401k Plan data: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST plan

LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 401k Plan overview

Plan Name	LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST
Plan identification number	501

LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision

401k Sponsoring company profile

LEWISTON PORTER CENTRAL SCHOOL DISTRICT has sponsored the creation of one or more 401k plans.

Company Name: LEWISTON PORTER CENTRAL SCHOOL DISTRICT

Employer identification number (EIN): 166001867

NAIC Classification: 921000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-07-01
501 2014-07-01
501 2013-07-01
501 2012-07-01 RICHARD LINDAMER
501 2011-07-01 RICHARD LINDAMER
501 2010-07-01 RICHARD LINDAMER
501 2009-07-01 GREG FERRAND

Plan Statistics for LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST

401k plan membership statisitcs for LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST

Measure Date Value
2015: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2015 401k membership
Total participants, beginning-of-year 2015-07-01 172
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 0
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 0
Total participants 2015-07-01 0
Number of participants with account balances 2015-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 0
Number of employers contributing to the scheme 2015-07-01 0
2014: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2014 401k membership
Total participants, beginning-of-year 2014-07-01 178
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 172
Total of all active and inactive participants 2014-07-01 172
Total participants 2014-07-01 172
2013: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2013 401k membership
Total participants, beginning-of-year 2013-07-01 187
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 178
Total of all active and inactive participants 2013-07-01 178
Total participants 2013-07-01 178
2012: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2012 401k membership
Total participants, beginning-of-year 2012-07-01 194
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 187
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 0
Total of all active and inactive participants 2012-07-01 187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 187
Number of participants with account balances 2012-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 0
2011: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2011 401k membership
Total participants, beginning-of-year 2011-07-01 199
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 194
Total of all active and inactive participants 2011-07-01 194
Total participants 2011-07-01 194
2010: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2010 401k membership
Total participants, beginning-of-year 2010-07-01 196
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 199
Total of all active and inactive participants 2010-07-01 199
Total participants 2010-07-01 199
2009: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2009 401k membership
Total participants, beginning-of-year 2009-07-01 192
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 196
Total of all active and inactive participants 2009-07-01 196
Total participants 2009-07-01 196

Measure	Date	Value
2015: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2015 401k membership
Total participants, beginning-of-year	2015-07-01	172
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	0
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	0
Total participants	2015-07-01	0
Number of participants with account balances	2015-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	0
Number of employers contributing to the scheme	2015-07-01	0
2014: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2014 401k membership
Total participants, beginning-of-year	2014-07-01	178
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	172
Total of all active and inactive participants	2014-07-01	172
Total participants	2014-07-01	172
2013: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2013 401k membership
Total participants, beginning-of-year	2013-07-01	187
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	178
Total of all active and inactive participants	2013-07-01	178
Total participants	2013-07-01	178
2012: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2012 401k membership
Total participants, beginning-of-year	2012-07-01	194
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	187
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	0
Total of all active and inactive participants	2012-07-01	187
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	187
Number of participants with account balances	2012-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	0
2011: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2011 401k membership
Total participants, beginning-of-year	2011-07-01	199
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	194
Total of all active and inactive participants	2011-07-01	194
Total participants	2011-07-01	194
2010: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2010 401k membership
Total participants, beginning-of-year	2010-07-01	196
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	199
Total of all active and inactive participants	2010-07-01	199
Total participants	2010-07-01	199
2009: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2009 401k membership
Total participants, beginning-of-year	2009-07-01	192
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	196
Total of all active and inactive participants	2009-07-01	196
Total participants	2009-07-01	196

