401k Plan data: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN plan

MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	MID-VALLEY IPA EMPLOYEE BENEFIT PLAN
Plan identification number	501

MID-VALLEY IPA EMPLOYEE BENEFIT PLAN Benefits

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

401k Sponsoring company profile

MID-VALLEY IPA EMPLOYEE BENEFIT TRUST has sponsored the creation of one or more 401k plans.

Company Name: MID-VALLEY IPA EMPLOYEE BENEFIT TRUST

Employer identification number (EIN): 207142144

NAIC Classification: 541990
NAIC Description: All Other Professional, Scientific, and Technical Services

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MID-VALLEY IPA EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01 DEAN ANDRETTA DEAN ANDRETTA 2019-06-25
501 2018-01-01 DEAN ANDRETTA DEAN ANDRETTA 2019-06-25
501 2017-01-01 DEAN ANDRETTA DEAN ANDRETTA 2018-10-03
501 2016-01-01 DEAN ANDRETTA DEAN ANDRETTA 2017-10-16
501 2015-01-01 DEAN ANDRETTA DEAN ANDRETTA 2016-05-24
501 2014-01-01 DEAN ANDRETTA DEAN ANDRETTA 2015-09-10
501 2013-01-01 DEAN ANDRETTA DEAN ANDRETTA 2014-07-11
501 2012-01-01 DEAN ANDRETTA DEAN ANDRETTA 2013-05-03
501 2011-01-01 DEAN ANDRETTA DEAN ANDRETTA 2012-06-20
501 2010-01-01 JAN BUFFA JAN BUFFA 2011-05-27
501 2009-01-01 JAN BUFFA JAN BUFFA 2010-10-05

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01	DEAN ANDRETTA	DEAN ANDRETTA	2019-06-25
501	2018-01-01	DEAN ANDRETTA	DEAN ANDRETTA	2019-06-25
501	2017-01-01	DEAN ANDRETTA	DEAN ANDRETTA	2018-10-03
501	2016-01-01	DEAN ANDRETTA	DEAN ANDRETTA	2017-10-16
501	2015-01-01	DEAN ANDRETTA	DEAN ANDRETTA	2016-05-24
501	2014-01-01	DEAN ANDRETTA	DEAN ANDRETTA	2015-09-10
501	2013-01-01	DEAN ANDRETTA	DEAN ANDRETTA	2014-07-11
501	2012-01-01	DEAN ANDRETTA	DEAN ANDRETTA	2013-05-03
501	2011-01-01	DEAN ANDRETTA	DEAN ANDRETTA	2012-06-20
501	2010-01-01	JAN BUFFA	JAN BUFFA	2011-05-27
501	2009-01-01	JAN BUFFA	JAN BUFFA	2010-10-05

Plan Statistics for MID-VALLEY IPA EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for MID-VALLEY IPA EMPLOYEE BENEFIT PLAN

Measure Date Value
2019: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 0
Number of retired or separated participants receiving benefits 2019-01-01 0
Total of all active and inactive participants 2019-01-01 0
2018: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
2017: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
2016: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 629
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
2015: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 837
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 622
Number of retired or separated participants receiving benefits 2015-01-01 7
Total of all active and inactive participants 2015-01-01 629
2014: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 998
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 829
Number of retired or separated participants receiving benefits 2014-01-01 8
Total of all active and inactive participants 2014-01-01 837
2013: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 991
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 987
Number of retired or separated participants receiving benefits 2013-01-01 11
Total of all active and inactive participants 2013-01-01 998
2012: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,085
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 977
Number of retired or separated participants receiving benefits 2012-01-01 14
Total of all active and inactive participants 2012-01-01 991
2011: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,227
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,069
Number of retired or separated participants receiving benefits 2011-01-01 16
Total of all active and inactive participants 2011-01-01 1,085
2010: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year 2010-01-01 1,167
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 1,199
Number of retired or separated participants receiving benefits 2010-01-01 28
Total of all active and inactive participants 2010-01-01 1,227
2009: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,078
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,146
Number of retired or separated participants receiving benefits 2009-01-01 21
Total of all active and inactive participants 2009-01-01 1,167

