GIORGIO FOODS, INC. has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan GIORGIO HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022 : GIORGIO HEALTH AND WELFARE PLAN 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $1,577,037 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $997,366 |
| Total income from all sources (including contributions) | 2022-12-31 | $16,662,735 |
| Total loss/gain on sale of assets | 2022-12-31 | $0 |
| Total of all expenses incurred | 2022-12-31 | $17,147,815 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $17,089,017 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $16,662,735 |
| Value of total assets at end of year | 2022-12-31 | $126,874 |
| Value of total assets at beginning of year | 2022-12-31 | $32,283 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $58,798 |
| Total interest from all sources | 2022-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $5,707,168 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $126,874 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $32,283 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-485,080 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $-1,450,163 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $-965,083 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $2,449,215 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $10,955,567 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $14,639,802 |
| Contract administrator fees | 2022-12-31 | $58,798 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $1,577,037 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $997,366 |
| Did the plan have assets held for investment | 2022-12-31 | No |
| 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 | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | RKL LLP |
| Accountancy firm EIN | 2022-12-31 | 232108173 |
| 2021 : GIORGIO HEALTH AND WELFARE PLAN 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $997,366 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $1,494,853 |
| Total income from all sources (including contributions) | 2021-12-31 | $14,373,210 |
| Total of all expenses incurred | 2021-12-31 | $13,843,440 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $13,776,481 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $14,373,210 |
| Value of total assets at end of year | 2021-12-31 | $32,283 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $66,959 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $4,973,859 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $32,283 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $529,770 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $-965,083 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $-1,494,853 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $2,551,503 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $9,399,351 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $11,224,978 |
| Contract administrator fees | 2021-12-31 | $66,959 |
| 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 | 2021-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $997,366 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $1,494,853 |
| Did the plan have assets held for investment | 2021-12-31 | No |
| 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 | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | RKL LLP |
| Accountancy firm EIN | 2021-12-31 | 232108173 |
| 2020 : GIORGIO HEALTH AND WELFARE PLAN 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $1,494,853 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $702,197 |
| Total income from all sources (including contributions) | 2020-12-31 | $15,340,956 |
| Total of all expenses incurred | 2020-12-31 | $16,133,612 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $15,975,081 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $15,340,956 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $158,531 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Administrative expenses professional fees incurred | 2020-12-31 | $0 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $4,631,062 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2020-12-31 | $10,344 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $-792,656 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $-1,494,853 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $-702,197 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $1,984,242 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $10,699,550 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $13,990,839 |
| Contract administrator fees | 2020-12-31 | $158,531 |
| 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 | 2020-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $1,494,853 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $702,197 |
| Did the plan have assets held for investment | 2020-12-31 | No |
| 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 | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | RKL LLP |
| Accountancy firm EIN | 2020-12-31 | 232108173 |
| 2019 : GIORGIO HEALTH AND WELFARE PLAN 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $702,197 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $702,197 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $849,515 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $849,515 |
| Total income from all sources (including contributions) | 2019-12-31 | $12,018,108 |
| Total income from all sources (including contributions) | 2019-12-31 | $12,018,108 |
| Total of all expenses incurred | 2019-12-31 | $11,870,790 |
| Total of all expenses incurred | 2019-12-31 | $11,870,790 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $11,772,831 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $11,772,831 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $12,018,108 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $97,959 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $97,959 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $15,336 |
| Administrative expenses professional fees incurred | 2019-12-31 | $15,336 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $5,000,000 |
| Value of fidelity bond cover | 2019-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $4,697,318 |
| Contributions received from participants | 2019-12-31 | $4,697,318 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $10,053 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2019-12-31 | $10,053 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $147,318 |
| Value of net income/loss | 2019-12-31 | $147,318 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $-702,197 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $-702,197 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $-849,515 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $-849,515 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $1,841,996 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $1,841,996 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $7,310,737 |
| Contributions received in cash from employer | 2019-12-31 | $7,310,737 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $9,930,835 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $9,930,835 |
