OPERATING ENGINEERS LOCAL 835 WELFARE FUND has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan OPERATING ENGINEERS LOCAL 835 WELFARE FUND
| Measure | Date | Value |
|---|
| 2022 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 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 | $262,496 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $315,966 |
| Total income from all sources (including contributions) | 2022-12-31 | $6,656,990 |
| Total loss/gain on sale of assets | 2022-12-31 | $0 |
| Total of all expenses incurred | 2022-12-31 | $5,062,392 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $5,030,485 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $6,940,866 |
| Value of total assets at end of year | 2022-12-31 | $7,020,223 |
| Value of total assets at beginning of year | 2022-12-31 | $5,479,095 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $31,907 |
| Total interest from all sources | 2022-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $54,466 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-12-31 | $54,466 |
| Administrative expenses professional fees incurred | 2022-12-31 | $12,000 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $53,053 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $4,288 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $760 |
| Administrative expenses (other) incurred | 2022-12-31 | $9,138 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $7,000 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $7,000 |
| Total non interest bearing cash at end of year | 2022-12-31 | $872,128 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $2,204,277 |
| 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 | $1,594,598 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $6,757,727 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $5,163,129 |
| 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 |
| Investment advisory and management fees | 2022-12-31 | $10,769 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $5,255,838 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $2,239,336 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $3,303,504 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-338,342 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
| 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 | $6,887,813 |
| Employer contributions (assets) at end of year | 2022-12-31 | $887,969 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $1,034,722 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $1,726,981 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $255,496 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $308,966 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 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 | Disclaimer |
| Accountancy firm name | 2022-12-31 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2022-12-31 | 320048632 |
| 2021 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $315,966 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $288,002 |
| Total income from all sources (including contributions) | 2021-12-31 | $7,099,355 |
| Total loss/gain on sale of assets | 2021-12-31 | $0 |
| Total of all expenses incurred | 2021-12-31 | $5,843,641 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $5,806,943 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $6,968,187 |
| Value of total assets at end of year | 2021-12-31 | $5,479,095 |
| Value of total assets at beginning of year | 2021-12-31 | $4,195,417 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $36,698 |
| Total interest from all sources | 2021-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $55,667 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-12-31 | $55,667 |
| Administrative expenses professional fees incurred | 2021-12-31 | $12,000 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $59,977 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $760 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $1,176 |
| Administrative expenses (other) incurred | 2021-12-31 | $9,878 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $7,000 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $7,000 |
| Total non interest bearing cash at end of year | 2021-12-31 | $2,204,277 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $1,630,201 |
| 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 | $1,255,714 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $5,163,129 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $3,907,415 |
| 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 |
| Investment advisory and management fees | 2021-12-31 | $14,820 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-12-31 | $2,239,336 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-12-31 | $1,608,310 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $2,842,922 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-12-31 | $75,501 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | Yes |
| 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 | $6,908,210 |
| Employer contributions (assets) at end of year | 2021-12-31 | $1,034,722 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $955,730 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $2,964,021 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $308,966 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $281,002 |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 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 | Disclaimer |
| Accountancy firm name | 2021-12-31 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2021-12-31 | 320048632 |
| 2020 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $288,002 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $360,934 |
| Total income from all sources (including contributions) | 2020-12-31 | $7,248,205 |
| Total loss/gain on sale of assets | 2020-12-31 | $44,184 |
| Total of all expenses incurred | 2020-12-31 | $5,568,035 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $5,536,151 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $7,049,846 |
| Value of total assets at end of year | 2020-12-31 | $4,195,417 |
| Value of total assets at beginning of year | 2020-12-31 | $2,588,179 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $31,884 |
| Total interest from all sources | 2020-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-12-31 | $37,448 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-12-31 | $37,448 |
| Administrative expenses professional fees incurred | 2020-12-31 | $12,038 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $26,056 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $1,176 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $17,502 |
| Administrative expenses (other) incurred | 2020-12-31 | $10,498 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $7,000 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $6,000 |
| Total non interest bearing cash at end of year | 2020-12-31 | $1,630,201 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $761,927 |
| 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 | $1,680,170 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $3,907,415 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $2,227,245 |
