | No |
| 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 |
| Opinion of an independent qualified public accountant for this plan | 2023-06-30 | Unqualified |
| Accountancy firm name | 2023-06-30 | LUMSDEN & MCCORMICK LLP |
| Accountancy firm EIN | 2023-06-30 | 160765486 |
| 2022 : BUFFALO LABORERS' WELFARE FUND 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $148,847 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $163,580 |
| Total income from all sources (including contributions) | 2022-06-30 | $8,466,700 |
| Total loss/gain on sale of assets | 2022-06-30 | $0 |
| Total of all expenses incurred | 2022-06-30 | $9,280,152 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-06-30 | $8,671,838 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-06-30 | $9,151,415 |
| Value of total assets at end of year | 2022-06-30 | $20,081,004 |
| Value of total assets at beginning of year | 2022-06-30 | $20,909,189 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-06-30 | $608,314 |
| Total interest from all sources | 2022-06-30 | $201,181 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-06-30 | $316,769 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-06-30 | $316,769 |
| Administrative expenses professional fees incurred | 2022-06-30 | $155,674 |
| Was this plan covered by a fidelity bond | 2022-06-30 | Yes |
| Value of fidelity bond cover | 2022-06-30 | $3,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-06-30 | No |
| Contributions received from participants | 2022-06-30 | $394,686 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2022-06-30 | $22,100 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-06-30 | $141,494 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-06-30 | $141,887 |
| Other income not declared elsewhere | 2022-06-30 | $99,114 |
| Administrative expenses (other) incurred | 2022-06-30 | $444,140 |
| Total non interest bearing cash at end of year | 2022-06-30 | $153,080 |
| Total non interest bearing cash at beginning of year | 2022-06-30 | $48,926 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-06-30 | No |
| Value of net income/loss | 2022-06-30 | $-813,452 |
| Value of net assets at end of year (total assets less liabilities) | 2022-06-30 | $19,932,157 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-06-30 | $20,745,609 |
| 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 | $775 |
| Assets. partnership/joint venture interests at beginning of year | 2022-06-30 | $775 |
| Investment advisory and management fees | 2022-06-30 | $8,500 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-06-30 | $9,670,757 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-06-30 | $10,980,767 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-06-30 | $927,731 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-06-30 | $756,696 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-06-30 | $756,696 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-06-30 | $201,181 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2022-06-30 | $7,608,449 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2022-06-30 | $7,782,802 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-06-30 | $3,929,716 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-06-30 | $-1,301,779 |
| 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 |
| Contributions received in cash from employer | 2022-06-30 | $8,756,729 |
| Employer contributions (assets) at end of year | 2022-06-30 | $1,548,000 |
| Employer contributions (assets) at beginning of year | 2022-06-30 | $1,185,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-06-30 | $4,720,022 |
| Liabilities. Value of benefit claims payable at end of year | 2022-06-30 | $148,847 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-06-30 | $163,580 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2022-06-30 | $30,718 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2022-06-30 | $12,336 |
| 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 | $375,000 |
| Aggregate carrying amount (costs) on sale of assets | 2022-06-30 | $375,000 |
| Opinion of an independent qualified public accountant for this plan | 2022-06-30 | Unqualified |
| Accountancy firm name | 2022-06-30 | LUMSDEN AND MCCORMICK LLP |
| Accountancy firm EIN | 2022-06-30 | 160765486 |
| 2021 : BUFFALO LABORERS' WELFARE FUND 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $163,580 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $125,861 |
| Total income from all sources (including contributions) | 2021-06-30 | $10,096,910 |
| Total loss/gain on sale of assets | 2021-06-30 | $0 |
| Total of all expenses incurred | 2021-06-30 | $8,785,774 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-06-30 | $8,178,551 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-06-30 | $8,632,516 |
| Value of total assets at end of year | 2021-06-30 | $20,909,189 |
| Value of total assets at beginning of year | 2021-06-30 | $19,560,334 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-06-30 | $607,223 |
| Total interest from all sources | 2021-06-30 | $196,833 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-06-30 | $297,524 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-06-30 | $297,524 |
| Administrative expenses professional fees incurred | 2021-06-30 | $168,691 |
| Was this plan covered by a fidelity bond | 2021-06-30 | Yes |
| Value of fidelity bond cover | 2021-06-30 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-06-30 | No |
| Contributions received from participants | 2021-06-30 | $414,668 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2021-06-30 | $22,100 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-06-30 | $141,887 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-06-30 | $69,120 |
| Other income not declared elsewhere | 2021-06-30 | $84,164 |
| Administrative expenses (other) incurred | 2021-06-30 | $430,032 |
| Liabilities. Value of operating payables at end of year | 2021-06-30 | $163,580 |
| Liabilities. Value of operating payables at beginning of year | 2021-06-30 | $125,861 |
| Total non interest bearing cash at end of year | 2021-06-30 | $48,926 |
| Total non interest bearing cash at beginning of year | 2021-06-30 | $630,299 |
| 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 | $1,311,136 |
| Value of net assets at end of year (total assets less liabilities) | 2021-06-30 | $20,745,609 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-06-30 | $19,434,473 |
| 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 | $775 |
| Assets. partnership/joint venture interests at beginning of year | 2021-06-30 | $775 |
| Investment advisory and management fees | 2021-06-30 | $8,500 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-06-30 | $10,980,767 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-06-30 | $9,793,222 |
| Interest earned on other investments | 2021-06-30 | $196,258 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-06-30 | $756,696 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-06-30 | $26,121 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-06-30 | $26,121 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-06-30 | $575 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2021-06-30 | $7,782,802 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2021-06-30 | $7,290,692 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-06-30 | $3,864,152 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-06-30 | $885,873 |
| 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 | $8,217,848 |
| Employer contributions (assets) at end of year | 2021-06-30 | $1,185,000 |
| Employer contributions (assets) at beginning of year | 2021-06-30 | $1,732,291 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-06-30 | $4,292,299 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2021-06-30 | $12,336 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2021-06-30 | $17,814 |
| 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 |
| Opinion of an independent qualified public accountant for this plan | 2021-06-30 | Unqualified |
| Accountancy firm name | 2021-06-30 | LUMSDEN & MCCORMICK, LLP |
| Accountancy firm EIN | 2021-06-30 | 160765486 |
| 2020 : BUFFALO LABORERS' WELFARE FUND 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $125,861 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $145,738 |
| Total income from all sources (including contributions) | 2020-06-30 | $9,372,169 |
| Total loss/gain on sale of assets | 2020-06-30 | $0 |
| Total of all expenses incurred | 2020-06-30 | $9,375,663 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-06-30 | $8,561,193 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-06-30 | $8,952,496 |
| Value of total assets at end of year | 2020-06-30 | $19,560,334 |
| Value of total assets at beginning of year | 2020-06-30 | $19,583,705 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-06-30 | $814,470 |
| Total interest from all sources | 2020-06-30 | $186,806 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-06-30 | $269,765 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-06-30 | $269,765 |