| Contract administrator fees | 2019-12-31 | $82,623 |
| Contract administrator fees | 2019-12-31 | $82,623 |
| 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 | 2019-12-31 | No |
| 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 | 2019-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $702,197 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $702,197 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $849,515 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $849,515 |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | No |
| 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 | 2019-12-31 | No |
| 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 | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | RKL LLP |
| Accountancy firm name | 2019-12-31 | RKL LLP |
| Accountancy firm EIN | 2019-12-31 | 232108173 |
| Accountancy firm EIN | 2019-12-31 | 232108173 |
| 2018 : GIORGIO HEALTH AND WELFARE PLAN 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $849,515 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $1,690,735 |
| Total income from all sources (including contributions) | 2018-12-31 | $15,860,786 |
| Total of all expenses incurred | 2018-12-31 | $15,173,356 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $14,482,841 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $15,860,786 |
| Value of total assets at end of year | 2018-12-31 | $0 |
| Value of total assets at beginning of year | 2018-12-31 | $153,790 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $690,515 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Administrative expenses professional fees incurred | 2018-12-31 | $4,994 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $4,287,859 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-12-31 | $153,790 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $687,430 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $-849,515 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $-1,536,945 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $1,808,399 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $11,572,927 |
| Employer contributions (assets) at end of year | 2018-12-31 | $0 |
| Employer contributions (assets) at beginning of year | 2018-12-31 | $153,790 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $12,674,442 |
| Contract administrator fees | 2018-12-31 | $685,521 |
| 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 | 2018-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $849,515 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $1,536,945 |
| Did the plan have assets held for investment | 2018-12-31 | No |
| 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 | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | RKL LLP |
| Accountancy firm EIN | 2018-12-31 | 232108173 |
| 2017 : GIORGIO HEALTH AND WELFARE PLAN 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $1,690,735 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $884,307 |
| Total income from all sources (including contributions) | 2017-12-31 | $14,999,107 |
| Total of all expenses incurred | 2017-12-31 | $15,651,745 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $14,918,115 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $14,999,107 |
| Value of total assets at end of year | 2017-12-31 | $153,790 |
| Value of total assets at beginning of year | 2017-12-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $733,630 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Administrative expenses professional fees incurred | 2017-12-31 | $4,988 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $4,171,181 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2017-12-31 | $33,482 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-12-31 | $153,790 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $-652,638 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $-1,536,945 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $-884,307 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $1,871,972 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $10,794,444 |
| Employer contributions (assets) at end of year | 2017-12-31 | $153,790 |
| Employer contributions (assets) at beginning of year | 2017-12-31 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $13,046,143 |
| Contract administrator fees | 2017-12-31 | $728,642 |
| 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 | 2017-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $1,536,945 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $884,307 |
| Did the plan have assets held for investment | 2017-12-31 | No |
| 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 | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | RKL LLP |
| Accountancy firm EIN | 2017-12-31 | 232108173 |
| 2016 : GIORGIO HEALTH AND WELFARE PLAN 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $884,307 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $1,656,536 |
| Total income from all sources (including contributions) | 2016-12-31 | $13,576,700 |
| Total of all expenses incurred | 2016-12-31 | $12,804,502 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $12,169,714 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $13,576,700 |
| Value of total assets at end of year | 2016-12-31 | $0 |
| Value of total assets at beginning of year | 2016-12-31 | $31 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $634,788 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Administrative expenses professional fees incurred | 2016-12-31 | $4,986 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $3,958,912 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2016-12-31 | $37,205 |
| Total non interest bearing cash at end of year | 2016-12-31 | $0 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $31 |
| 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 | $772,198 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $-884,307 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $-1,656,505 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $1,654,095 |
| 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 | $9,580,583 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $10,515,619 |
| Contract administrator fees | 2016-12-31 | $629,802 |
| 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 | 2016-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $884,307 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $1,656,536 |
| Did the plan have assets held for investment | 2016-12-31 | No |
| 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 | RKL LLP |
| Accountancy firm EIN | 2016-12-31 | 232108173 |
| 2015 : GIORGIO HEALTH AND WELFARE PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $1,656,536 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $956,912 |
| Total income from all sources (including contributions) | 2015-12-31 | $11,806,903 |
| Total of all expenses incurred | 2015-12-31 | $12,530,766 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $11,968,574 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $11,806,903 |
| Value of total assets at end of year | 2015-12-31 | $31 |