Measure	Date	Value
2019: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	0
Number of retired or separated participants receiving benefits	2019-01-01	0
Total of all active and inactive participants	2019-01-01	0
2018: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
2017: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
2016: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	629
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
2015: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	837
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	622
Number of retired or separated participants receiving benefits	2015-01-01	7
Total of all active and inactive participants	2015-01-01	629
2014: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	998
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	829
Number of retired or separated participants receiving benefits	2014-01-01	8
Total of all active and inactive participants	2014-01-01	837
2013: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	991
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	987
Number of retired or separated participants receiving benefits	2013-01-01	11
Total of all active and inactive participants	2013-01-01	998
2012: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,085
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	977
Number of retired or separated participants receiving benefits	2012-01-01	14
Total of all active and inactive participants	2012-01-01	991
2011: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,227
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,069
Number of retired or separated participants receiving benefits	2011-01-01	16
Total of all active and inactive participants	2011-01-01	1,085
2010: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year	2010-01-01	1,167
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	1,199
Number of retired or separated participants receiving benefits	2010-01-01	28
Total of all active and inactive participants	2010-01-01	1,227
2009: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,078
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,146
Number of retired or separated participants receiving benefits	2009-01-01	21
Total of all active and inactive participants	2009-01-01	1,167

Financial Data on MID-VALLEY IPA EMPLOYEE BENEFIT PLAN

Measure	Date	Value
2019 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2019 401k financial data
Expenses. Total of all expenses incurred	2019-01-31	$26,519
Benefits paid (including direct rollovers)	2019-01-31	$26,519
Total plan assets at end of year	2019-01-31	$0
Total plan assets at beginning of year	2019-01-31	$26,519
Net income (gross income less expenses)	2019-01-31	$-26,519
Net plan assets at end of year (total assets less liabilities)	2019-01-31	$0
Net plan assets at beginning of year (total assets less liabilities)	2019-01-31	$26,519
2018 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2018 401k financial data
Total income from all sources	2018-12-31	$276,000
Expenses. Total of all expenses incurred	2018-12-31	$499,481
Benefits paid (including direct rollovers)	2018-12-31	$499,481
Total plan assets at end of year	2018-12-31	$26,519
Total plan assets at beginning of year	2018-12-31	$250,000
Other income received	2018-12-31	$276,000
Net income (gross income less expenses)	2018-12-31	$-223,481
Net plan assets at end of year (total assets less liabilities)	2018-12-31	$26,519
Net plan assets at beginning of year (total assets less liabilities)	2018-12-31	$250,000
2017 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2017 401k financial data
Total plan assets at end of year	2017-12-31	$250,000
Total plan assets at beginning of year	2017-12-31	$250,000
Net plan assets at end of year (total assets less liabilities)	2017-12-31	$250,000
Net plan assets at beginning of year (total assets less liabilities)	2017-12-31	$250,000
2016 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$896,272
Total income from all sources (including contributions)	2016-12-31	$300,000
Total of all expenses incurred	2016-12-31	$126,171
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$0
Value of total assets at end of year	2016-12-31	$250,000
Value of total assets at beginning of year	2016-12-31	$972,443
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$126,171
Total interest from all sources	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Was this plan covered by a fidelity bond	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$54,467
Other income not declared elsewhere	2016-12-31	$300,000
Administrative expenses (other) incurred	2016-12-31	$126,171
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$173,829
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$250,000
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$76,171
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$250,000
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$917,976
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$917,976
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2016-12-31	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$0
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$896,272
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2016-12-31	910189318
2015 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$896,272
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$1,206,503
Total income from all sources (including contributions)	2015-12-31	$6,752,525
Total of all expenses incurred	2015-12-31	$7,533,382
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$7,169,926
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$6,751,904
Value of total assets at end of year	2015-12-31	$972,443
Value of total assets at beginning of year	2015-12-31	$2,063,531
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$363,456
Total interest from all sources	2015-12-31	$621
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan	2015-12-31	$0
Administrative expenses professional fees incurred	2015-12-31	$70,773
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$225,000
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$310,231
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$54,467
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$98,547
Administrative expenses (other) incurred	2015-12-31	$59,433
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-780,857
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$76,171
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$857,028
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$917,976
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$1,136,643
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$1,136,643
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$621
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$191,782
Asset value of US Government securities at beginning of year	2015-12-31	$828,341
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$6,751,904
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$6,667,913
Contract administrator fees	2015-12-31	$233,250
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$896,272
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$1,206,503
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2015-12-31	910189318
2014 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$1,206,503
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$2,065,990
Total income from all sources (including contributions)	2014-12-31	$10,079,800
Total of all expenses incurred	2014-12-31	$10,095,669
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$9,681,119
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$10,072,320
Value of total assets at end of year	2014-12-31	$2,063,531
Value of total assets at beginning of year	2014-12-31	$2,938,887
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$414,550
Total interest from all sources	2014-12-31	$758
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$50,052
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$225,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$859,487
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$98,547
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$718,664
Other income not declared elsewhere	2014-12-31	$6,722
Administrative expenses (other) incurred	2014-12-31	$50,335
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-15,869
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$857,028
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$872,897
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$1,136,643
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$1,391,993
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$1,391,993
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$758
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$183,313
Asset value of US Government securities at end of year	2014-12-31	$828,341
Asset value of US Government securities at beginning of year	2014-12-31	$828,230