| 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 |
| Investment advisory and management fees | 2020-12-31 | $9,348 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-12-31 | $1,608,310 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-12-31 | $960,132 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $2,831,767 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-12-31 | $116,727 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | Yes |
| 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 | $7,023,790 |
| Employer contributions (assets) at end of year | 2020-12-31 | $955,730 |
| Employer contributions (assets) at beginning of year | 2020-12-31 | $848,618 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $2,704,384 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $281,002 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $354,934 |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 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 |
| Aggregate proceeds on sale of assets | 2020-12-31 | $1,262,325 |
| Aggregate carrying amount (costs) on sale of assets | 2020-12-31 | $1,218,141 |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2020-12-31 | 320048632 |
| 2019 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2019 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2019-12-31 | $51,217 |
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $51,217 |
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $51,217 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $360,934 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $360,934 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $381,568 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $381,568 |
| Total income from all sources (including contributions) | 2019-12-31 | $6,892,488 |
| Total loss/gain on sale of assets | 2019-12-31 | $22,759 |
| Total loss/gain on sale of assets | 2019-12-31 | $22,759 |
| Total of all expenses incurred | 2019-12-31 | $6,258,769 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $6,235,494 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $6,235,494 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $6,796,772 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $6,796,772 |
| Value of total assets at end of year | 2019-12-31 | $2,588,179 |
| Value of total assets at end of year | 2019-12-31 | $2,588,179 |
| Value of total assets at beginning of year | 2019-12-31 | $1,975,094 |
| Value of total assets at beginning of year | 2019-12-31 | $1,975,094 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $23,275 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $23,275 |
| Total interest from all sources | 2019-12-31 | $419 |
| Total interest from all sources | 2019-12-31 | $419 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $21,321 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $21,321 |
| 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 |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-12-31 | $21,321 |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-12-31 | $21,321 |
| Administrative expenses professional fees incurred | 2019-12-31 | $11,475 |
| Administrative expenses professional fees incurred | 2019-12-31 | $11,475 |
| 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 | $500,000 |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| 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 | $40,834 |
| Contributions received from participants | 2019-12-31 | $40,834 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $17,502 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $17,502 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $10,134 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $10,134 |
| Administrative expenses (other) incurred | 2019-12-31 | $7,474 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $6,000 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $6,000 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $6,000 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $6,000 |
| Total non interest bearing cash at end of year | 2019-12-31 | $761,927 |
| Total non interest bearing cash at end of year | 2019-12-31 | $761,927 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $338,445 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $338,445 |
| 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 | $633,719 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $2,227,245 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $2,227,245 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $1,593,526 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $1,593,526 |
| 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 |
| Investment advisory and management fees | 2019-12-31 | $4,326 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-12-31 | $960,132 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-12-31 | $960,132 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-12-31 | $614,714 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-12-31 | $614,714 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $419 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $2,996,399 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $2,996,399 |
| 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 |
| 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 | $6,755,938 |
| Employer contributions (assets) at end of year | 2019-12-31 | $848,618 |
| Employer contributions (assets) at end of year | 2019-12-31 | $848,618 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $1,011,801 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $1,011,801 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $3,239,095 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $3,239,095 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $354,934 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $354,934 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $375,568 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $375,568 |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 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 |
| Aggregate proceeds on sale of assets | 2019-12-31 | $553,805 |
| Aggregate proceeds on sale of assets | 2019-12-31 | $553,805 |
| Aggregate carrying amount (costs) on sale of assets | 2019-12-31 | $531,046 |
| Aggregate carrying amount (costs) on sale of assets | 2019-12-31 | $531,046 |
| 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 |
| Accountancy firm name | 2019-12-31 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2019-12-31 | 320048632 |
| Accountancy firm EIN | 2019-12-31 | 320048632 |
| 2018 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2018 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2018-12-31 | $-72,561 |
| Total unrealized appreciation/depreciation of assets | 2018-12-31 | $-72,561 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $381,568 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $391,293 |
| Total income from all sources (including contributions) | 2018-12-31 | $6,421,573 |
| Total loss/gain on sale of assets | 2018-12-31 | $30,967 |
| Total of all expenses incurred | 2018-12-31 | $6,727,446 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $6,699,269 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $6,441,850 |