| Administrative expenses professional fees incurred | 2020-06-30 | $316,531 |
| Was this plan covered by a fidelity bond | 2020-06-30 | Yes |
| Value of fidelity bond cover | 2020-06-30 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2020-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-06-30 | No |
| Contributions received from participants | 2020-06-30 | $418,028 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2020-06-30 | $26,038 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-06-30 | $69,120 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-06-30 | $57,087 |
| Other income not declared elsewhere | 2020-06-30 | $53,742 |
| Administrative expenses (other) incurred | 2020-06-30 | $489,439 |
| Liabilities. Value of operating payables at end of year | 2020-06-30 | $125,861 |
| Liabilities. Value of operating payables at beginning of year | 2020-06-30 | $145,738 |
| Total non interest bearing cash at end of year | 2020-06-30 | $630,299 |
| Total non interest bearing cash at beginning of year | 2020-06-30 | $70,209 |
| 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 | $-3,494 |
| Value of net assets at end of year (total assets less liabilities) | 2020-06-30 | $19,434,473 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-06-30 | $19,437,967 |
| 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 | $775 |
| Assets. partnership/joint venture interests at beginning of year | 2020-06-30 | $775 |
| Investment advisory and management fees | 2020-06-30 | $8,500 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-06-30 | $9,793,222 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-06-30 | $9,989,097 |
| Interest earned on other investments | 2020-06-30 | $185,962 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-06-30 | $26,121 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-06-30 | $371,311 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-06-30 | $371,311 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-06-30 | $844 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2020-06-30 | $7,290,692 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2020-06-30 | $7,304,730 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-06-30 | $3,892,428 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-06-30 | $-90,640 |
| 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 | $8,534,468 |
| Employer contributions (assets) at end of year | 2020-06-30 | $1,732,291 |
| Employer contributions (assets) at beginning of year | 2020-06-30 | $1,781,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-06-30 | $4,642,727 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2020-06-30 | $17,814 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2020-06-30 | $9,496 |
| 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 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-06-30 | Unqualified |
| Accountancy firm name | 2020-06-30 | LUMSDEN & MCCORMICK LLP |
| Accountancy firm EIN | 2020-06-30 | 160765486 |
| 2019 : BUFFALO LABORERS' WELFARE FUND 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $145,738 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $158,237 |
| Total income from all sources (including contributions) | 2019-06-30 | $9,928,132 |
| Total loss/gain on sale of assets | 2019-06-30 | $0 |
| Total of all expenses incurred | 2019-06-30 | $9,716,527 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-06-30 | $9,028,407 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-06-30 | $9,229,976 |
| Value of total assets at end of year | 2019-06-30 | $19,583,705 |
| Value of total assets at beginning of year | 2019-06-30 | $19,384,599 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-06-30 | $688,120 |
| Total interest from all sources | 2019-06-30 | $169,307 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-06-30 | $327,987 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-06-30 | $327,987 |
| Administrative expenses professional fees incurred | 2019-06-30 | $263,183 |
| Was this plan covered by a fidelity bond | 2019-06-30 | Yes |
| Value of fidelity bond cover | 2019-06-30 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-06-30 | No |
| Contributions received from participants | 2019-06-30 | $404,848 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2019-06-30 | $58,156 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-06-30 | $57,087 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-06-30 | $99,050 |
| Other income not declared elsewhere | 2019-06-30 | $105,606 |
| Administrative expenses (other) incurred | 2019-06-30 | $418,187 |
| Liabilities. Value of operating payables at end of year | 2019-06-30 | $145,738 |
| Liabilities. Value of operating payables at beginning of year | 2019-06-30 | $158,237 |
| Total non interest bearing cash at end of year | 2019-06-30 | $70,209 |
| Total non interest bearing cash at beginning of year | 2019-06-30 | $198,814 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-06-30 | No |
| Value of net income/loss | 2019-06-30 | $211,605 |
| Value of net assets at end of year (total assets less liabilities) | 2019-06-30 | $19,437,967 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-06-30 | $19,226,362 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2019-06-30 | $775 |
| Assets. partnership/joint venture interests at beginning of year | 2019-06-30 | $775 |
| Investment advisory and management fees | 2019-06-30 | $6,750 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-06-30 | $9,989,097 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-06-30 | $8,765,854 |
| Interest earned on other investments | 2019-06-30 | $168,026 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-06-30 | $371,311 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-06-30 | $1,965,072 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-06-30 | $1,965,072 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-06-30 | $1,281 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2019-06-30 | $7,304,730 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2019-06-30 | $6,636,703 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-06-30 | $3,933,331 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-06-30 | $95,256 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-06-30 | No |
| Contributions received in cash from employer | 2019-06-30 | $8,825,128 |
| Employer contributions (assets) at end of year | 2019-06-30 | $1,781,000 |
| Employer contributions (assets) at beginning of year | 2019-06-30 | $1,700,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-06-30 | $5,036,920 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2019-06-30 | $9,496 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2019-06-30 | $18,331 |
| Did the plan have assets held for investment | 2019-06-30 | 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 | 2019-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-06-30 | Unqualified |
| Accountancy firm name | 2019-06-30 | LUMSDEN & MCCORMICK LLP |
| Accountancy firm EIN | 2019-06-30 | 160765486 |
| 2018 : BUFFALO LABORERS' WELFARE FUND 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $158,237 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $186,715 |
| Total income from all sources (including contributions) | 2018-06-30 | $10,379,545 |
| Total loss/gain on sale of assets | 2018-06-30 | $0 |
| Total of all expenses incurred | 2018-06-30 | $9,876,539 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-06-30 | $9,200,867 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-06-30 | $9,951,505 |
| Value of total assets at end of year | 2018-06-30 | $19,384,599 |
| Value of total assets at beginning of year | 2018-06-30 | $18,910,071 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-06-30 | $675,672 |
| Total interest from all sources | 2018-06-30 | $139,486 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-06-30 | $268,613 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-06-30 | $268,613 |
| Administrative expenses professional fees incurred | 2018-06-30 | $263,842 |
| Was this plan covered by a fidelity bond | 2018-06-30 | Yes |
| Value of fidelity bond cover | 2018-06-30 | $3,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-06-30 | No |
| Contributions received from participants | 2018-06-30 | $443,350 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2018-06-30 | $63,112 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-06-30 | $99,050 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-06-30 | $61,245 |
| Other income not declared elsewhere | 2018-06-30 | $120,585 |
| Administrative expenses (other) incurred | 2018-06-30 | $406,830 |
| Liabilities. Value of operating payables at end of year | 2018-06-30 | $158,237 |
| Liabilities. Value of operating payables at beginning of year | 2018-06-30 | $186,715 |
| Total non interest bearing cash at end of year | 2018-06-30 | $198,814 |
| Total non interest bearing cash at beginning of year | 2018-06-30 | $53,086 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Value of net income/loss | 2018-06-30 | $503,006 |
