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PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 401k Plan overview

Plan NamePHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN
Plan identification number 501

PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental
  • Vision
  • Other welfare benefit cover

401k Sponsoring company profile

PHOTONIS has sponsored the creation of one or more 401k plans.

Company Name:PHOTONIS
Employer identification number (EIN):232464652
NAIC Classification:334410

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012023-04-01
5012023-04-01PAUL JONES
5012022-04-01
5012022-04-01DAVID WEICHERT
5012021-04-01
5012021-04-01DAVID WEICHERT
5012020-04-01
5012019-04-01
5012018-04-01
5012018-01-01
5012017-04-01PAM DAUB
5012016-04-01SCOTT CHARNOFF
5012015-04-01SCOTT CHARNOFF
5012015-01-01SCOTT CHARNOFF
5012014-01-01SCOTT CHARNOFF
5012013-01-01JEANNINE BOGACKI
5012012-01-01JEFFREY BAKER
5012011-01-01JEFFREY BAKER
5012010-01-01JEFFREY BAKER
5012009-01-01JEFFREY BAKER
5012009-01-01JEFFREY BAKER

Financial Data on PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN

Measure Date Value
2024 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2024 401k financial data
Total plan liabilities at end of year2024-03-31$176,810
Total plan liabilities at beginning of year2024-03-31$37,414
Total income from all sources2024-03-31$1,629,869
Expenses. Total of all expenses incurred2024-03-31$2,768,294
Benefits paid (including direct rollovers)2024-03-31$2,129,812
Total plan assets at end of year2024-03-31$225,026
Total plan assets at beginning of year2024-03-31$1,224,055
Value of fidelity bond covering the plan2024-03-31$1,000,000
Total contributions received or receivable from participants2024-03-31$231,362
Expenses. Other expenses not covered elsewhere2024-03-31$596,938
Other income received2024-03-31$46,405
Net income (gross income less expenses)2024-03-31$-1,138,425
Net plan assets at end of year (total assets less liabilities)2024-03-31$48,216
Net plan assets at beginning of year (total assets less liabilities)2024-03-31$1,186,641
Total contributions received or receivable from employer(s)2024-03-31$1,352,102
Expenses. Administrative service providers (salaries,fees and commissions)2024-03-31$41,544
2022 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2022 401k financial data
Total plan liabilities at end of year2022-03-31$0
Total plan liabilities at beginning of year2022-03-31$33,911
Total income from all sources2022-03-31$2,079,278
Expenses. Total of all expenses incurred2022-03-31$1,593,834
Benefits paid (including direct rollovers)2022-03-31$1,114,630
Total plan assets at end of year2022-03-31$1,027,702
Total plan assets at beginning of year2022-03-31$576,169
Value of fidelity bond covering the plan2022-03-31$1,000,000
Total contributions received or receivable from participants2022-03-31$400,537
Expenses. Other expenses not covered elsewhere2022-03-31$436,422
Other income received2022-03-31$108
Net income (gross income less expenses)2022-03-31$485,444
Net plan assets at end of year (total assets less liabilities)2022-03-31$1,027,702
Net plan assets at beginning of year (total assets less liabilities)2022-03-31$542,258
Total contributions received or receivable from employer(s)2022-03-31$1,678,633
Expenses. Administrative service providers (salaries,fees and commissions)2022-03-31$42,782
2021 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2021 401k financial data
Total plan liabilities at end of year2021-03-31$33,911
Total plan liabilities at beginning of year2021-03-31$83,754
Total income from all sources2021-03-31$1,640,172
Expenses. Total of all expenses incurred2021-03-31$1,315,743
Benefits paid (including direct rollovers)2021-03-31$908,053
Total plan assets at end of year2021-03-31$576,169
Total plan assets at beginning of year2021-03-31$301,583
Value of fidelity bond covering the plan2021-03-31$1,000,000
Total contributions received or receivable from participants2021-03-31$327,799
Expenses. Other expenses not covered elsewhere2021-03-31$353,187
Other income received2021-03-31$101
Net income (gross income less expenses)2021-03-31$324,429
Net plan assets at end of year (total assets less liabilities)2021-03-31$542,258