| Value of total assets at beginning of year | 2015-12-31 | $24,270 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $562,192 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Administrative expenses professional fees incurred | 2015-12-31 | $18,565 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $3,691,367 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2015-12-31 | $35,760 |
| Total non interest bearing cash at end of year | 2015-12-31 | $31 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $24,270 |
| 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 | $-723,863 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $-1,656,505 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $-932,642 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $1,463,230 |
| 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 | $8,079,776 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $10,505,344 |
| Contract administrator fees | 2015-12-31 | $543,627 |
| 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 | 2015-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $1,656,536 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $956,912 |
| Did the plan have assets held for investment | 2015-12-31 | No |
| 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 | REINSEL KUNTZ LESHER LLP |
| Accountancy firm EIN | 2015-12-31 | 232108173 |
| 2014 : GIORGIO HEALTH AND WELFARE PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $956,912 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $963,750 |
| Total income from all sources (including contributions) | 2014-12-31 | $11,421,375 |
| Total of all expenses incurred | 2014-12-31 | $11,432,728 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $10,741,915 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $11,421,375 |
| Value of total assets at end of year | 2014-12-31 | $24,270 |
| Value of total assets at beginning of year | 2014-12-31 | $42,461 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $690,813 |
| 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 | $12,020 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $2,000,000 |
| 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 |
| Contributions received from participants | 2014-12-31 | $3,450,352 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2014-12-31 | $42,249 |
| Total non interest bearing cash at end of year | 2014-12-31 | $24,270 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $42,461 |
| 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 | $-11,353 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $-932,642 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $-921,289 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $1,342,671 |
| 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 | $7,928,774 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $9,399,244 |
| Contract administrator fees | 2014-12-31 | $678,793 |
| 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 | $956,912 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $963,750 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| 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 | REINSEL KUNTZ LESHER LLP |
| Accountancy firm EIN | 2014-12-31 | 232108173 |
| 2013 : GIORGIO HEALTH AND WELFARE PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $963,750 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $935,875 |
| Total income from all sources (including contributions) | 2013-12-31 | $11,840,056 |
| Total of all expenses incurred | 2013-12-31 | $11,856,820 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $11,059,561 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $11,840,056 |
| Value of total assets at end of year | 2013-12-31 | $42,461 |
| Value of total assets at beginning of year | 2013-12-31 | $31,350 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $797,259 |
| 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 | $13,345 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $2,000,000 |
| 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 |
| Contributions received from participants | 2013-12-31 | $2,513,402 |
| Total non interest bearing cash at end of year | 2013-12-31 | $42,461 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $31,350 |
| 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 | $-16,764 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $-921,289 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $-904,525 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $1,052,801 |
| 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 | $9,326,654 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $10,006,760 |
| Contract administrator fees | 2013-12-31 | $783,914 |
| 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 | $963,750 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $935,875 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| 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 | REINSEL KUNTZ LESHER LLP |
| Accountancy firm EIN | 2013-12-31 | 232108173 |
| 2012 : GIORGIO HEALTH AND WELFARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $935,875 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $883,388 |
| Total income from all sources (including contributions) | 2012-12-31 | $9,320,312 |
| Total of all expenses incurred | 2012-12-31 | $9,402,346 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $8,726,627 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $9,320,312 |
| Value of total assets at end of year | 2012-12-31 | $31,350 |
| Value of total assets at beginning of year | 2012-12-31 | $60,897 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $675,719 |
| 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 | $10,325 |
| Was this plan covered by a fidelity bond | 2012-12-31 | No |
| 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 |
| Contributions received from participants | 2012-12-31 | $2,342,382 |
| Total non interest bearing cash at end of year | 2012-12-31 | $31,350 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $60,897 |
| 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 | $-82,034 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $-904,525 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $-822,491 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $1,007,442 |
| 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 | $6,977,930 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $7,719,185 |
| Contract administrator fees | 2012-12-31 | $665,394 |
| 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 | $935,875 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $883,388 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| 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 | REINSEL KUNTZ LESHER LLP |
| Accountancy firm EIN | 2012-12-31 | 232108173 |
| 2011 : GIORGIO HEALTH AND WELFARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $883,388 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $843,220 |
| Total income from all sources (including contributions) | 2011-12-31 | $1,342,842 |
| Total of all expenses incurred | 2011-12-31 | $1,352,126 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $1,244,907 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $1,342,842 |
| Value of total assets at end of year | 2011-12-31 | $60,897 |