| Value of total assets at end of year | 2018-12-31 | $1,975,094 |
| Value of total assets at beginning of year | 2018-12-31 | $2,290,692 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $28,177 |
| Total interest from all sources | 2018-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-12-31 | $21,317 |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-12-31 | $21,317 |
| Administrative expenses professional fees incurred | 2018-12-31 | $21,338 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $32,208 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $10,134 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $6,028 |
| Administrative expenses (other) incurred | 2018-12-31 | $2,304 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $6,000 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $6,000 |
| 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 | $-305,873 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $1,593,526 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $1,899,399 |
| 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 |
| Investment advisory and management fees | 2018-12-31 | $4,535 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-12-31 | $613,886 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-12-31 | $932,736 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $338,445 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $455,835 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $455,835 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $3,405,560 |
| Asset value of US Government securities at end of year | 2018-12-31 | $828 |
| Asset value of US Government securities at beginning of year | 2018-12-31 | $2,390 |
| 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 | $6,409,642 |
| Employer contributions (assets) at end of year | 2018-12-31 | $1,011,801 |
| Employer contributions (assets) at beginning of year | 2018-12-31 | $893,703 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $3,293,709 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $375,568 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $385,293 |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 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 |
| Aggregate proceeds on sale of assets | 2018-12-31 | $772,429 |
| Aggregate carrying amount (costs) on sale of assets | 2018-12-31 | $741,462 |
| 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 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2018-12-31 | 320048632 |
| 2017 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2017 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2017-12-31 | $43,026 |
| Total unrealized appreciation/depreciation of assets | 2017-12-31 | $43,026 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $391,293 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $400,406 |
| Total income from all sources (including contributions) | 2017-12-31 | $6,263,677 |
| Total loss/gain on sale of assets | 2017-12-31 | $26,106 |
| Total of all expenses incurred | 2017-12-31 | $6,379,604 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $6,345,884 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $6,168,310 |
| Value of total assets at end of year | 2017-12-31 | $2,290,692 |
| Value of total assets at beginning of year | 2017-12-31 | $2,415,732 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $33,720 |
| Total interest from all sources | 2017-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-12-31 | $26,235 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-12-31 | $26,235 |
| Administrative expenses professional fees incurred | 2017-12-31 | $11,237 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Income. Received or receivable in cash from other sources (including rollovers) | 2017-12-31 | $37,233 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $6,028 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $575 |
| Administrative expenses (other) incurred | 2017-12-31 | $16,485 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $6,000 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $6,000 |
| 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 | $-115,927 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $1,899,399 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $2,015,326 |
| 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 |
| Investment advisory and management fees | 2017-12-31 | $5,998 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-12-31 | $932,736 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-12-31 | $965,013 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $455,835 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $631,254 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $631,254 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $2,829,337 |
| Asset value of US Government securities at end of year | 2017-12-31 | $2,390 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | Yes |
| 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 | $6,131,077 |
| Employer contributions (assets) at end of year | 2017-12-31 | $893,703 |
| Employer contributions (assets) at beginning of year | 2017-12-31 | $818,890 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $3,516,547 |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $385,293 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $394,406 |
| Did the plan have assets held for investment | 2017-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 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 |
| Aggregate proceeds on sale of assets | 2017-12-31 | $702,477 |
| Aggregate carrying amount (costs) on sale of assets | 2017-12-31 | $676,371 |
| 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 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2017-12-31 | 320048632 |
| 2016 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2016 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2016-12-31 | $-51,869 |
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $-51,869 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $400,406 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $382,848 |
| Total income from all sources (including contributions) | 2016-12-31 | $6,260,850 |
| Total loss/gain on sale of assets | 2016-12-31 | $0 |
| Total of all expenses incurred | 2016-12-31 | $6,671,789 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $6,633,852 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $6,166,060 |
| Value of total assets at end of year | 2016-12-31 | $2,415,732 |
| Value of total assets at beginning of year | 2016-12-31 | $2,809,113 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $37,937 |
| Total interest from all sources | 2016-12-31 | $144 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $35,261 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-12-31 | $35,261 |
| Administrative expenses professional fees incurred | 2016-12-31 | $14,537 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $24,703 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $575 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $5,474 |