Net plan assets at beginning of year (total assets less liabilities)2021-03-31$217,829
Total contributions received or receivable from employer(s)2021-03-31$1,312,272
Expenses. Administrative service providers (salaries,fees and commissions)2021-03-31$54,503
2020 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2020 401k financial data
Total plan liabilities at end of year2020-03-31$83,754
Total plan liabilities at beginning of year2020-03-31$71,823
Total income from all sources2020-03-31$1,350,709
Expenses. Total of all expenses incurred2020-03-31$1,327,673
Benefits paid (including direct rollovers)2020-03-31$926,156
Total plan assets at end of year2020-03-31$301,583
Total plan assets at beginning of year2020-03-31$266,616
Value of fidelity bond covering the plan2020-03-31$1,000,000
Total contributions received or receivable from participants2020-03-31$294,444
Expenses. Other expenses not covered elsewhere2020-03-31$342,239
Other income received2020-03-31$4,855
Net income (gross income less expenses)2020-03-31$23,036
Net plan assets at end of year (total assets less liabilities)2020-03-31$217,829
Net plan assets at beginning of year (total assets less liabilities)2020-03-31$194,793
Total contributions received or receivable from employer(s)2020-03-31$1,051,410
Expenses. Administrative service providers (salaries,fees and commissions)2020-03-31$59,278
2019 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2019 401k financial data
Total plan liabilities at end of year2019-03-31$71,823
Total plan liabilities at beginning of year2019-03-31$0
Total income from all sources2019-03-31$1,040,654
Expenses. Total of all expenses incurred2019-03-31$1,476,619
Benefits paid (including direct rollovers)2019-03-31$1,082,418
Total plan assets at end of year2019-03-31$266,616
Total plan assets at beginning of year2019-03-31$630,758
Value of fidelity bond covering the plan2019-03-31$1,000,000
Total contributions received or receivable from participants2019-03-31$132,555
Expenses. Other expenses not covered elsewhere2019-03-31$331,863
Other income received2019-03-31$12,102
Net income (gross income less expenses)2019-03-31$-435,965
Net plan assets at end of year (total assets less liabilities)2019-03-31$194,793
Net plan assets at beginning of year (total assets less liabilities)2019-03-31$630,758
Total contributions received or receivable from employer(s)2019-03-31$895,997
Expenses. Administrative service providers (salaries,fees and commissions)2019-03-31$62,338
2018 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$71,823
Total plan liabilities at beginning of year2018-12-31$0
Total income from all sources2018-12-31$1,040,654
Expenses. Total of all expenses incurred2018-12-31$1,476,619
Benefits paid (including direct rollovers)2018-12-31$1,082,418
Total plan assets at end of year2018-12-31$266,616
Total plan assets at beginning of year2018-12-31$630,758
Value of fidelity bond covering the plan2018-12-31$1,000,000
Total contributions received or receivable from participants2018-12-31$132,555
Expenses. Other expenses not covered elsewhere2018-12-31$331,863
Other income received2018-12-31$12,102
Net income (gross income less expenses)2018-12-31$-435,965
Net plan assets at end of year (total assets less liabilities)2018-12-31$194,793
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$630,758
Total contributions received or receivable from employer(s)2018-12-31$895,997
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$62,338
Total plan liabilities at end of year2018-03-31$0
Total plan liabilities at beginning of year2018-03-31$0
Total income from all sources2018-03-31$1,080,044
Expenses. Total of all expenses incurred2018-03-31$1,214,372
Benefits paid (including direct rollovers)2018-03-31$813,686
Total plan assets at end of year2018-03-31$630,758
Total plan assets at beginning of year2018-03-31$765,086
Value of fidelity bond covering the plan2018-03-31$1,000,000
Total contributions received or receivable from participants2018-03-31$453,800
Expenses. Other expenses not covered elsewhere2018-03-31$324,824
Other income received2018-03-31$6,002
Net income (gross income less expenses)2018-03-31$-134,328
Net plan assets at end of year (total assets less liabilities)2018-03-31$630,758
