HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT
401k plan membership statisitcs for HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT
| Measure | Date | Value |
|---|
| 2021: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 84 |
| Number of retired or separated participants receiving benefits | 2021-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-01-01 | 0 |
| Total of all active and inactive participants | 2021-01-01 | 84 |
| Number of employers contributing to the scheme | 2021-01-01 | 22 |
| 2020: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 94 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 88 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 88 |
| 2019: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 94 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 94 |
| 2018: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 90 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 90 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 90 |
| 2017: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 92 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 90 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 90 |
| Number of employers contributing to the scheme | 2017-01-01 | 23 |
| 2016: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 186 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 92 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 92 |
| Number of employers contributing to the scheme | 2016-01-01 | 20 |
| 2015: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 197 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 197 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 197 |
| Number of employers contributing to the scheme | 2015-01-01 | 17 |
| 2014: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 132 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 132 |
| Total of all active and inactive participants | 2014-01-01 | 132 |
| Total participants | 2014-01-01 | 132 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Number of employers contributing to the scheme | 2014-01-01 | 15 |
| 2013: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 112 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 112 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 112 |
| Number of employers contributing to the scheme | 2013-01-01 | 13 |
| 2012: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 118 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 118 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 118 |
| Number of employers contributing to the scheme | 2012-01-01 | 17 |
| 2011: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 120 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 120 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 120 |
| Number of employers contributing to the scheme | 2011-01-01 | 14 |
| 2010: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 117 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 117 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 117 |
| 2009: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 106 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 102 |
| Total of all active and inactive participants | 2009-01-01 | 102 |
| Total participants | 2009-01-01 | 102 |
| Number of employers contributing to the scheme | 2009-01-01 | 4 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-01-01 | 0 |
| Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested | 2009-01-01 | 0 |
| Measure | Date | Value |
|---|
| 2021 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2021 401k financial data |
|---|
| Transfers to/from the plan | 2021-12-31 | $-178,996 |
| Total plan liabilities at end of year | 2021-12-31 | $0 |
| Total plan liabilities at beginning of year | 2021-12-31 | $102,393 |
| Total income from all sources | 2021-12-31 | $0 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $0 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $0 |
| Total plan assets at end of year | 2021-12-31 | $0 |
| Total plan assets at beginning of year | 2021-12-31 | $281,389 |
| Total contributions received or receivable from participants | 2021-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2021-12-31 | $0 |
| Other income received | 2021-12-31 | $0 |
| Noncash contributions received | 2021-12-31 | $0 |
| Net income (gross income less expenses) | 2021-12-31 | $0 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $178,996 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $0 |
| Value of certain deemed distributions of participant loans | 2021-12-31 | $0 |
| Value of corrective distributions | 2021-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $0 |
| 2020 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $102,393 |
| Total plan liabilities at beginning of year | 2020-12-31 | $161,917 |
| Total income from all sources | 2020-12-31 | $1,894,652 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $1,752,139 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $1,050,438 |
| Total plan assets at end of year | 2020-12-31 | $281,389 |
| Total plan assets at beginning of year | 2020-12-31 | $198,400 |
| Total contributions received or receivable from participants | 2020-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $597,912 |
| Contributions received from other sources (not participants or employers) | 2020-12-31 | $3,637 |
| Other income received | 2020-12-31 | $977 |
| Net income (gross income less expenses) | 2020-12-31 | $142,513 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $178,996 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $36,483 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $1,890,038 |
| Value of corrective distributions | 2020-12-31 | $98,460 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $5,329 |
| 2019 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $161,917 |
| Total plan liabilities at beginning of year | 2019-12-31 | $146,309 |
| Total income from all sources | 2019-12-31 | $1,719,393 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $1,655,566 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $1,079,562 |
| Total plan assets at end of year | 2019-12-31 | $198,400 |
| Total plan assets at beginning of year | 2019-12-31 | $118,965 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $510,788 |
| Other income received | 2019-12-31 | $371 |
| Net income (gross income less expenses) | 2019-12-31 | $63,827 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $36,483 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $-27,344 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $1,719,022 |
| Value of corrective distributions | 2019-12-31 | $39,843 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $25,373 |
| 2018 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $146,309 |
| Total plan liabilities at beginning of year | 2018-12-31 | $74,983 |
| Total income from all sources | 2018-12-31 | $1,402,915 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $1,506,674 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $997,568 |
| Total plan assets at end of year | 2018-12-31 | $118,965 |
| Total plan assets at beginning of year | 2018-12-31 | $151,398 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $481,108 |
| Other income received | 2018-12-31 | $154 |
| Net income (gross income less expenses) | 2018-12-31 | $-103,759 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $-27,344 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $76,415 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $1,402,761 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $27,998 |