| Value of net assets at end of year (total assets less liabilities) | 2018-06-30 | $19,226,362 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-06-30 | $18,723,356 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2018-06-30 | $775 |
| Assets. partnership/joint venture interests at beginning of year | 2018-06-30 | $775 |
| Investment advisory and management fees | 2018-06-30 | $5,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-06-30 | $8,765,854 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-06-30 | $9,276,299 |
| Interest earned on other investments | 2018-06-30 | $137,837 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-06-30 | $1,965,072 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-06-30 | $865,026 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-06-30 | $865,026 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-06-30 | $1,649 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2018-06-30 | $6,636,703 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2018-06-30 | $6,740,421 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-06-30 | $4,040,035 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-06-30 | $-100,644 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-06-30 | No |
| Contributions received in cash from employer | 2018-06-30 | $9,508,155 |
| Employer contributions (assets) at end of year | 2018-06-30 | $1,700,000 |
| Employer contributions (assets) at beginning of year | 2018-06-30 | $1,889,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-06-30 | $5,097,720 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2018-06-30 | $18,331 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2018-06-30 | $24,219 |
| Did the plan have assets held for investment | 2018-06-30 | 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 | 2018-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-06-30 | Unqualified |
| Accountancy firm name | 2018-06-30 | LUMSDEN AND MCCORMICK, LLP |
| Accountancy firm EIN | 2018-06-30 | 160765486 |
| 2017 : BUFFALO LABORERS' WELFARE FUND 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $186,715 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $176,183 |
| Total income from all sources (including contributions) | 2017-06-30 | $10,421,549 |
| Total loss/gain on sale of assets | 2017-06-30 | $0 |
| Total of all expenses incurred | 2017-06-30 | $10,911,822 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-06-30 | $10,203,175 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-06-30 | $9,639,839 |
| Value of total assets at end of year | 2017-06-30 | $18,910,071 |
| Value of total assets at beginning of year | 2017-06-30 | $19,389,812 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-06-30 | $708,647 |
| Total interest from all sources | 2017-06-30 | $154,956 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-06-30 | $196,819 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-06-30 | $196,819 |
| Administrative expenses professional fees incurred | 2017-06-30 | $281,451 |
| Was this plan covered by a fidelity bond | 2017-06-30 | Yes |
| Value of fidelity bond cover | 2017-06-30 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-06-30 | No |
| Contributions received from participants | 2017-06-30 | $551,731 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2017-06-30 | $63,822 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-06-30 | $61,245 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-06-30 | $521,726 |
| Other income not declared elsewhere | 2017-06-30 | $130,408 |
| Administrative expenses (other) incurred | 2017-06-30 | $422,196 |
| Liabilities. Value of operating payables at end of year | 2017-06-30 | $186,715 |
| Liabilities. Value of operating payables at beginning of year | 2017-06-30 | $176,183 |
| Total non interest bearing cash at end of year | 2017-06-30 | $53,086 |
| Total non interest bearing cash at beginning of year | 2017-06-30 | $84,115 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-06-30 | No |
| Value of net income/loss | 2017-06-30 | $-490,273 |
| Value of net assets at end of year (total assets less liabilities) | 2017-06-30 | $18,723,356 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-06-30 | $19,213,629 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2017-06-30 | $775 |
| Assets. partnership/joint venture interests at beginning of year | 2017-06-30 | $775 |
| Investment advisory and management fees | 2017-06-30 | $5,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-06-30 | $9,276,299 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-06-30 | $9,329,952 |
| Interest earned on other investments | 2017-06-30 | $153,756 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-06-30 | $865,026 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-06-30 | $584,826 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-06-30 | $584,826 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-06-30 | $1,200 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2017-06-30 | $6,740,421 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2017-06-30 | $6,943,624 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-06-30 | $4,989,283 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-06-30 | $299,527 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-06-30 | No |
| Contributions received in cash from employer | 2017-06-30 | $9,088,108 |
| Employer contributions (assets) at end of year | 2017-06-30 | $1,889,000 |
| Employer contributions (assets) at beginning of year | 2017-06-30 | $1,896,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-06-30 | $5,150,070 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2017-06-30 | $24,219 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2017-06-30 | $28,794 |
| Did the plan have assets held for investment | 2017-06-30 | 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 | 2017-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-06-30 | Unqualified |
| Accountancy firm name | 2017-06-30 | LUMSDEN AND MCCORMICK LLP |
| Accountancy firm EIN | 2017-06-30 | 160765486 |
| 2016 : BUFFALO LABORERS' WELFARE FUND 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-06-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $176,183 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $308,436 |
| Total income from all sources (including contributions) | 2016-06-30 | $11,054,894 |
| Total loss/gain on sale of assets | 2016-06-30 | $0 |
| Total of all expenses incurred | 2016-06-30 | $10,066,666 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-06-30 | $9,401,686 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-06-30 | $10,664,429 |
| Value of total assets at end of year | 2016-06-30 | $19,389,812 |
| Value of total assets at beginning of year | 2016-06-30 | $18,533,837 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-06-30 | $664,980 |
| Total interest from all sources | 2016-06-30 | $166,428 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-06-30 | $219,726 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-06-30 | $219,726 |
| Administrative expenses professional fees incurred | 2016-06-30 | $201,049 |
| Was this plan covered by a fidelity bond | 2016-06-30 | Yes |
| Value of fidelity bond cover | 2016-06-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-06-30 | No |
| Contributions received from participants | 2016-06-30 | $578,511 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-06-30 | $521,726 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-06-30 | $533,229 |
| Other income not declared elsewhere | 2016-06-30 | $218,571 |
| Administrative expenses (other) incurred | 2016-06-30 | $458,931 |
| Liabilities. Value of operating payables at end of year | 2016-06-30 | $176,183 |
| Liabilities. Value of operating payables at beginning of year | 2016-06-30 | $308,436 |
| Total non interest bearing cash at end of year | 2016-06-30 | $84,115 |
| Total non interest bearing cash at beginning of year | 2016-06-30 | $75,042 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-06-30 | No |
| Value of net income/loss | 2016-06-30 | $988,228 |
| Value of net assets at end of year (total assets less liabilities) | 2016-06-30 | $19,213,629 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-06-30 | $18,225,401 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2016-06-30 | $775 |
| Assets. partnership/joint venture interests at beginning of year | 2016-06-30 | $775 |
| Investment advisory and management fees | 2016-06-30 | $5,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-06-30 | $9,329,952 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-06-30 | $9,020,958 |
| Interest earned on other investments | 2016-06-30 | $165,620 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-06-30 | $584,826 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-06-30 | $1,034,075 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-06-30 | $1,034,075 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-06-30 | $808 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2016-06-30 | $6,943,624 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2016-06-30 | $6,048,070 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-06-30 | $4,407,826 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-06-30 | $-214,260 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-06-30 | No |