| Administrative expenses (other) incurred | 2016-12-31 | $13,967 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $6,000 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $5,750 |
| Total non interest bearing cash at end of year | 2016-12-31 | $46,685 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $281,917 |
| 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 | $-410,939 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $2,015,326 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $2,426,265 |
| 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 |
| Investment advisory and management fees | 2016-12-31 | $9,433 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-12-31 | $965,013 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-12-31 | $2,070,355 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $584,569 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $1,232 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $1,232 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-12-31 | $144 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $2,986,916 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-12-31 | $111,254 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | Yes |
| 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 | $6,141,357 |
| Employer contributions (assets) at end of year | 2016-12-31 | $818,890 |
| Employer contributions (assets) at beginning of year | 2016-12-31 | $450,135 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $3,646,936 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $394,406 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $377,098 |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2016-12-31 | 320048632 |
| 2015 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $382,848 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $329,643 |
| Total income from all sources (including contributions) | 2015-12-31 | $5,115,657 |
| Total loss/gain on sale of assets | 2015-12-31 | $62,076 |
| Total of all expenses incurred | 2015-12-31 | $5,905,169 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $5,865,501 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $5,087,943 |
| Value of total assets at end of year | 2015-12-31 | $2,809,113 |
| Value of total assets at beginning of year | 2015-12-31 | $3,545,420 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $39,668 |
| Total interest from all sources | 2015-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $58,608 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-12-31 | $58,608 |
| Administrative expenses professional fees incurred | 2015-12-31 | $17,982 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $27,234 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $5,474 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $5,966 |
| Administrative expenses (other) incurred | 2015-12-31 | $8,439 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $5,750 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $5,750 |
| Total non interest bearing cash at end of year | 2015-12-31 | $281,917 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $41,833 |
| 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 | $-789,512 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $2,426,265 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $3,215,777 |
| 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 |
| Investment advisory and management fees | 2015-12-31 | $13,247 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-12-31 | $2,070,355 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-12-31 | $2,492,770 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-12-31 | $1,232 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $607,767 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $607,767 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $2,368,337 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-12-31 | $-92,970 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
| 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 | $5,060,709 |
| Employer contributions (assets) at end of year | 2015-12-31 | $450,135 |
| Employer contributions (assets) at beginning of year | 2015-12-31 | $397,084 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $3,497,164 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $377,098 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $323,893 |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Aggregate proceeds on sale of assets | 2015-12-31 | $3,080,569 |
| Aggregate carrying amount (costs) on sale of assets | 2015-12-31 | $3,018,493 |
| 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 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2015-12-31 | 320048632 |
| 2014 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2014 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2014-12-31 | $34,908 |
| Total unrealized appreciation/depreciation of assets | 2014-12-31 | $34,908 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $329,643 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $284,897 |
| Total income from all sources (including contributions) | 2014-12-31 | $5,108,051 |
| Total loss/gain on sale of assets | 2014-12-31 | $15,916 |
| Total of all expenses incurred | 2014-12-31 | $5,268,507 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $5,233,197 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $4,982,655 |
| Value of total assets at end of year | 2014-12-31 | $3,545,420 |
| Value of total assets at beginning of year | 2014-12-31 | $3,661,130 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $35,310 |
| Total interest from all sources | 2014-12-31 | $582 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $73,990 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2014-12-31 | $73,990 |
| Administrative expenses professional fees incurred | 2014-12-31 | $11,015 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $15,660 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2014-12-31 | $2,570,941 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $5,966 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $5,382 |
| Administrative expenses (other) incurred | 2014-12-31 | $9,514 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $5,750 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $5,750 |
| Total non interest bearing cash at end of year | 2014-12-31 | $41,833 |
| 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 | $-160,456 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $3,215,777 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $3,376,233 |
| 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 |
| Investment advisory and management fees | 2014-12-31 | $14,781 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-12-31 | $2,492,770 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-12-31 | $2,367,957 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $607,767 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $885,096 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $885,096 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $582 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $2,578,854 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| 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 | $4,966,995 |