| 2017 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $0 |
| Total plan liabilities at beginning of year | 2017-12-31 | $0 |
| Total income from all sources | 2017-12-31 | $1,946,452 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $1,454,122 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $1,451,500 |
| Total plan assets at end of year | 2017-12-31 | $1,041,595 |
| Total plan assets at beginning of year | 2017-12-31 | $549,265 |
| Total contributions received or receivable from participants | 2017-12-31 | $15,056 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2017-12-31 | $0 |
| Other income received | 2017-12-31 | $67,499 |
| Noncash contributions received | 2017-12-31 | $0 |
| Net income (gross income less expenses) | 2017-12-31 | $492,330 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $1,041,595 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $549,265 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $1,863,897 |
| Value of certain deemed distributions of participant loans | 2017-12-31 | $0 |
| Value of corrective distributions | 2017-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $2,622 |
| 2016 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $0 |
| Total income from all sources (including contributions) | 2016-12-31 | $1,455,596 |
| Total loss/gain on sale of assets | 2016-12-31 | $0 |
| Total of all expenses incurred | 2016-12-31 | $1,503,801 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $1,475,590 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $1,453,175 |
| Value of total assets at end of year | 2016-12-31 | $549,265 |
| Value of total assets at beginning of year | 2016-12-31 | $597,470 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $28,211 |
| Total interest from all sources | 2016-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $5,001 |
| 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 | $5,001 |
| Was this plan covered by a fidelity bond | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $61,983 |
| Assets. Other investments not covered elsewhere at end of year | 2016-12-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2016-12-31 | $0 |
| Other income not declared elsewhere | 2016-12-31 | $-2,580 |
| Administrative expenses (other) incurred | 2016-12-31 | $26,427 |
| 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 | $-48,205 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $549,265 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $597,470 |
| 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 | $1,784 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-12-31 | $541,380 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-12-31 | $582,448 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $7,885 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $15,022 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $15,022 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $1,475,590 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $1,391,192 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $0 |
| 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 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Disclaimer |
| Accountancy firm name | 2016-12-31 | SNYDER & CLEMENTE |
| Accountancy firm EIN | 2016-12-31 | 232535812 |
| 2015 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 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 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $0 |
| Total income from all sources (including contributions) | 2015-12-31 | $1,467,644 |
| Total loss/gain on sale of assets | 2015-12-31 | $0 |
| Total of all expenses incurred | 2015-12-31 | $1,931,418 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $1,924,058 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $1,466,341 |
| Value of total assets at end of year | 2015-12-31 | $597,470 |
| Value of total assets at beginning of year | 2015-12-31 | $1,061,244 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $7,360 |
| Total interest from all sources | 2015-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $9,413 |
| 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 | $9,413 |
| Was this plan covered by a fidelity bond | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $193,408 |
| Assets. Other investments not covered elsewhere at end of year | 2015-12-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2015-12-31 | $0 |
| Other income not declared elsewhere | 2015-12-31 | $0 |
| Administrative expenses (other) incurred | 2015-12-31 | $4,865 |
| 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 | $-463,774 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $597,470 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $1,061,244 |
| 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 | $2,495 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-12-31 | $582,448 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-12-31 | $846,458 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-12-31 | $15,022 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $214,786 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $214,786 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $1,924,058 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-12-31 | $-8,110 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $1,272,933 |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Disclaimer |
| Accountancy firm name | 2015-12-31 | SNYDER & CLEMENTE |
| Accountancy firm EIN | 2015-12-31 | 232535812 |
| 2014 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $0 |
| Total income from all sources (including contributions) | 2014-12-31 | $2,075,583 |
| Total loss/gain on sale of assets | 2014-12-31 | $0 |
| Total of all expenses incurred | 2014-12-31 | $1,940,862 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $1,935,382 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $2,031,632 |
| Value of total assets at end of year | 2014-12-31 | $1,061,244 |
| Value of total assets at beginning of year | 2014-12-31 | $926,523 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $5,480 |
| Total interest from all sources | 2014-12-31 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $13,258 |
| 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 | $13,258 |
| Was this plan covered by a fidelity bond | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $155,322 |
| Assets. Other investments not covered elsewhere at end of year | 2014-12-31 | $0 |
| Assets. Other investments not covered elsewhere at beginning of year | 2014-12-31 | $187,163 |
| Other income not declared elsewhere | 2014-12-31 | $0 |
| Administrative expenses (other) incurred | 2014-12-31 | $2,255 |
| 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 | $134,721 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $1,061,244 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $926,523 |
| 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 | $3,225 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-12-31 | $846,458 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-12-31 | $739,360 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $214,786 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $1,935,382 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2014-12-31 | $30,693 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $1,876,310 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | Yes |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Disclaimer |