| Contributions received in cash from employer | 2016-06-30 | $10,085,918 |
| Employer contributions (assets) at end of year | 2016-06-30 | $1,896,000 |
| Employer contributions (assets) at beginning of year | 2016-06-30 | $1,786,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-06-30 | $4,993,860 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2016-06-30 | $28,794 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2016-06-30 | $35,688 |
| Did the plan have assets held for investment | 2016-06-30 | 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 | 2016-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-06-30 | Unqualified |
| Accountancy firm name | 2016-06-30 | LUMSDEN AND MCCORMICK LLP |
| Accountancy firm EIN | 2016-06-30 | 160765486 |
| 2015 : BUFFALO LABORERS' WELFARE FUND 2015 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2015-06-30 | $-2,180 |
| Total unrealized appreciation/depreciation of assets | 2015-06-30 | $-2,180 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-06-30 | $308,436 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-06-30 | $145,273 |
| Total income from all sources (including contributions) | 2015-06-30 | $11,367,074 |
| Total loss/gain on sale of assets | 2015-06-30 | $0 |
| Total of all expenses incurred | 2015-06-30 | $9,824,247 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-06-30 | $9,090,965 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-06-30 | $11,186,498 |
| Value of total assets at end of year | 2015-06-30 | $18,533,837 |
| Value of total assets at beginning of year | 2015-06-30 | $16,827,847 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-06-30 | $733,282 |
| Total interest from all sources | 2015-06-30 | $103,242 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-06-30 | $503,607 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-06-30 | $503,607 |
| Administrative expenses professional fees incurred | 2015-06-30 | $263,480 |
| Was this plan covered by a fidelity bond | 2015-06-30 | Yes |
| Value of fidelity bond cover | 2015-06-30 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-06-30 | No |
| Contributions received from participants | 2015-06-30 | $626,057 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2015-06-30 | $4,913,606 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-06-30 | $533,229 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-06-30 | $473,771 |
| Other income not declared elsewhere | 2015-06-30 | $137,373 |
| Administrative expenses (other) incurred | 2015-06-30 | $464,394 |
| Liabilities. Value of operating payables at end of year | 2015-06-30 | $308,436 |
| Liabilities. Value of operating payables at beginning of year | 2015-06-30 | $145,273 |
| Total non interest bearing cash at end of year | 2015-06-30 | $75,042 |
| Total non interest bearing cash at beginning of year | 2015-06-30 | $73,876 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-06-30 | No |
| Value of net income/loss | 2015-06-30 | $1,542,827 |
| Value of net assets at end of year (total assets less liabilities) | 2015-06-30 | $18,225,401 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-06-30 | $16,682,574 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2015-06-30 | $775 |
| Assets. partnership/joint venture interests at beginning of year | 2015-06-30 | $2,955 |
| Investment advisory and management fees | 2015-06-30 | $5,408 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-06-30 | $9,020,958 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-06-30 | $11,230,739 |
| Interest earned on other investments | 2015-06-30 | $101,718 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-06-30 | $1,034,075 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-06-30 | $1,630,873 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-06-30 | $1,630,873 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-06-30 | $1,524 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2015-06-30 | $6,048,070 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2015-06-30 | $1,801,422 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-06-30 | $4,177,359 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-06-30 | $-561,466 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-06-30 | No |
| Contributions received in cash from employer | 2015-06-30 | $10,560,441 |
| Employer contributions (assets) at end of year | 2015-06-30 | $1,786,000 |
| Employer contributions (assets) at beginning of year | 2015-06-30 | $1,588,000 |
| Contract administrator fees | 2015-06-30 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2015-06-30 | $35,688 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2015-06-30 | $26,211 |
| Did the plan have assets held for investment | 2015-06-30 | 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 | 2015-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-06-30 | Unqualified |
| Accountancy firm name | 2015-06-30 | LUMSDEN AND MCCORMICK LLP |
| Accountancy firm EIN | 2015-06-30 | 160765486 |
| 2014 : BUFFALO LABORERS' WELFARE FUND 2014 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2014-06-30 | $-4,279 |
| Total unrealized appreciation/depreciation of assets | 2014-06-30 | $-4,279 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-06-30 | $145,273 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-06-30 | $259,006 |
| Total income from all sources (including contributions) | 2014-06-30 | $10,576,934 |
| Total loss/gain on sale of assets | 2014-06-30 | $19,813 |
| Total of all expenses incurred | 2014-06-30 | $10,385,702 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-06-30 | $9,617,013 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-06-30 | $9,969,703 |
| Value of total assets at end of year | 2014-06-30 | $16,827,847 |
| Value of total assets at beginning of year | 2014-06-30 | $16,750,348 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-06-30 | $768,689 |
| Total interest from all sources | 2014-06-30 | $124,644 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-06-30 | $169,608 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2014-06-30 | $169,608 |
| Administrative expenses professional fees incurred | 2014-06-30 | $264,743 |
| Was this plan covered by a fidelity bond | 2014-06-30 | Yes |
| Value of fidelity bond cover | 2014-06-30 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-06-30 | No |
| Contributions received from participants | 2014-06-30 | $692,009 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2014-06-30 | $68,217 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-06-30 | $473,771 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-06-30 | $1,264,601 |
| Other income not declared elsewhere | 2014-06-30 | $115,107 |
| Administrative expenses (other) incurred | 2014-06-30 | $496,831 |
| Liabilities. Value of operating payables at end of year | 2014-06-30 | $145,273 |
| Liabilities. Value of operating payables at beginning of year | 2014-06-30 | $259,006 |
| Total non interest bearing cash at end of year | 2014-06-30 | $73,876 |
| Total non interest bearing cash at beginning of year | 2014-06-30 | $537,304 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-06-30 | No |
| Value of net income/loss | 2014-06-30 | $191,232 |
| Value of net assets at end of year (total assets less liabilities) | 2014-06-30 | $16,682,574 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-06-30 | $16,491,342 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2014-06-30 | $2,955 |
| Assets. partnership/joint venture interests at beginning of year | 2014-06-30 | $2,955 |
| Investment advisory and management fees | 2014-06-30 | $7,115 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-06-30 | $11,230,739 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-06-30 | $7,878,793 |
| Interest earned on other investments | 2014-06-30 | $113,763 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-06-30 | $1,630,873 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-06-30 | $2,670,681 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-06-30 | $2,670,681 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-06-30 | $10,881 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2014-06-30 | $1,801,422 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2014-06-30 | $2,911,168 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-06-30 | $5,105,970 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2014-06-30 | $182,338 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-06-30 | No |
| Contributions received in cash from employer | 2014-06-30 | $9,277,694 |
| Employer contributions (assets) at end of year | 2014-06-30 | $1,588,000 |
| Employer contributions (assets) at beginning of year | 2014-06-30 | $1,479,648 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-06-30 | $4,442,826 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2014-06-30 | $26,211 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2014-06-30 | $5,198 |