| Value of total assets at beginning of year | 2011-12-31 | $30,013 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $107,219 |
| 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 | $1,815 |
| Was this plan covered by a fidelity bond | 2011-12-31 | No |
| 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 |
| Contributions received from participants | 2011-12-31 | $408,991 |
| Total non interest bearing cash at end of year | 2011-12-31 | $60,897 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $30,013 |
| 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 | $-9,284 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $-822,491 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $-813,207 |
| 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 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $116,525 |
| 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 | $933,851 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $1,128,382 |
| Contract administrator fees | 2011-12-31 | $105,404 |
| 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 | $883,388 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $843,220 |
| Did the plan have assets held for investment | 2011-12-31 | No |
| 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 | REINSEL KUNTZ LESHER LLP |
| Accountancy firm EIN | 2011-12-31 | 232108173 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $843,220 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-10-31 | $562,517 |
| Total income from all sources (including contributions) | 2011-10-31 | $8,358,462 |
| Total of all expenses incurred | 2011-10-31 | $8,639,977 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-10-31 | $8,049,009 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-10-31 | $8,358,462 |
| Value of total assets at end of year | 2011-10-31 | $30,013 |
| Value of total assets at beginning of year | 2011-10-31 | $30,825 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-10-31 | $590,968 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-10-31 | No |
| Administrative expenses professional fees incurred | 2011-10-31 | $6,756 |
| Was this plan covered by a fidelity bond | 2011-10-31 | No |
| If this is an individual account plan, was there a blackout period | 2011-10-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-10-31 | No |
| Contributions received from participants | 2011-10-31 | $2,342,015 |
| Total non interest bearing cash at end of year | 2011-10-31 | $30,013 |
| Total non interest bearing cash at beginning of year | 2011-10-31 | $30,825 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-10-31 | No |
| Value of net income/loss | 2011-10-31 | $-281,515 |
| Value of net assets at end of year (total assets less liabilities) | 2011-10-31 | $-813,207 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-10-31 | $-531,692 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-10-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-10-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-10-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-10-31 | $787,556 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-10-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-10-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-10-31 | No |
| Contributions received in cash from employer | 2011-10-31 | $6,016,447 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-10-31 | $7,261,453 |
| Contract administrator fees | 2011-10-31 | $584,212 |
| 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 | 2011-10-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-10-31 | $843,220 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-10-31 | $562,517 |
| Did the plan have assets held for investment | 2011-10-31 | No |
| 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 | 2011-10-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-10-31 | No |
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 10638-01 |
| Policy instance | 4 |
| Insurance contract or identification number | 10638-01 | | Number of Individuals Covered | 10944 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $140,882 | | Total amount of fees paid to insurance company | USD $82,181 | | 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 $1,174,020 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $140,882 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 82181 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 922703-000 |
| Policy instance | 3 |
| Insurance contract or identification number | 922703-000 | | Number of Individuals Covered | 3070 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $32,017 | | Total amount of fees paid to insurance company | USD $2,668 | | 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 | No | | Dental Insurance Welfare Benefit | Yes | | 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 $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $32,017 | | Amount paid for insurance broker fees | 2668 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402698G |
| Policy instance | 2 |
| Insurance contract or identification number | 402698G | | Number of Individuals Covered | 2429 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $49,201 | | Total amount of fees paid to insurance company | USD $2,547 | | 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 | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | 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 $535,936 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $49,201 | | Amount paid for insurance broker fees | 2547 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 1 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 2446 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,393 | | 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 | Yes | | 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 $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,393 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 1 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 1764 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,154 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,154 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402698G |
| Policy instance | 2 |
| Insurance contract or identification number | 402698G | | Number of Individuals Covered | 1952 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $50,941 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $509,410 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,941 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 922703-000 |
| Policy instance | 3 |
| Insurance contract or identification number | 922703-000 | | Number of Individuals Covered | 2650 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $27,999 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,999 | | Insurance broker organization code? | 3 |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 10638-00 |
| Policy instance | 4 |
| Insurance contract or identification number | 10638-00 | | Number of Individuals Covered | 8838 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $145,338 | | Total amount of fees paid to insurance company | USD $67,824 | | Welfare Benefit Premiums Paid to Carrier | USD $968,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $145,338 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | ADMINISTRATIVE FEES |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 407253 0010 |