Financial Data on LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST

Measure	Date	Value
2013 : LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2013-06-30	$-19,398
Total unrealized appreciation/depreciation of assets	2013-06-30	$-19,398
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$95,158
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$68,246
Total income from all sources (including contributions)	2013-06-30	$4,274
Total loss/gain on sale of assets	2013-06-30	$-2,761
Total of all expenses incurred	2013-06-30	$443,887
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$425,927
Value of total assets at end of year	2013-06-30	$1,086,513
Value of total assets at beginning of year	2013-06-30	$1,499,214
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$17,960
Total interest from all sources	2013-06-30	$12,946
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$13,487
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Administrative expenses professional fees incurred	2013-06-30	$1,975
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$300,000
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
Administrative expenses (other) incurred	2013-06-30	$10,251
Total non interest bearing cash at end of year	2013-06-30	$7,954
Total non interest bearing cash at beginning of year	2013-06-30	$22,896
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	$-439,613
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$991,355
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$1,430,968
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
Investment advisory and management fees	2013-06-30	$5,734
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-06-30	$495,272
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-06-30	$582,788
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-06-30	$582,788
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-06-30	$12,946
Expenses. Payments to insurance carriers foe the provision of benefits	2013-06-30	$303,627
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
Income. Dividends from common stock	2013-06-30	$13,487
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$122,300
Assets. Corporate common stocks other than exployer securities at end of year	2013-06-30	$583,287
Assets. Corporate common stocks other than exployer securities at beginning of year	2013-06-30	$893,530
Liabilities. Value of benefit claims payable at end of year	2013-06-30	$95,158
Liabilities. Value of benefit claims payable at beginning of year	2013-06-30	$68,246
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	$539,000
Aggregate carrying amount (costs) on sale of assets	2013-06-30	$541,761
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	BROWN AND COMPANY, LLP
Accountancy firm EIN	2013-06-30	161162269
2012 : LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$68,246
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$93,259
Total income from all sources (including contributions)	2012-06-30	$596,759
Total loss/gain on sale of assets	2012-06-30	$-5,284
Total of all expenses incurred	2012-06-30	$1,132,470
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$1,099,620
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$562,418
Value of total assets at end of year	2012-06-30	$1,499,214
Value of total assets at beginning of year	2012-06-30	$2,059,938
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$32,850
Total interest from all sources	2012-06-30	$19,080
Total dividends received (eg from common stock, registered investment company shares)	2012-06-30	$15,495
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Administrative expenses professional fees incurred	2012-06-30	$19,055
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$390,000
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	$5,226
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-06-30	$2,233
Administrative expenses (other) incurred	2012-06-30	$6,508
Liabilities. Value of operating payables at beginning of year	2012-06-30	$7,243
Total non interest bearing cash at end of year	2012-06-30	$22,896
Total non interest bearing cash at beginning of year	2012-06-30	$39,240
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	$-535,711
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$1,430,968
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$1,966,679
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
Investment advisory and management fees	2012-06-30	$7,287
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-06-30	$582,788
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-06-30	$1,053,048
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-06-30	$1,053,048
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-06-30	$19,080
Expenses. Payments to insurance carriers foe the provision of benefits	2012-06-30	$882,821
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2012-06-30	$5,050
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	$557,192
Income. Dividends from common stock	2012-06-30	$15,495
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-06-30	$216,799
Assets. Corporate common stocks other than exployer securities at end of year	2012-06-30	$893,530
Assets. Corporate common stocks other than exployer securities at beginning of year	2012-06-30	$965,417
Liabilities. Value of benefit claims payable at end of year	2012-06-30	$68,246
Liabilities. Value of benefit claims payable at beginning of year	2012-06-30	$86,016
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	$377,000
Aggregate carrying amount (costs) on sale of assets	2012-06-30	$382,284
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	BROWN AND COMPANY, LLP
Accountancy firm EIN	2012-06-30	161162269
2011 : LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2011-06-30	$2,996
Total unrealized appreciation/depreciation of assets	2011-06-30	$2,996
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$93,259
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$98,501
Total income from all sources (including contributions)	2011-06-30	$2,446,732
Total loss/gain on sale of assets	2011-06-30	$-3,605
Total of all expenses incurred	2011-06-30	$3,509,592
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$3,467,417
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$2,405,614
Value of total assets at end of year	2011-06-30	$2,059,938
Value of total assets at beginning of year	2011-06-30	$3,128,040
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$42,175
Total interest from all sources	2011-06-30	$27,495
Total dividends received (eg from common stock, registered investment company shares)	2011-06-30	$14,232
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Administrative expenses professional fees incurred	2011-06-30	$30,533
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$390,000
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$190,637
Participant contributions at end of year	2011-06-30	$2,233
Participant contributions at beginning of year	2011-06-30	$508
Administrative expenses (other) incurred	2011-06-30	$926
Liabilities. Value of operating payables at end of year	2011-06-30	$7,243
Total non interest bearing cash at end of year	2011-06-30	$39,240
Total non interest bearing cash at beginning of year	2011-06-30	$344,470
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	$-1,062,860
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$1,966,679
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$3,029,539
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
Investment advisory and management fees	2011-06-30	$10,716
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-06-30	$1,053,048
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-06-30	$1,932,561
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-06-30	$1,932,561
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-06-30	$27,495
Expenses. Payments to insurance carriers foe the provision of benefits	2011-06-30	$3,092,150
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	$2,214,977
Income. Dividends from common stock	2011-06-30	$14,232
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-06-30	$375,267
Assets. Corporate common stocks other than exployer securities at end of year	2011-06-30	$965,417
Assets. Corporate common stocks other than exployer securities at beginning of year	2011-06-30	$850,501
Liabilities. Value of benefit claims payable at end of year	2011-06-30	$86,016
Liabilities. Value of benefit claims payable at beginning of year	2011-06-30	$98,501
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	$922,000
Aggregate carrying amount (costs) on sale of assets	2011-06-30	$925,605
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	BROWN AND COMPANY
Accountancy firm EIN	2011-06-30	161162269