| Did the plan have assets held for investment | 2014-06-30 | 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 | 2014-06-30 | Yes |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-06-30 | No |
| Aggregate proceeds on sale of assets | 2014-06-30 | $1,668,078 |
| Aggregate carrying amount (costs) on sale of assets | 2014-06-30 | $1,648,265 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-06-30 | Unqualified |
| Accountancy firm name | 2014-06-30 | LUMSDEN & MCCORMICK, LLP |
| Accountancy firm EIN | 2014-06-30 | 160765486 |
| 2013 : BUFFALO LABORERS' WELFARE FUND 2013 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2013-06-30 | $-28,897 |
| Total unrealized appreciation/depreciation of assets | 2013-06-30 | $-28,897 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $259,006 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $170,620 |
| Total income from all sources (including contributions) | 2013-06-30 | $10,996,988 |
| Total loss/gain on sale of assets | 2013-06-30 | $0 |
| Total of all expenses incurred | 2013-06-30 | $10,403,846 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-06-30 | $9,750,061 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-06-30 | $9,619,242 |
| Value of total assets at end of year | 2013-06-30 | $16,750,348 |
| Value of total assets at beginning of year | 2013-06-30 | $16,068,820 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-06-30 | $653,785 |
| Total interest from all sources | 2013-06-30 | $203,666 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-06-30 | $93,818 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2013-06-30 | $93,818 |
| Administrative expenses professional fees incurred | 2013-06-30 | $264,080 |
| Was this plan covered by a fidelity bond | 2013-06-30 | Yes |
| Value of fidelity bond cover | 2013-06-30 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-06-30 | No |
| Contributions received from participants | 2013-06-30 | $663,315 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2013-06-30 | $31,272 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-06-30 | $63,711 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-06-30 | $1,264,601 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-06-30 | $775,298 |
| Other income not declared elsewhere | 2013-06-30 | $1,265,641 |
| Administrative expenses (other) incurred | 2013-06-30 | $381,680 |
| Liabilities. Value of operating payables at end of year | 2013-06-30 | $259,006 |
| Liabilities. Value of operating payables at beginning of year | 2013-06-30 | $170,620 |
| Total non interest bearing cash at end of year | 2013-06-30 | $537,304 |
| Total non interest bearing cash at beginning of year | 2013-06-30 | $80,217 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Value of net income/loss | 2013-06-30 | $593,142 |
| Value of net assets at end of year (total assets less liabilities) | 2013-06-30 | $16,491,342 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-06-30 | $15,898,200 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2013-06-30 | $2,955 |
| Assets. partnership/joint venture interests at beginning of year | 2013-06-30 | $3,203 |
| Investment advisory and management fees | 2013-06-30 | $8,025 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2013-06-30 | $7,878,793 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2013-06-30 | $4,853,138 |
| Interest earned on other investments | 2013-06-30 | $169,544 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-06-30 | $2,670,681 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-06-30 | $5,479,475 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-06-30 | $5,479,475 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-06-30 | $34,122 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2013-06-30 | $2,911,168 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2013-06-30 | $2,942,400 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-06-30 | $4,921,637 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-06-30 | $-156,482 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-06-30 | No |
| Contributions received in cash from employer | 2013-06-30 | $8,924,655 |
| Employer contributions (assets) at end of year | 2013-06-30 | $1,479,648 |
| Employer contributions (assets) at beginning of year | 2013-06-30 | $1,525,070 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-06-30 | $4,764,713 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2013-06-30 | $401,972 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2013-06-30 | $5,198 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2013-06-30 | $8,047 |
| Did the plan have assets held for investment | 2013-06-30 | 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 | 2013-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-06-30 | No |
| Aggregate proceeds on sale of assets | 2013-06-30 | $1,624,550 |
| Aggregate carrying amount (costs) on sale of assets | 2013-06-30 | $1,624,550 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-06-30 | Unqualified |
| Accountancy firm name | 2013-06-30 | LUMSDEN & MCCORMICK, LLP |
| Accountancy firm EIN | 2013-06-30 | 160765486 |
| 2012 : BUFFALO LABORERS' WELFARE FUND 2012 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2012-06-30 | $-9,757 |
| Total unrealized appreciation/depreciation of assets | 2012-06-30 | $-9,757 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $170,620 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $273,546 |
| Total income from all sources (including contributions) | 2012-06-30 | $11,894,036 |
| Total loss/gain on sale of assets | 2012-06-30 | $-27,975 |
| Total of all expenses incurred | 2012-06-30 | $10,549,506 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-06-30 | $9,800,432 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-06-30 | $11,543,767 |
| Value of total assets at end of year | 2012-06-30 | $16,068,820 |
| Value of total assets at beginning of year | 2012-06-30 | $14,827,216 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-06-30 | $749,074 |
| Total interest from all sources | 2012-06-30 | $275,704 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-06-30 | $61,766 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-06-30 | $61,766 |
| Administrative expenses professional fees incurred | 2012-06-30 | $245,310 |
| Was this plan covered by a fidelity bond | 2012-06-30 | Yes |
| Value of fidelity bond cover | 2012-06-30 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-06-30 | No |
| Contributions received from participants | 2012-06-30 | $694,789 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-06-30 | $44,004 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-06-30 | $73,830 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-06-30 | $775,298 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-06-30 | $618,404 |
| Other income not declared elsewhere | 2012-06-30 | $69,030 |
| Administrative expenses (other) incurred | 2012-06-30 | $497,403 |
| Liabilities. Value of operating payables at end of year | 2012-06-30 | $170,620 |
| Liabilities. Value of operating payables at beginning of year | 2012-06-30 | $273,546 |
| Total non interest bearing cash at end of year | 2012-06-30 | $80,217 |
| Total non interest bearing cash at beginning of year | 2012-06-30 | $53,567 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Value of net income/loss | 2012-06-30 | $1,344,530 |
| Value of net assets at end of year (total assets less liabilities) | 2012-06-30 | $15,898,200 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-06-30 | $14,553,670 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2012-06-30 | $3,203 |
| Assets. partnership/joint venture interests at beginning of year | 2012-06-30 | $2,955 |
| Investment advisory and management fees | 2012-06-30 | $6,361 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-06-30 | $4,853,138 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-06-30 | $1,039,241 |
| Interest earned on other investments | 2012-06-30 | $164,821 |
| Income. Interest from corporate debt instruments | 2012-06-30 | $25,704 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-06-30 | $5,479,475 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-06-30 | $7,824,379 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-06-30 | $7,824,379 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-06-30 | $85,179 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2012-06-30 | $2,942,400 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2012-06-30 | $2,942,400 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-06-30 | $4,576,767 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-06-30 | $-18,499 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-06-30 | No |
| Contributions received in cash from employer | 2012-06-30 | $10,804,974 |
| Employer contributions (assets) at end of year | 2012-06-30 | $1,525,070 |
| Employer contributions (assets) at beginning of year | 2012-06-30 | $1,665,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-06-30 | $5,149,835 |