| Employer contributions (assets) at end of year | 2014-12-31 | $397,084 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $402,695 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $83,402 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $323,893 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $279,147 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Aggregate proceeds on sale of assets | 2014-12-31 | $775,000 |
| Aggregate carrying amount (costs) on sale of assets | 2014-12-31 | $759,084 |
| 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 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2014-12-31 | 320048632 |
| 2013 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $284,897 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $292,188 |
| Total income from all sources (including contributions) | 2013-12-31 | $5,093,339 |
| Total loss/gain on sale of assets | 2013-12-31 | $34,792 |
| Total of all expenses incurred | 2013-12-31 | $4,736,786 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $4,700,151 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $4,921,551 |
| Value of total assets at end of year | 2013-12-31 | $3,661,130 |
| Value of total assets at beginning of year | 2013-12-31 | $3,311,868 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $36,635 |
| Total interest from all sources | 2013-12-31 | $516 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-12-31 | $70,932 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2013-12-31 | $70,932 |
| Administrative expenses professional fees incurred | 2013-12-31 | $13,750 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $32,075 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $5,382 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $1,379 |
| Administrative expenses (other) incurred | 2013-12-31 | $10,018 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $5,750 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $5,000 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $161,488 |
| 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 | $356,553 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $3,376,233 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $3,019,680 |
| 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 |
| Investment advisory and management fees | 2013-12-31 | $12,867 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2013-12-31 | $2,367,957 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2013-12-31 | $2,195,780 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $885,096 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $327,804 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $327,804 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-12-31 | $516 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $2,376,976 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-12-31 | $65,548 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| 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 | $4,889,476 |
| Employer contributions (assets) at end of year | 2013-12-31 | $402,695 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $625,417 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $2,323,175 |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $279,147 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $287,188 |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Aggregate proceeds on sale of assets | 2013-12-31 | $737,075 |
| Aggregate carrying amount (costs) on sale of assets | 2013-12-31 | $702,283 |
| 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 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2013-12-31 | 320048632 |
| 2012 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $292,188 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $264,128 |
| Total income from all sources (including contributions) | 2012-12-31 | $5,144,546 |
| Total loss/gain on sale of assets | 2012-12-31 | $10,651 |
| Total of all expenses incurred | 2012-12-31 | $4,732,796 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $4,705,408 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $4,907,008 |
| Value of total assets at end of year | 2012-12-31 | $3,310,963 |
| Value of total assets at beginning of year | 2012-12-31 | $2,872,058 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $27,388 |
| Total interest from all sources | 2012-12-31 | $671 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $76,110 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-12-31 | $76,110 |
| Administrative expenses professional fees incurred | 2012-12-31 | $7,103 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $34,229 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $474 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $766 |
| Administrative expenses (other) incurred | 2012-12-31 | $9,441 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $5,000 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $5,000 |
| Total non interest bearing cash at end of year | 2012-12-31 | $161,488 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $113,952 |
| 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 | $411,750 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $3,018,775 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $2,607,930 |
| 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 |
| Investment advisory and management fees | 2012-12-31 | $10,844 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-12-31 | $2,195,780 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-12-31 | $1,944,735 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $327,804 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $410,197 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $410,197 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $671 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $2,314,329 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-12-31 | $150,106 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | Yes |
| 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 | $4,872,779 |
| Employer contributions (assets) at end of year | 2012-12-31 | $625,417 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $402,408 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $2,391,079 |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $287,188 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $259,128 |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Aggregate proceeds on sale of assets | 2012-12-31 | $709,054 |
| Aggregate carrying amount (costs) on sale of assets | 2012-12-31 | $698,403 |
| 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 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2012-12-31 | 320048632 |
| 2011 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $264,128 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $257,433 |
| Total income from all sources (including contributions) | 2011-12-31 | $4,757,906 |
| Total of all expenses incurred | 2011-12-31 | $4,525,465 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $4,496,285 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $4,714,909 |
| Value of total assets at end of year | 2011-12-31 | $2,872,058 |
| Value of total assets at beginning of year | 2011-12-31 | $2,632,922 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $29,180 |