| Policy instance | 4 |
| Insurance contract or identification number | 407253 0010 | | Number of Individuals Covered | 1322 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $126,235 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $841,568 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $126,235 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 922703-000 |
| Policy instance | 3 |
| Insurance contract or identification number | 922703-000 | | Number of Individuals Covered | 2457 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $30,697 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,697 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402698G |
| Policy instance | 2 |
| Insurance contract or identification number | 402698G | | Number of Individuals Covered | 1804 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $40,250 | | Total amount of fees paid to insurance company | USD $9,606 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $437,152 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,250 | | Amount paid for insurance broker fees | 9606 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 1 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 1321 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $1,702 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,702 | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 09422 |
| Policy instance | 1 |
| Insurance contract or identification number | 09422 | | Number of Individuals Covered | 2408 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $6,745 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $466,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,745 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 2 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 1084 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $2,572 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,572 | | Insurance broker organization code? | 3 |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000064774265 |
| Policy instance | 3 |
| Insurance contract or identification number | 000064774265 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $525 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $300 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402698G |
| Policy instance | 4 |
| Insurance contract or identification number | 402698G | | Number of Individuals Covered | 1960 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $40,597 | | Total amount of fees paid to insurance company | USD $1,087 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $400,229 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40,597 | | Amount paid for insurance broker fees | 1087 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | 10483-00 |
| Policy instance | 5 |
| Insurance contract or identification number | 10483-00 | | Number of Individuals Covered | 1244 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $79,768 | | Total amount of fees paid to insurance company | USD $36,258 | | Welfare Benefit Premiums Paid to Carrier | USD $725,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $79,768 | | Amount paid for insurance broker fees | 36258 | | Additional information about fees paid to insurance broker | ADMIN FEE | | Insurance broker organization code? | 3 |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 09422 |
| Policy instance | 1 |
| Insurance contract or identification number | 09422 | | Number of Individuals Covered | 2742 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $18,673 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $536,792 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,673 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 2 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 1226 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $2,776 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,776 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000064774265 |
| Policy instance | 3 |
| Insurance contract or identification number | 000064774265 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2016-01-01 | | Insurance policy end date | 2017-01-01 | | Total amount of commissions paid to insurance broker | USD $525 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $300 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE LLC |
|
| AVALON INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 12358 ) |
| Policy contract number | 00521855 |
| Policy instance | 4 |
| Insurance contract or identification number | 00521855 | | Number of Individuals Covered | 1463 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $18,708 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $123,429 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,708 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 402698G |
| Policy instance | 5 |
| Insurance contract or identification number | 402698G | | Number of Individuals Covered | 2019 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $34,007 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $353,650 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $34,007 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-4649 |
| Policy instance | 6 |
| Insurance contract or identification number | 947-4649 | | Number of Individuals Covered | 1478 | | Insurance policy start date | 2017-04-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $52,563 | | Total amount of fees paid to insurance company | USD $30,224 | | Welfare Benefit Premiums Paid to Carrier | USD $604,471 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,563 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 30224 | | Additional information about fees paid to insurance broker | SERVICE FEES PAID | | Insurance broker name | INDEPENDENCE UNDERWRITING PARTNERS |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 6477-42-65 |
| Policy instance | 4 |
| Insurance contract or identification number | 6477-42-65 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2015-01-01 | | Total amount of commissions paid to insurance broker | USD $525 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $300 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 0013-6133-AUL |
| Policy instance | 9 |
| Insurance contract or identification number | 0013-6133-AUL | | Number of Individuals Covered | 1405 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $42,017 | | Total amount of fees paid to insurance company | USD $49,415 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $245,998 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 42022 | | Additional information about fees paid to insurance broker | TPA FEES PRODUCTION BONUS | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $42,017 | | Insurance broker name | EMERSON REID & COMPANY INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1707-LFG |
| Policy instance | 8 |