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$10,072,320
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$8,638,319
Contract administrator fees	2014-12-31	$314,163
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	2014-12-31	No
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$1,206,503
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$2,065,990
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2014-12-31	910189318
2013 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$2,065,990
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$1,653,411
Total income from all sources (including contributions)	2013-12-31	$9,467,314
Total of all expenses incurred	2013-12-31	$9,782,495
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$9,181,716
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$9,466,109
Value of total assets at end of year	2013-12-31	$2,938,887
Value of total assets at beginning of year	2013-12-31	$2,841,489
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$600,779
Total interest from all sources	2013-12-31	$1,205
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$77,988
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$225,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$412,579
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$718,664
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$65,043
Administrative expenses (other) incurred	2013-12-31	$83,139
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-315,181
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$872,897
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,188,078
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$1,391,993
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$1,947,256
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$1,947,256
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$1,205
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$368,305
Asset value of US Government securities at end of year	2013-12-31	$828,230
Asset value of US Government securities at beginning of year	2013-12-31	$829,190
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$9,466,109
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-12-31	$8,400,832
Contract administrator fees	2013-12-31	$439,652
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	2013-12-31	No
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$2,065,990
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$1,653,411
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2013-12-31	910189318
2012 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$1,653,411
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$1,766,663
Total income from all sources (including contributions)	2012-12-31	$9,711,775
Total of all expenses incurred	2012-12-31	$9,563,290
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$8,982,788
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$9,710,829
Value of total assets at end of year	2012-12-31	$2,841,489
Value of total assets at beginning of year	2012-12-31	$2,806,256
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$580,502
Total interest from all sources	2012-12-31	$946
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$52,143
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$225,000
If this is an individual account plan, was there a blackout period	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2012-12-31	$-113,252
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$65,043
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$73,596
Administrative expenses (other) incurred	2012-12-31	$89,340
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$148,485
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,188,078
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,039,593
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$1,947,256
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$2,732,660
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$2,732,660
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$946
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$259,194
Asset value of US Government securities at end of year	2012-12-31	$829,190
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$9,710,829
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$8,836,846
Contract administrator fees	2012-12-31	$439,019
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	2012-12-31	No
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$1,653,411
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$1,766,663
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2012-12-31	910189318
2011 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$1,766,663
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$1,841,319
Total income from all sources (including contributions)	2011-12-31	$9,755,838
Total of all expenses incurred	2011-12-31	$9,345,976
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$8,731,940
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$9,752,664
Value of total assets at end of year	2011-12-31	$2,806,256
Value of total assets at beginning of year	2011-12-31	$2,471,050
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$614,036
Total interest from all sources	2011-12-31	$3,174
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$60,499
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$225,000
If this is an individual account plan, was there a blackout period	2011-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2011-12-31	$-74,656
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$73,596
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$1,048,826
Administrative expenses (other) incurred	2011-12-31	$14,256
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$409,862
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,039,593
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$629,731
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-12-31	$2,732,660
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-12-31	$1,422,224
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-12-31	$1,422,224
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-12-31	$3,174
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$335,101
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$9,752,664
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$8,471,495
Contract administrator fees	2011-12-31	$539,281
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	2011-12-31	No
Liabilities. Value of benefit claims payable at end of year	2011-12-31	$1,766,663
Liabilities. Value of benefit claims payable at beginning of year	2011-12-31	$1,841,319
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2011-12-31	910189318
2010 : MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,841,319
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$1,220,526
Total income from all sources (including contributions)	2010-12-31	$11,441,012
Total of all expenses incurred	2010-12-31	$11,592,499
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$10,840,798
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$11,437,714
Value of total assets at end of year	2010-12-31	$2,471,050
Value of total assets at beginning of year	2010-12-31	$2,001,744
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$751,701
Total interest from all sources	2010-12-31	$3,298
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$55,279
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$225,000
If this is an individual account plan, was there a blackout period	2010-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$1,014,950
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2010-12-31	$632,353
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$1,048,826
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2010-12-31	$482,350
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$11,560
Administrative expenses (other) incurred	2010-12-31	$78,768
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$-151,487
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$629,731
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$781,218
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$1,422,224
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$1,519,394
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$1,519,394
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$3,298
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$485,124
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$10,422,764
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$9,723,321
Contract administrator fees	2010-12-31	$617,654
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	2010-12-31	No
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$1,841,319
Liabilities. Value of benefit claims payable at beginning of year	2010-12-31	$1,208,966
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	MOSS ADAMS LLP
Accountancy firm EIN	2010-12-31	910189318