Form 5500 Responses for LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST

2015: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	This submission is the final filing	Yes
2015-07-01	Plan is a collectively bargained plan	Yes
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2014: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2013: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – General assets of the sponsor	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – General assets of the sponsor	Yes
2012: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes
2011: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2011 form 5500 responses
2011-07-01	Type of plan entity	Single employer plan
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2011-07-01	Plan benefit arrangement - Trust	Yes
2010: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan is a collectively bargained plan	Yes
2010-07-01	Plan funding arrangement – Trust	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2010-07-01	Plan benefit arrangement - Trust	Yes
2009: LEWISTON PORTER UNITED TEACHERS BENEFIT TRUST 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	Plan is a collectively bargained plan	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes
2009-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

2303

Policy instance

Insurance contract or identification number	2303
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $29,590

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

2303

Policy instance

Insurance contract or identification number	2303
Number of Individuals Covered	175
Insurance policy start date	2014-07-01
Insurance policy end date	2014-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

2303

Policy instance

Insurance contract or identification number	2303
Number of Individuals Covered	178
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

2303

Policy instance

Insurance contract or identification number	2303
Number of Individuals Covered	187
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,812
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH NOW NEW YORK INC. DBA BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 55204 )

Policy contract number

00400808

Policy instance

Insurance contract or identification number	00400808
Number of Individuals Covered	190
Insurance policy start date	2011-07-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $19,749
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $789,970
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

2303

Policy instance

Insurance contract or identification number	2303
Number of Individuals Covered	194
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Total amount of commissions paid to insurance broker	USD $1,164
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $53,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DELTA DENTAL OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 55263 )

Policy contract number

2303

Policy instance

Insurance contract or identification number	2303
Number of Individuals Covered	199
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $4,798
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $184,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HEALTH NOW NEW YORK INC. DBA BLUE CROSS BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 55204 )

Policy contract number

00400808

Policy instance

Insurance contract or identification number	00400808
Number of Individuals Covered	190
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $70,141
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,907,815
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	LEWISTON PORTER CENTRAL SCHOOL DISTRICT
Employer identification number (EIN):	166001867
NAIC Classification:	921000