Net plan assets at beginning of year (total assets less liabilities)2018-03-31$765,086
Total contributions received or receivable from employer(s)2018-03-31$620,242
Expenses. Administrative service providers (salaries,fees and commissions)2018-03-31$75,862
2017 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2017 401k financial data
Total plan liabilities at end of year2017-03-31$0
Total plan liabilities at beginning of year2017-03-31$5,586
Total income from all sources2017-03-31$1,293,929
Expenses. Total of all expenses incurred2017-03-31$1,203,173
Benefits paid (including direct rollovers)2017-03-31$822,584
Total plan assets at end of year2017-03-31$765,086
Total plan assets at beginning of year2017-03-31$679,916
Value of fidelity bond covering the plan2017-03-31$1,000,000
Total contributions received or receivable from participants2017-03-31$366,807
Expenses. Other expenses not covered elsewhere2017-03-31$288,579
Noncash contributions received2017-03-31$1,014
Net income (gross income less expenses)2017-03-31$90,756
Net plan assets at end of year (total assets less liabilities)2017-03-31$765,086
Net plan assets at beginning of year (total assets less liabilities)2017-03-31$674,330
Total contributions received or receivable from employer(s)2017-03-31$926,108
Expenses. Administrative service providers (salaries,fees and commissions)2017-03-31$92,010
2016 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2016 401k financial data
Total plan liabilities at end of year2016-03-31$5,586
Total plan liabilities at beginning of year2016-03-31$0
Total income from all sources2016-03-31$1,285,847
Expenses. Total of all expenses incurred2016-03-31$1,234,838
Benefits paid (including direct rollovers)2016-03-31$900,320
Total plan assets at end of year2016-03-31$679,916
Total plan assets at beginning of year2016-03-31$623,321
Value of fidelity bond covering the plan2016-03-31$1,000,000
Total contributions received or receivable from participants2016-03-31$337,991
Expenses. Other expenses not covered elsewhere2016-03-31$243,945
Other income received2016-03-31$294
Net income (gross income less expenses)2016-03-31$51,009
Net plan assets at end of year (total assets less liabilities)2016-03-31$674,330
Net plan assets at beginning of year (total assets less liabilities)2016-03-31$623,321
Total contributions received or receivable from employer(s)2016-03-31$947,562
Expenses. Administrative service providers (salaries,fees and commissions)2016-03-31$90,573
2015 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2015 401k financial data
Total income from all sources2015-03-31$387,733
Expenses. Total of all expenses incurred2015-03-31$280,319
Benefits paid (including direct rollovers)2015-03-31$258,030
Total plan assets at end of year2015-03-31$623,321
Total plan assets at beginning of year2015-03-31$515,907
Value of fidelity bond covering the plan2015-03-31$1,000,000
Total contributions received or receivable from participants2015-03-31$58,552
Other income received2015-03-31$23
Net income (gross income less expenses)2015-03-31$107,414
Net plan assets at end of year (total assets less liabilities)2015-03-31$623,321
Net plan assets at beginning of year (total assets less liabilities)2015-03-31$515,907
Total contributions received or receivable from employer(s)2015-03-31$329,158
Expenses. Administrative service providers (salaries,fees and commissions)2015-03-31$22,289
2014 : PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2014 401k financial data
Total income from all sources2014-12-31$1,549,651
Expenses. Total of all expenses incurred2014-12-31$1,033,744
Benefits paid (including direct rollovers)2014-12-31$944,351
Total plan assets at end of year2014-12-31$515,907
Total plan assets at beginning of year2014-12-31$0
Value of fidelity bond covering the plan2014-12-31$1,000,000
Total contributions received or receivable from participants2014-12-31$233,784
Other income received2014-12-31$33
Net income (gross income less expenses)2014-12-31$515,907
Net plan assets at end of year (total assets less liabilities)2014-12-31$515,907
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$1,315,834
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$89,393