| Insurance contract or identification number | 1707-LFG | | Number of Individuals Covered | 125 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,792 | | Total amount of fees paid to insurance company | USD $2,852 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $40,745 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2852 | | Additional information about fees paid to insurance broker | TPA FEES BONUS | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $1,792 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 0013-AUL |
| Policy instance | 7 |
| Insurance contract or identification number | 0013-AUL | | Number of Individuals Covered | 1512 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,098 | | Total amount of fees paid to insurance company | USD $7,060 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $72,522 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7060 | | Additional information about fees paid to insurance broker | TPA FEES PRODUCTION BONUS | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $3,098 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 2 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 1152 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $2,624 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,624 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 09422 |
| Policy instance | 1 |
| Insurance contract or identification number | 09422 | | Number of Individuals Covered | 2713 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $29,270 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $487,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,270 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 1707-4EL |
| Policy instance | 3 |
| Insurance contract or identification number | 1707-4EL | | Number of Individuals Covered | 1745 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $1,097 | | Total amount of fees paid to insurance company | USD $1,234 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $9,145 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,097 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 777 | | Additional information about fees paid to insurance broker | TPA FEES | | Insurance broker name | EMERSON REID & COMPANY INC |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 401667 0010SSLS |
| Policy instance | 5 |
| Insurance contract or identification number | 401667 0010SSLS | | Number of Individuals Covered | 1401 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2015-03-31 | | Total amount of commissions paid to insurance broker | USD $59,195 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $394,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $59,195 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1707-LFG |
| Policy instance | 6 |
| Insurance contract or identification number | 1707-LFG | | Number of Individuals Covered | 165 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-01-31 | | Total amount of commissions paid to insurance broker | USD $478 | | Total amount of fees paid to insurance company | USD $2,307 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,776 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 2116 | | Additional information about fees paid to insurance broker | TPA FEES BONUS | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $478 | | Insurance broker name | EMERSON REID & COMPANY INC |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 2 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 1105 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,708 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,708 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000064774265 |
| Policy instance | 4 |
| Insurance contract or identification number | 000064774265 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2014-01-01 | | Total amount of commissions paid to insurance broker | USD $450 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $450 | | Insurance broker organization code? | 3 | | Insurance broker name | REUBEN WARNER ASSOCIATES, INC. |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1707-LFG |
| Policy instance | 6 |
| Insurance contract or identification number | 1707-LFG | | Number of Individuals Covered | 169 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $5,677 | | Total amount of fees paid to insurance company | USD $8,487 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,774 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 6216 | | Additional information about fees paid to insurance broker | TPA FEES BONUS | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $5,677 | | Insurance broker name | EMERSON REID & COMPANY INC |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 0013-6133-AUL |
| Policy instance | 7 |
| Insurance contract or identification number | 0013-6133-AUL | | Number of Individuals Covered | 1465 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $33,502 | | Total amount of fees paid to insurance company | USD $39,408 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $196,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 33511 | | Additional information about fees paid to insurance broker | TPA FEES PRODUCTION BONUS | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $33,502 | | Insurance broker name | EMERSON REID & COMPANY INC |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 09422 |
| Policy instance | 1 |
| Insurance contract or identification number | 09422 | | Number of Individuals Covered | 2564 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $36,741 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $501,564 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $36,741 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 401667 0010SSLS |
| Policy instance | 5 |
| Insurance contract or identification number | 401667 0010SSLS | | Number of Individuals Covered | 1318 | | Insurance policy start date | 2013-04-01 | | Insurance policy end date | 2014-03-31 | | Total amount of commissions paid to insurance broker | USD $52,444 | | 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 $349,628 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $52,444 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 1707-4EL |
| Policy instance | 3 |
| Insurance contract or identification number | 1707-4EL | | Number of Individuals Covered | 1755 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $8,938 | | Total amount of fees paid to insurance company | USD $14,826 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $109,819 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 9335 | | Additional information about fees paid to insurance broker | TPA FEES | | Insurance broker organization code? | 5 | | Commission paid to Insurance Broker | USD $8,938 | | Insurance broker name | EMERSON REID & COMPANY INC |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 09422 |
| Policy instance | 1 |
| Insurance contract or identification number | 09422 | | Number of Individuals Covered | 2488 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $38,869 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $485,856 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,869 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 2 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 1051 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,555 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,555 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 1707-4EL |