Form 5500 Responses for MID-VALLEY IPA EMPLOYEE BENEFIT PLAN

2019: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Mulitple employer plan
2019-01-01	This submission is the final filing	Yes
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes
2018: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-01-01	Type of plan entity	Mulitple employer plan
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Mulitple employer plan
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Mulitple employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Mulitple employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Mulitple employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Mulitple employer plan
2013-01-01	Submission has been amended	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Mulitple employer plan
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Mulitple employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2010 form 5500 responses
2010-01-01	Type of plan entity	Mulitple employer plan
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: MID-VALLEY IPA EMPLOYEE BENEFIT PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Mulitple employer plan
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

PARTNERRE AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11835 )

Policy contract number

P0312465401

Policy instance

Insurance contract or identification number	P0312465401
Number of Individuals Covered	676
Insurance policy start date	2014-08-01
Insurance policy end date	2015-07-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Welfare Benefit Premiums Paid to Carrier	USD $191,782
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PARTNERRE AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11835 )

Policy contract number

P0312465402

Policy instance

Insurance contract or identification number	P0312465402
Number of Individuals Covered	986
Insurance policy start date	2013-08-01
Insurance policy end date	2014-07-31
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 $183,313
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

439146500

Policy instance

Insurance contract or identification number	439146500
Number of Individuals Covered	985
Insurance policy start date	2013-01-01
Insurance policy end date	2013-07-31
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 $259,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

PARTNERRE AMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 11835 )

Policy contract number

43-91-456-01

Policy instance

Insurance contract or identification number	43-91-456-01
Number of Individuals Covered	986
Insurance policy start date	2013-08-01
Insurance policy end date	2013-12-31
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 $109,024
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

439146500

Policy instance

Insurance contract or identification number	439146500
Number of Individuals Covered	991
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
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 $259,194
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )

Policy contract number

9906-1167

Policy instance

Insurance contract or identification number	9906-1167
Number of Individuals Covered	1085
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
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 $144,984
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )

Policy contract number

439146500

Policy instance

Insurance contract or identification number	439146500
Number of Individuals Covered	1085
Insurance policy start date	2011-05-01
Insurance policy end date	2011-12-31
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 $190,117
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN NATIONAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60739 )

Policy contract number

9906-1167

Policy instance

Insurance contract or identification number	9906-1167
Number of Individuals Covered	1227
Insurance policy start date	2009-05-01
Insurance policy end date	2010-04-30
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 $485,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	MID-VALLEY IPA EMPLOYEE BENEFIT TRUST
Employer identification number (EIN):	207142144
NAIC Classification:	541990
NAIC Description:	All Other Professional, Scientific, and Technical Services