| Total interest from all sources | 2011-12-31 | $1,567 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $73,531 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-12-31 | $73,531 |
| Administrative expenses professional fees incurred | 2011-12-31 | $8,113 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $32,841 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $766 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $182 |
| Administrative expenses (other) incurred | 2011-12-31 | $9,336 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $5,000 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $5,000 |
| Total non interest bearing cash at end of year | 2011-12-31 | $113,952 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $52,682 |
| 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 | $232,441 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $2,607,930 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $2,375,489 |
| 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 |
| Investment advisory and management fees | 2011-12-31 | $11,731 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-12-31 | $1,944,735 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2011-12-31 | $1,918,388 |
| Income. Interest from corporate debt instruments | 2011-12-31 | $1,190 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $410,197 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $142,047 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $142,047 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $377 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $2,332,049 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2011-12-31 | $-32,101 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| 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 | $4,682,068 |
| Employer contributions (assets) at end of year | 2011-12-31 | $402,408 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $423,623 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $2,164,236 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2011-12-31 | $96,000 |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $259,128 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $252,433 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2011-12-31 | 320048632 |
| 2010 : OPERATING ENGINEERS LOCAL 835 WELFARE FUND 2010 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $257,433 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $223,501 |
| Total income from all sources (including contributions) | 2010-12-31 | $4,050,998 |
| Total loss/gain on sale of assets | 2010-12-31 | $4,121 |
| Total of all expenses incurred | 2010-12-31 | $3,950,079 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $3,924,300 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $4,014,401 |
| Value of total assets at end of year | 2010-12-31 | $2,632,922 |
| Value of total assets at beginning of year | 2010-12-31 | $2,493,563 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $25,779 |
| Total interest from all sources | 2010-12-31 | $16,612 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $15,864 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2010-12-31 | $15,864 |
| Administrative expenses professional fees incurred | 2010-12-31 | $14,443 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $21,923 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $182 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $474 |
| Administrative expenses (other) incurred | 2010-12-31 | $11,336 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $5,000 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $4,500 |
| Total non interest bearing cash at end of year | 2010-12-31 | $52,682 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $6,716 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $100,919 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $2,375,489 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $2,270,062 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2010-12-31 | $1,918,388 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2010-12-31 | $613,540 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $142,047 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $1,533,922 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $1,533,922 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $16,612 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $1,788,436 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $3,992,478 |
| Employer contributions (assets) at end of year | 2010-12-31 | $423,623 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $338,911 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $2,135,864 |
| Asset. Corporate debt instrument debt (other) at end of year | 2010-12-31 | $96,000 |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $252,433 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $219,001 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Aggregate proceeds on sale of assets | 2010-12-31 | $94,316 |
| Aggregate carrying amount (costs) on sale of assets | 2010-12-31 | $90,195 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | ANTHONY M PONTARELLI CPA LLC |
| Accountancy firm EIN | 2010-12-31 | 320048632 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 030 |
| Policy instance | 4 |
| Insurance contract or identification number | 030 | | Number of Individuals Covered | 210 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $473 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $473 | | Insurance broker organization code? | 3 |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 3 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $67,544 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $67,544 | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 232 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $62,168 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $62,168 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 871587G |
| Policy instance | 1 |
| Insurance contract or identification number | 871587G | | Number of Individuals Covered | 58 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,124 | | 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 | 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 $27,540 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,124 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 180 |
| Policy instance | 5 |
| Insurance contract or identification number | 180 | | Number of Individuals Covered | 667 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $908 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $908 | | Insurance broker organization code? | 3 |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $69,049 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,049 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 871587G |
| Policy instance | 1 |
| Insurance contract or identification number | 871587G | | Number of Individuals Covered | 43 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $3,130 | | 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 | 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 $20,867 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,130 | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 3 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $54,920 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $54,920 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 030 |