| Policy instance | 3 |
| Insurance contract or identification number | 1707-4EL | | Number of Individuals Covered | 1735 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $8,364 | | Total amount of fees paid to insurance company | USD $12,071 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $89,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,364 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 7600 | | Additional information about fees paid to insurance broker | TPA FEES | | Insurance broker name | EMERSON REID & COMPANY INC |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000064774265 |
| Policy instance | 4 |
| Insurance contract or identification number | 000064774265 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2012-03-14 | | Insurance policy end date | 2013-01-01 | | Total amount of commissions paid to insurance broker | USD $389 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $181 | | Insurance broker organization code? | 3 | | Insurance broker name | REUBEN WARNER ASSOCIATES, INC. |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 401667 0010 SLA |
| Policy instance | 5 |
| Insurance contract or identification number | 401667 0010 SLA | | Number of Individuals Covered | 1312 | | Insurance policy start date | 2012-04-01 | | Insurance policy end date | 2013-03-31 | | Total amount of commissions paid to insurance broker | USD $45,286 | | 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 $301,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $25,932 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 1707-LFG |
| Policy instance | 6 |
| Insurance contract or identification number | 1707-LFG | | Number of Individuals Covered | 166 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,866 | | Total amount of fees paid to insurance company | USD $2,053 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,866 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 1306 | | Additional information about fees paid to insurance broker | TPA FEES | | Insurance broker name | EMERSON REID & COMPANY INC |
|
| PROVIDENT LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68195 ) |
| Policy contract number | 29231 |
| Policy instance | 7 |
| Insurance contract or identification number | 29231 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2013-01-01 | | 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 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $134 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 2 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 967 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,485 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $868 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 09422 |
| Policy instance | 1 |
| Insurance contract or identification number | 09422 | | Number of Individuals Covered | 2394 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $36,408 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $455,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $21,359 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 1707-4EL |
| Policy instance | 3 |
| Insurance contract or identification number | 1707-4EL | | Number of Individuals Covered | 1597 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $6,876 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $79,919 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,908 | | Insurance broker organization code? | 3 | | Insurance broker name | TOMPKINS INSURANCE AGENCIES INC |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 000064774265 |
| Policy instance | 4 |
| Insurance contract or identification number | 000064774265 | | Number of Individuals Covered | 196 | | Insurance policy start date | 2011-03-14 | | Insurance policy end date | 2012-03-14 | | Total amount of commissions paid to insurance broker | USD $465 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $225 | | Insurance broker organization code? | 3 | | Insurance broker name | REUBEN WARNER ASSOCIATES, INC. |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 401667 0010 SLA |
| Policy instance | 5 |
| Insurance contract or identification number | 401667 0010 SLA | | Number of Individuals Covered | 1211 | | Insurance policy start date | 2011-04-01 | | Insurance policy end date | 2012-03-31 | | Total amount of commissions paid to insurance broker | USD $42,093 | | 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 $280,622 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $42,093 | | Insurance broker organization code? | 3 | | Insurance broker name | VIST INSURANCE LLC |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 2 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 898 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,368 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 9422 |
| Policy instance | 1 |
| Insurance contract or identification number | 9422 | | Number of Individuals Covered | 2306 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $34,868 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $435,851 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 1707-BCS |
| Policy instance | 3 |
| Insurance contract or identification number | 1707-BCS | | Number of Individuals Covered | 1466 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $1,556 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,963 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 9422 |
| Policy instance | 1 |
| Insurance contract or identification number | 9422 | | Number of Individuals Covered | 2231 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $39,874 | | 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 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $398,742 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 ) |
| Policy contract number | 6477-42-65 |
| Policy instance | 5 |
| Insurance contract or identification number | 6477-42-65 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2010-03-14 | | Insurance policy end date | 2011-03-14 | | Total amount of commissions paid to insurance broker | USD $484 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,500 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 401667 0010 |
| Policy instance | 4 |
| Insurance contract or identification number | 401667 0010 | | Number of Individuals Covered | 1174 | | Insurance policy start date | 2010-04-01 | | Insurance policy end date | 2011-03-31 | | Total amount of commissions paid to insurance broker | USD $34,388 | | 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 $229,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 1707-BCS |
| Policy instance | 3 |
| Insurance contract or identification number | 1707-BCS | | Number of Individuals Covered | 1420 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $7,353 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $75,314 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 1335 |
| Policy instance | 2 |
| Insurance contract or identification number | 1335 | | Number of Individuals Covered | 867 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,409 | | 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 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