| Asset. Corporate debt instrument debt (other) at end of year | 2012-06-30 | $401,972 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2012-06-30 | $667,567 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2012-06-30 | $8,047 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2012-06-30 | $13,703 |
| Did the plan have assets held for investment | 2012-06-30 | 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 | 2012-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-06-30 | No |
| Aggregate proceeds on sale of assets | 2012-06-30 | $1,271,330 |
| Aggregate carrying amount (costs) on sale of assets | 2012-06-30 | $1,299,305 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-06-30 | Unqualified |
| Accountancy firm name | 2012-06-30 | LUMSDEN & MCCORMICK, LLP |
| Accountancy firm EIN | 2012-06-30 | 160765486 |
| 2011 : BUFFALO LABORERS' WELFARE FUND 2011 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2011-06-30 | $-43,560 |
| Total unrealized appreciation/depreciation of assets | 2011-06-30 | $-43,560 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $273,546 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $193,939 |
| Total income from all sources (including contributions) | 2011-06-30 | $11,187,138 |
| Total loss/gain on sale of assets | 2011-06-30 | $-14,495 |
| Total of all expenses incurred | 2011-06-30 | $10,287,566 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-06-30 | $9,729,943 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-06-30 | $10,932,799 |
| Value of total assets at end of year | 2011-06-30 | $14,827,216 |
| Value of total assets at beginning of year | 2011-06-30 | $13,848,037 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-06-30 | $557,623 |
| Total interest from all sources | 2011-06-30 | $270,522 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-06-30 | $43,551 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-06-30 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-06-30 | $43,551 |
| Administrative expenses professional fees incurred | 2011-06-30 | $183,899 |
| Was this plan covered by a fidelity bond | 2011-06-30 | Yes |
| Value of fidelity bond cover | 2011-06-30 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-06-30 | No |
| Contributions received from participants | 2011-06-30 | $781,262 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-06-30 | $42,529 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-06-30 | $74,012 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-06-30 | $618,404 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-06-30 | $480,629 |
| Other income not declared elsewhere | 2011-06-30 | $19 |
| Liabilities. Value of operating payables at end of year | 2011-06-30 | $273,546 |
| Liabilities. Value of operating payables at beginning of year | 2011-06-30 | $193,939 |
| Total non interest bearing cash at end of year | 2011-06-30 | $53,567 |
| Total non interest bearing cash at beginning of year | 2011-06-30 | $32,649 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Value of net income/loss | 2011-06-30 | $899,572 |
| Value of net assets at end of year (total assets less liabilities) | 2011-06-30 | $14,553,670 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-06-30 | $13,654,098 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-06-30 | No |
| Assets. partnership/joint venture interests at end of year | 2011-06-30 | $2,955 |
| Assets. partnership/joint venture interests at beginning of year | 2011-06-30 | $438,552 |
| Investment advisory and management fees | 2011-06-30 | $373,724 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-06-30 | $1,039,241 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2011-06-30 | $1,019,637 |
| Interest earned on other investments | 2011-06-30 | $130,795 |
| Income. Interest from US Government securities | 2011-06-30 | $1,192 |
| Income. Interest from corporate debt instruments | 2011-06-30 | $31,500 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-06-30 | $7,824,379 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-06-30 | $6,146,283 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-06-30 | $6,146,283 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-06-30 | $107,035 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2011-06-30 | $2,942,400 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2011-06-30 | $2,942,400 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-06-30 | $4,791,411 |
| Asset value of US Government securities at end of year | 2011-06-30 | $0 |
| Asset value of US Government securities at beginning of year | 2011-06-30 | $300,189 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2011-06-30 | $-1,698 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-06-30 | No |
| Contributions received in cash from employer | 2011-06-30 | $10,109,008 |
| Employer contributions (assets) at end of year | 2011-06-30 | $1,665,000 |
| Employer contributions (assets) at beginning of year | 2011-06-30 | $1,794,145 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-06-30 | $4,864,520 |
| Asset. Corporate debt instrument debt (other) at end of year | 2011-06-30 | $667,567 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2011-06-30 | $677,873 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-06-30 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2011-06-30 | $13,703 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2011-06-30 | $15,680 |
| Did the plan have assets held for investment | 2011-06-30 | 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 | 2011-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-06-30 | No |
| Aggregate proceeds on sale of assets | 2011-06-30 | $1,107,663 |
| Aggregate carrying amount (costs) on sale of assets | 2011-06-30 | $1,122,158 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-06-30 | Unqualified |
| Accountancy firm name | 2011-06-30 | LUMSDEN & MCCORMICK, LLP |
| Accountancy firm EIN | 2011-06-30 | 160765486 |
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00554857 |
| Policy instance | 2 |
| Insurance contract or identification number | 00554857 | | Number of Individuals Covered | 528 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $3,998 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $102,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,998 | | Insurance broker organization code? | 1 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 282393 |
| Policy instance | 6 |
| Insurance contract or identification number | 282393 | | Number of Individuals Covered | 93 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $9,326 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $129,387 | | Commission paid to Insurance Broker | USD $9,326 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 069020 |
| Policy instance | 1 |
| Insurance contract or identification number | 069020 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 31709 |
| Policy instance | 3 |
| Insurance contract or identification number | 31709 | | Number of Individuals Covered | 404 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $61,668 | | 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 $3,424,573 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $61,668 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00413676 |
| Policy instance | 4 |
| Insurance contract or identification number | 00413676 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $5,708 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | 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 $57,309 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,708 | | Insurance broker organization code? | 3 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00990214 |
| Policy instance | 5 |
| Insurance contract or identification number | 00990214 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Total amount of commissions paid to insurance broker | USD $8,293 | | 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 $49,661 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,293 | | Insurance broker organization code? | 3 |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 31709 |
| Policy instance | 1 |
| Insurance contract or identification number | 31709 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $59,649 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $3,567,346 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,649 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 990214 |
| Policy instance | 4 |
| Insurance contract or identification number | 990214 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $11,164 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | 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 $134,005 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,164 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00554857 |
| Policy instance | 3 |
| Insurance contract or identification number | 00554857 | | Number of Individuals Covered | 514 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,964 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $102,875 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,964 | | Insurance broker organization code? | 1 |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 069020 |
| Policy instance | 2 |