| Policy instance | 4 |
| Insurance contract or identification number | 030 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $384 | | 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 | | 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 | 180 |
| Policy instance | 5 |
| Insurance contract or identification number | 180 | | Number of Individuals Covered | 492 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,022 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,022 | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 218 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $54,920 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $54,920 | | Insurance broker organization code? | 3 |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 3 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $69,049 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $69,049 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 180 |
| Policy instance | 4 |
| Insurance contract or identification number | 180 | | Number of Individuals Covered | 492 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,022 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,022 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 030 |
| Policy instance | 5 |
| Insurance contract or identification number | 030 | | Number of Individuals Covered | 197 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $384 | | 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 | | 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 | 030 |
| Policy instance | 1 |
| Insurance contract or identification number | 030 | | Number of Individuals Covered | 195 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $42 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $420 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 180 |
| Policy instance | 2 |
| Insurance contract or identification number | 180 | | Number of Individuals Covered | 475 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $802 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $802 | | Insurance broker organization code? | 3 |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 3 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 248 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-01-01 | | Total amount of commissions paid to insurance broker | USD $70,375 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,375 | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 4 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $53,811 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $53,811 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 180 |
| Policy instance | 2 |
| Insurance contract or identification number | 180 | | Number of Individuals Covered | 590 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $1,263 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1263 | | Insurance broker organization code? | 3 |
|
| IBC KEYSTONE (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 3 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 251 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $81,203 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 81203 | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 4 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $60,967 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 60967 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 030 |
| Policy instance | 1 |
| Insurance contract or identification number | 030 | | Number of Individuals Covered | 259 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $566 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 566 | | Insurance broker organization code? | 3 |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 1 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $83,897 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $41,139 | | Insurance broker organization code? | 3 |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 162 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $58,596 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Commission paid to Insurance Broker | USD $29,138 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 030 |
| Policy instance | 3 |
| Insurance contract or identification number | 030 | | Number of Individuals Covered | 33 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,519 | | 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 $25,316 | | Commission paid to Insurance Broker | USD $1,519 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 180 |
| Policy instance | 4 |
| Insurance contract or identification number | 180 | | Number of Individuals Covered | 565 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $1,526 | | 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 $25,431 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 180 |
| Policy instance | 4 |
| Insurance contract or identification number | 180 | | Number of Individuals Covered | 560 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,249 | | 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 $29,048 | | Commission paid to Insurance Broker | USD $1,249 | | Insurance broker name | ONEILL CONSULTING CORP |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 030 |
| Policy instance | 3 |
| Insurance contract or identification number | 030 | | Number of Individuals Covered | 325 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $683 | | 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 $15,898 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $683 | | Insurance broker name | ONEILL CONSULTING CORP |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 167 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $51,164 | | Total amount of fees paid to insurance company | USD $7,034 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,164 | | Amount paid for insurance broker fees | 7034 | | Additional information about fees paid to insurance broker | OVERRIDE | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED INSURANCE CONCEPTS |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 1 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 238 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $7,646 | | Total amount of fees paid to insurance company | USD $10,638 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $76,464 | | Amount paid for insurance broker fees | 10638 | | Additional information about fees paid to insurance broker | OVERRRIDE COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED INSURANCE CONCEPTS |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27154 |
| Policy instance | 1 |
| Insurance contract or identification number | 27154 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $24,861 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,096 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PA LP |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27154 |
| Policy instance | 2 |