| Accountancy firm name | 2014-12-31 | SNYDER & CLEMENTE |
| Accountancy firm EIN | 2014-12-31 | 232535812 |
| 2013 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-12-31 | $0 |
| Total plan liabilities at beginning of year | 2013-12-31 | $0 |
| Total income from all sources | 2013-12-31 | $2,040,698 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $2,138,319 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $2,133,678 |
| Total plan assets at end of year | 2013-12-31 | $926,523 |
| Total plan assets at beginning of year | 2013-12-31 | $1,024,144 |
| Other income received | 2013-12-31 | $97,031 |
| Net income (gross income less expenses) | 2013-12-31 | $-97,621 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $926,523 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $1,024,144 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $1,943,667 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $4,641 |
| 2012 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2012 401k financial data |
|---|
| Transfers to/from the plan | 2012-12-31 | $0 |
| Total plan liabilities at end of year | 2012-12-31 | $0 |
| Total plan liabilities at beginning of year | 2012-12-31 | $0 |
| Total income from all sources | 2012-12-31 | $1,585,710 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $2,087,636 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $2,080,652 |
| Total plan assets at end of year | 2012-12-31 | $1,024,144 |
| Total plan assets at beginning of year | 2012-12-31 | $1,526,070 |
| Total contributions received or receivable from participants | 2012-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2012-12-31 | $0 |
| Other income received | 2012-12-31 | $120,050 |
| Noncash contributions received | 2012-12-31 | $0 |
| Net income (gross income less expenses) | 2012-12-31 | $-501,926 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $1,024,144 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $1,526,070 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $1,465,660 |
| Value of certain deemed distributions of participant loans | 2012-12-31 | $0 |
| Value of corrective distributions | 2012-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $6,984 |
| 2011 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2011 401k financial data |
|---|
| Transfers to/from the plan | 2011-12-31 | $0 |
| Total plan liabilities at end of year | 2011-12-31 | $0 |
| Total plan liabilities at beginning of year | 2011-12-31 | $0 |
| Total income from all sources | 2011-12-31 | $2,086,303 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $2,341,612 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $2,333,094 |
| Total plan assets at end of year | 2011-12-31 | $1,526,070 |
| Total plan assets at beginning of year | 2011-12-31 | $1,781,379 |
| Total contributions received or receivable from participants | 2011-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2011-12-31 | $0 |
| Other income received | 2011-12-31 | $18,948 |
| Noncash contributions received | 2011-12-31 | $0 |
| Net income (gross income less expenses) | 2011-12-31 | $-255,309 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $1,526,070 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $1,781,379 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $2,067,355 |
| Value of certain deemed distributions of participant loans | 2011-12-31 | $0 |
| Value of corrective distributions | 2011-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $8,518 |
| 2010 : HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2010 401k financial data |
|---|
| Transfers to/from the plan | 2010-12-31 | $0 |
| Total plan liabilities at end of year | 2010-12-31 | $0 |
| Total plan liabilities at beginning of year | 2010-12-31 | $0 |
| Total income from all sources | 2010-12-31 | $2,243,543 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $2,147,145 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $2,134,454 |
| Total plan assets at end of year | 2010-12-31 | $1,781,379 |
| Total plan assets at beginning of year | 2010-12-31 | $1,684,981 |
| Total contributions received or receivable from participants | 2010-12-31 | $0 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2010-12-31 | $0 |
| Other income received | 2010-12-31 | $161,389 |
| Noncash contributions received | 2010-12-31 | $0 |
| Net income (gross income less expenses) | 2010-12-31 | $96,398 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $1,781,379 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $1,684,981 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $2,082,154 |
| Value of certain deemed distributions of participant loans | 2010-12-31 | $0 |
| Value of corrective distributions | 2010-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $12,691 |
| 2021: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Multi-employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | Yes |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | Yes |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Section 412(e)(3) insurance Contracts | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement – Section 412(e)(3) insurance Contracts | Yes |
| 2020: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Multi-employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | Yes |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Multi-employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | Yes |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Multi-employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | Yes |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Multi-employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | Yes |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Multi-employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | Yes |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Multi-employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | Yes |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Multi-employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | Yes |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Multi-employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | Yes |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Multi-employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | Yes |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Multi-employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | Yes |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Multi-employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | Yes |
| 2010-01-01 | Plan funding arrangement – Insurance | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: HEAT & FROST INSULATORS & ASBESTOS WORKERS LOCAL 38 WELFARE BENEFIT 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Multi-employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | No |
| 2009-01-01 | Plan funding arrangement – Insurance | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 10118925 |
| Policy instance | 1 |
| Insurance contract or identification number | 10118925 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $50,650 | | Total amount of fees paid to insurance company | USD $50 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,149,315 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $50,650 | | Amount paid for insurance broker fees | 50 | | Additional information about fees paid to insurance broker | BROKER FEE | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05945771 |