| Insurance contract or identification number | 069020 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | Yes | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF WNY (National Association of Insurance Commissioners NAIC id number: 55204 ) |
| Policy contract number | 00413676 |
| Policy instance | 5 |
| Insurance contract or identification number | 00413676 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $7,161 | | 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 $148,250 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,161 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00413676 |
| Policy instance | 5 |
| Insurance contract or identification number | 00413676 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $6,980 | | 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 $121,803 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,980 | | Insurance broker organization code? | 3 |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 31709 |
| Policy instance | 1 |
| Insurance contract or identification number | 31709 | | Number of Individuals Covered | 401 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $53,169 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $3,220,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,169 | | Insurance broker organization code? | 3 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 990214 |
| Policy instance | 4 |
| Insurance contract or identification number | 990214 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $11,490 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $119,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,490 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 069020 |
| Policy instance | 2 |
| Insurance contract or identification number | 069020 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | Yes | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00554857 |
| Policy instance | 3 |
| Insurance contract or identification number | 00554857 | | Number of Individuals Covered | 521 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $3,974 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $104,882 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,724 | | Insurance broker organization code? | 1 |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 31709 |
| Policy instance | 1 |
| Insurance contract or identification number | 31709 | | Number of Individuals Covered | 414 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $68,138 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $3,802,891 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $68,138 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00413676 |
| Policy instance | 5 |
| Insurance contract or identification number | 00413676 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $6,291 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $139,059 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,291 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00554857 |
| Policy instance | 3 |
| Insurance contract or identification number | 00554857 | | Number of Individuals Covered | 459 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $4,724 | | 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 $132,594 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,724 | | Insurance broker organization code? | 1 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 990214 |
| Policy instance | 4 |
| Insurance contract or identification number | 990214 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $10,478 | | 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 $146,752 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,478 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 069020 |
| Policy instance | 2 |
| Insurance contract or identification number | 069020 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | Yes | | 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 | | 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 number | 872808G |
| Policy instance | 4 |
| Insurance contract or identification number | 872808G | | Number of Individuals Covered | 609 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2018-12-01 | | Total amount of commissions paid to insurance broker | USD $2,736 | | 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 $48,808 | | Commission paid to Insurance Broker | USD $2,736 | | Insurance broker organization code? | 3 |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 31709 |
| Policy instance | 2 |
| Insurance contract or identification number | 31709 | | Number of Individuals Covered | 424 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $80,098 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $3,280,633 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $80,098 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00554857 |
| Policy instance | 5 |
| Insurance contract or identification number | 00554857 | | Number of Individuals Covered | 470 | | Insurance policy start date | 2018-12-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $2,785 | | 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 $36,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,785 |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 069020 |
| Policy instance | 1 |
| Insurance contract or identification number | 069020 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | Yes | | 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 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 9990214 |
| Policy instance | 3 |
| Insurance contract or identification number | 9990214 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $9,188 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $118,595 | | Commission paid to Insurance Broker | USD $9,188 | | Insurance broker organization code? | 3 |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00990214 |
| Policy instance | 2 |
| Insurance contract or identification number | 00990214 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $15,574 | | 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 $171,837 | | 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 number | 872808G |
| Policy instance | 4 |
| Insurance contract or identification number | 872808G | | Number of Individuals Covered | 561 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | Total amount of commissions paid to insurance broker | USD $4,809 | | 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 $111,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 069020 |
| Policy instance | 3 |
| Insurance contract or identification number | 069020 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | Yes | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 31709 |
| Policy instance | 1 |
| Insurance contract or identification number | 31709 | | Number of Individuals Covered | 761 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $93,095 | | 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 $3,642,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00413676 |
| Policy instance | 3 |
| Insurance contract or identification number | 00413676 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $1,575 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $26,637 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,575 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES INC |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 31709 |
| Policy instance | 1 |
| Insurance contract or identification number | 31709 | | Number of Individuals Covered | 752 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $76,641 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $3,903,487 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $76,641 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00990214 |
| Policy instance | 2 |
| Insurance contract or identification number | 00990214 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $1,925 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $133,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,925 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES INC |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 069020 |
| Policy instance | 5 |
| Insurance contract or identification number | 069020 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| F&G LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 63274 ) |
| Policy contract number | P0058 |
| Policy instance | 6 |
| Insurance contract or identification number | P0058 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | 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 |
|
| ALLIANZ LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 90611 ) |
| Policy contract number | 70626449 |
| Policy instance | 7 |
| Insurance contract or identification number | 70626449 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | 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 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 872808-G |
| Policy instance | 4 |