| Insurance contract or identification number | 27154 | | Number of Individuals Covered | 266 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $97,178 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $104 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $91,128 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PA LP |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 030 |
| Policy instance | 3 |
| Insurance contract or identification number | 030 | | Number of Individuals Covered | 263 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $732 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $732 | | Insurance broker organization code? | 3 | | Insurance broker name | ONEILL CONSULTING CORP |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 180 |
| Policy instance | 4 |
| Insurance contract or identification number | 180 | | Number of Individuals Covered | 596 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,232 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,232 | | Insurance broker organization code? | 3 | | Insurance broker name | ONEILL CONSULTING INC |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 1 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 64 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $15,193 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,571 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PA LP |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $61,501 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $58,887 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PA LP |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 00354 |
| Policy instance | 5 |
| Insurance contract or identification number | 00354 | | Number of Individuals Covered | 302 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $3,680 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | 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 $91,993 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,680 | | Insurance broker organization code? | 3 | | Insurance broker name | ONEILL CONSULTING CORP |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 3 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $16,351 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,866 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PA INC |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 264 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $70,856 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $68,244 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PA INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 871587G |
| Policy instance | 1 |
| Insurance contract or identification number | 871587G | | Number of Individuals Covered | 19 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,925 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,366 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,925 | | Insurance broker organization code? | 3 | | Insurance broker name | ONEILL CONSULTING CORP |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 00349 |
| Policy instance | 4 |
| Insurance contract or identification number | 00349 | | Number of Individuals Covered | 178 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $2,628 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | 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 $65,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $268 | | Insurance broker organization code? | 3 | | Insurance broker name | ONEIL CONSULTING CORP |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 871587G |
| Policy instance | 5 |
| Insurance contract or identification number | 871587G | | Number of Individuals Covered | 18 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,822 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,822 | | Insurance broker organization code? | 3 | | Insurance broker name | ONEILL CONSULTING CORP |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 136 |
| Policy instance | 4 |
| Insurance contract or identification number | 136 | | Number of Individuals Covered | 307 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,920 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $98,008 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,920 | | Insurance broker organization code? | 3 | | Insurance broker name | ONEILL CONSULTING GROUP |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 00374 |
| Policy instance | 3 |
| Insurance contract or identification number | 00374 | | Number of Individuals Covered | 688 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $7,916 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $197,913 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,916 | | Insurance broker organization code? | 3 | | Insurance broker name | ONEILL CONSULTING GROUP |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 61 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $13,714 | | Health 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 $13,106 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PA INC |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 1 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 294 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $60,281 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $113 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $56,918 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF PA INC |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 871587G |
| Policy instance | 5 |
| Insurance contract or identification number | 871587G | | Number of Individuals Covered | 17 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $744 | | Life Insurance Welfare Benefit | No | | Other welfare benefits provided | LTD, WD INST | | Welfare Benefit Premiums Paid to Carrier | USD $5,021 |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 354 |
| Policy instance | 4 |
| Insurance contract or identification number | 354 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $4,466 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $102,594 |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 00349 |
| Policy instance | 3 |
| Insurance contract or identification number | 00349 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $2,414 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,847 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $10,782 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 1 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 289 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $75,841 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 ) |
| Policy contract number | 27164 |
| Policy instance | 1 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 258 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $94,049 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1635 | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED INSURANCE CONCEPTS |
|
| INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 ) |
| Policy contract number | 27164 |
| Policy instance | 2 |
| Insurance contract or identification number | 27164 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $5,558 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 75 | | Insurance broker organization code? | 3 | | Insurance broker name | ADVANCED INSURANCE CONCEPTS INC |
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