Form 5500 Responses for PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN

2023: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2023 form 5500 responses
2023-04-01Type of plan entitySingle employer plan
2023-04-01Submission has been amendedNo
2023-04-01This submission is the final filingNo
2023-04-01This return/report is a short plan year return/report (less than 12 months)No
2023-04-01Plan is a collectively bargained planNo
2023-04-01Plan funding arrangement – InsuranceYes
2023-04-01Plan funding arrangement – TrustYes
2023-04-01Plan funding arrangement – General assets of the sponsorYes
2023-04-01Plan benefit arrangement – InsuranceYes
2023-04-01Plan benefit arrangement - TrustYes
2023-04-01Plan benefit arrangement – General assets of the sponsorYes
2022: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2022 form 5500 responses
2022-04-01Type of plan entitySingle employer plan
2022-04-01Submission has been amendedNo
2022-04-01This submission is the final filingNo
2022-04-01This return/report is a short plan year return/report (less than 12 months)No
2022-04-01Plan is a collectively bargained planNo
2022-04-01Plan funding arrangement – InsuranceYes
2022-04-01Plan funding arrangement – General assets of the sponsorYes
2022-04-01Plan benefit arrangement – InsuranceYes
2022-04-01Plan benefit arrangement – General assets of the sponsorYes
2021: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2021 form 5500 responses
2021-04-01Type of plan entitySingle employer plan
2021-04-01Submission has been amendedNo
2021-04-01This submission is the final filingNo
2021-04-01This return/report is a short plan year return/report (less than 12 months)No
2021-04-01Plan is a collectively bargained planNo
2021-04-01Plan funding arrangement – TrustYes
2021-04-01Plan funding arrangement – General assets of the sponsorYes
2021-04-01Plan benefit arrangement - TrustYes
2021-04-01Plan benefit arrangement – General assets of the sponsorYes
2020: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2020 form 5500 responses
2020-04-01Type of plan entitySingle employer plan
2020-04-01Submission has been amendedNo
2020-04-01This submission is the final filingNo
2020-04-01This return/report is a short plan year return/report (less than 12 months)No
2020-04-01Plan is a collectively bargained planNo
2020-04-01Plan funding arrangement – TrustYes
2020-04-01Plan funding arrangement – General assets of the sponsorYes
2020-04-01Plan benefit arrangement - TrustYes
2020-04-01Plan benefit arrangement – General assets of the sponsorYes
2019: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2019 form 5500 responses
2019-04-01Type of plan entitySingle employer plan
2019-04-01Submission has been amendedNo
2019-04-01This submission is the final filingNo
2019-04-01This return/report is a short plan year return/report (less than 12 months)No
2019-04-01Plan is a collectively bargained planNo
2019-04-01Plan funding arrangement – TrustYes
2019-04-01Plan funding arrangement – General assets of the sponsorYes
2019-04-01Plan benefit arrangement - TrustYes
2019-04-01Plan benefit arrangement – General assets of the sponsorYes
2018: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2018 form 5500 responses
2018-04-01Type of plan entitySingle employer plan
2018-04-01Submission has been amendedNo
2018-04-01This submission is the final filingNo
2018-04-01This return/report is a short plan year return/report (less than 12 months)No
2018-04-01Plan is a collectively bargained planNo
2018-04-01Plan funding arrangement – TrustYes
2018-04-01Plan funding arrangement – General assets of the sponsorYes
2018-04-01Plan benefit arrangement - TrustYes
2018-04-01Plan benefit arrangement – General assets of the sponsorYes
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2017 form 5500 responses
2017-04-01Type of plan entitySingle employer plan
2017-04-01Submission has been amendedNo
2017-04-01This submission is the final filingNo
2017-04-01This return/report is a short plan year return/report (less than 12 months)No
2017-04-01Plan is a collectively bargained planNo
2017-04-01Plan funding arrangement – TrustYes
2017-04-01Plan funding arrangement – General assets of the sponsorYes
2017-04-01Plan benefit arrangement - TrustYes
2017-04-01Plan benefit arrangement – General assets of the sponsorYes
2016: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2016 form 5500 responses
2016-04-01Type of plan entitySingle employer plan
2016-04-01Submission has been amendedNo
2016-04-01This submission is the final filingNo
2016-04-01This return/report is a short plan year return/report (less than 12 months)No
2016-04-01Plan is a collectively bargained planNo
2016-04-01Plan funding arrangement – InsuranceYes
2016-04-01Plan funding arrangement – TrustYes
2016-04-01Plan benefit arrangement – InsuranceYes
2016-04-01Plan benefit arrangement - TrustYes
2015: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingNo
2015-04-01This return/report is a short plan year return/report (less than 12 months)No
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan funding arrangement – TrustYes
2015-04-01Plan benefit arrangement – InsuranceYes
2015-04-01Plan benefit arrangement - TrustYes
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan funding arrangement – General assets of the sponsorYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2015-01-01Plan benefit arrangement – General assets of the sponsorYes
2014: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entityMulti-employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – General assets of the sponsorYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement – General assets of the sponsorYes
2013: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – General assets of the sponsorYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement – General assets of the sponsorYes
2012: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – General assets of the sponsorYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement – General assets of the sponsorYes
2011: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – General assets of the sponsorYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement – General assets of the sponsorYes
2010: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – General assets of the sponsorYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement – General assets of the sponsorYes
2009: PHOTONIS USA PENNSYLVANIA, INC. HEALTH CARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – General assets of the sponsorYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number168424
Policy instance 1
Insurance contract or identification number168424
Number of Individuals Covered123
Insurance policy start date2023-04-01
Insurance policy end date2024-03-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $585,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 )
Policy contract number168424
Policy instance 1
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number168424
Policy instance 1
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number16619
Policy instance 2
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number168424
Policy instance 1
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number168424
Policy instance 1
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05722942
Policy instance 2
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79354000,4001
Policy instance 1
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberCLI-70644
Policy instance 4
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number45600800,801
Policy instance 3
ZURICH AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 16535 )
Policy contract number98-47-835
Policy instance 1
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number79354000
Policy instance 4
TUFTS ASSOCIATED HEALTH MAINTENANCE ORG., INC. (National Association of Insurance Commissioners NAIC id number: 95688 )
Policy contract number45600800
Policy instance 3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05722942
Policy instance 1
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number46-002903
Policy instance 5
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
Policy contract number4488899
Policy instance 4
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract number4488899
Policy instance 3
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number655767
Policy instance 2
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTM05722942
Policy instance 1
FALLON HEALTH AND LIFE INSURANCE COMPANY - FHLAC (National Association of Insurance Commissioners NAIC id number: 66828 )
Policy contract number9982336
Policy instance 6
FALLON COMMUNITY HEALTH PLAN -MEDICARE (National Association of Insurance Commissioners NAIC id number: 95541 )
Policy contract number4488899
Policy instance 5
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4933240
Policy instance 4
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number655767
Policy instance 3
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number46-002903
Policy instance 2

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