| Insurance contract or identification number | 872808-G | | Number of Individuals Covered | 544 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $4,859 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $122,036 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,859 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES INC. |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 872808-G |
| Policy instance | 4 |
| Insurance contract or identification number | 872808-G | | Number of Individuals Covered | 544 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $4,859 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | 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 $122,036 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,859 | | Insurance broker name | LYTLE ASSOCIATES INC |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00413676 |
| Policy instance | 3 |
| Insurance contract or identification number | 00413676 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $4,019 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $50,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,019 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES INC |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00990214 |
| Policy instance | 2 |
| Insurance contract or identification number | 00990214 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $2,801 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $133,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,801 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 31709 |
| Policy instance | 1 |
| Insurance contract or identification number | 31709 | | Number of Individuals Covered | 787 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $79,296 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | 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 $4,042,819 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $79,296 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | 872808-G |
| Policy instance | 4 |
| Insurance contract or identification number | 872808-G | | Number of Individuals Covered | 543 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $4,689 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $87,816 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,689 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00413676 |
| Policy instance | 3 |
| Insurance contract or identification number | 00413676 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $3,028 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $83,490 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $3,028 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 990214 |
| Policy instance | 2 |
| Insurance contract or identification number | 990214 | | Number of Individuals Covered | 92 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $2,757 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $250,491 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,757 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 16414A, G & R |
| Policy instance | 1 |
| Insurance contract or identification number | 16414A, G & R | | Number of Individuals Covered | 772 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $86,321 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,315,793 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $86,321 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 990214 |
| Policy instance | 2 |
| Insurance contract or identification number | 990214 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $300 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $256,356 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 300 | | Additional information about fees paid to insurance broker | BROKER FEE-OPEN ENROLLMENT | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES, INC |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 16414A, G & R |
| Policy instance | 1 |
| Insurance contract or identification number | 16414A, G & R | | Number of Individuals Covered | 815 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $100,140 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,475,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $100,140 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | 872808-OGL |
| Policy instance | 4 |
| Insurance contract or identification number | 872808-OGL | | Number of Individuals Covered | 487 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $4,693 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $88,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,693 | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00413676 |
| Policy instance | 3 |
| Insurance contract or identification number | 00413676 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,329 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $84,132 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2329 | | Additional information about fees paid to insurance broker | BROKER FEE-OPEN ENROLLMENT | | Insurance broker organization code? | 3 | | Insurance broker name | LYTLE ASSOCIATES |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00416477 |
| Policy instance | 1 |
| Insurance contract or identification number | 00416477 | | Number of Individuals Covered | 650 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $6,333 | | Total amount of fees paid to insurance company | USD $4,621 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $115,242 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 16414A |
| Policy instance | 2 |
| Insurance contract or identification number | 16414A | | Number of Individuals Covered | 144 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $12,446 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $517,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 16414G |
| Policy instance | 3 |
| Insurance contract or identification number | 16414G | | Number of Individuals Covered | 749 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $86,085 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,431,688 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 16414R |
| Policy instance | 4 |
| Insurance contract or identification number | 16414R | | Number of Individuals Covered | 67 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $4,149 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $154,397 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 990214 |
| Policy instance | 5 |
| Insurance contract or identification number | 990214 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $264,983 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 00413676 |
| Policy instance | 7 |
| Insurance contract or identification number | 00413676 | | Number of Individuals Covered | 26 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $39,015 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 95308 ) |
| Policy contract number | 16414M |
| Policy instance | 6 |
| Insurance contract or identification number | 16414M | | Number of Individuals Covered | 0 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $1,037 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $53,867 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00416477 |
| Policy instance | 1 |
| Insurance contract or identification number | 00416477 | | Number of Individuals Covered | 634 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $6,555 | | Total amount of fees paid to insurance company | USD $4,359 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $119,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 16414A |
| Policy instance | 2 |
| Insurance contract or identification number | 16414A | | Number of Individuals Covered | 122 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $399,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 16414G |
| Policy instance | 3 |
| Insurance contract or identification number | 16414G | | Number of Individuals Covered | 778 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $108,714 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,242,517 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENT HEALTH (National Association of Insurance Commissioners NAIC id number: 47034 ) |
| Policy contract number | 16414R |
| Policy instance | 4 |
| Insurance contract or identification number | 16414R | | Number of Individuals Covered | 29 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $87,900 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 312180 |
| Policy instance | 5 |
| Insurance contract or identification number | 312180 | | Number of Individuals Covered | 448 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2010-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $393,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 48496 |
| Policy instance | 7 |
| Insurance contract or identification number | 48496 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2010-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $27,823 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 990214 |
| Policy instance | 6 |
| Insurance contract or identification number | 990214 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $19,555 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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