| Policy instance | 4 |
| Insurance contract or identification number | TM05945771 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4303 |
| Policy instance | 3 |
| Insurance contract or identification number | 4303 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | VERIS |
| Policy instance | 2 |
| Insurance contract or identification number | VERIS | | Number of Individuals Covered | 88 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $555,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 246050 |
| Policy instance | 1 |
| Insurance contract or identification number | 246050 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | 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 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 | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 246050 |
| Policy instance | 1 |
| Insurance contract or identification number | 246050 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 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 | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | VERIS |
| Policy instance | 2 |
| Insurance contract or identification number | VERIS | | Number of Individuals Covered | 94 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $466,119 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05945771 |
| Policy instance | 4 |
| Insurance contract or identification number | TM05945771 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $2,830 | | Total amount of fees paid to insurance company | USD $34 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes | | Commission paid to Insurance Broker | USD $2,830 | | Amount paid for insurance broker fees | 34 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4303 |
| Policy instance | 3 |
| Insurance contract or identification number | 4303 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $543 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $543 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | NONE | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 246050 |
| Policy instance | 1 |
| Insurance contract or identification number | 246050 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2018-12-31 | | 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 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 | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | VERIS |
| Policy instance | 2 |
| Insurance contract or identification number | VERIS | | Number of Individuals Covered | 88 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $401,781 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC. (National Association of Insurance Commissioners NAIC id number: 12743 ) |
| Policy contract number | 117810 |
| Policy instance | 2 |
| Insurance contract or identification number | 117810 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-10-31 | | Total amount of commissions paid to insurance broker | USD $13,025 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | 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 $868,305 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,025 | | Insurance broker organization code? | 3 | | Insurance broker name | BB & T INSURANCE SERVICES |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 246050 |
| Policy instance | 1 |
| Insurance contract or identification number | 246050 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $1,232 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $21,804 | | 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 | GALLAGHER BENEFIT SERVICES, INC. |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 100-0233-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 100-0233-00 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $1,201 | | Total amount of fees paid to insurance company | USD $0 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $20,794 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,201 | | Insurance broker organization code? | 3 | | Insurance broker name | MID AMERICA GROUP, INC. |
|
| BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 ) |
| Policy contract number | 013076;036072 |
| Policy instance | 1 |
| Insurance contract or identification number | 013076;036072 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2014-09-01 | | Insurance policy end date | 2015-08-31 | | 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 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 100-0233-00 |
| Policy instance | 1 |
| Insurance contract or identification number | 100-0233-00 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $1,173 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $20,576 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 6131-4EL |
| Policy instance | 2 |
| Insurance contract or identification number | 6131-4EL | | Number of Individuals Covered | 99 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $4,598 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $23,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 ) |
| Policy contract number | 013076;036072 |
| Policy instance | 1 |
| Insurance contract or identification number | 013076;036072 | | Number of Individuals Covered | 149 | | Insurance policy start date | 2013-09-01 | | Insurance policy end date | 2014-08-31 | | 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 |
|
| BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 ) |
| Policy contract number | 013076;036072 |
| Policy instance | 1 |
| Insurance contract or identification number | 013076;036072 | | Number of Individuals Covered | 112 | | Insurance policy start date | 2012-09-01 | | Insurance policy end date | 2013-08-31 | | 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 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 100-0233-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 100-0233-00 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $1,208 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $21,321 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 6131-4EL |
| Policy instance | 1 |
| Insurance contract or identification number | 6131-4EL | | Number of Individuals Covered | 106 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $4,941 | | 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 | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $24,822 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 6131-4EL |
| Policy instance | 2 |
| Insurance contract or identification number | 6131-4EL | | Number of Individuals Covered | 108 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $5,035 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $25,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 ) |
| Policy contract number | 013076;036072 |
| Policy instance | 1 |
| Insurance contract or identification number | 013076;036072 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2012-08-31 | | 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 |
|
| SUN LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80926 ) |
| Policy contract number | 100-0233-00 |
| Policy instance | 1 |
| Insurance contract or identification number | 100-0233-00 | | Number of Individuals Covered | 137 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $1,239 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 ) |
| Policy contract number | 013076;036072 |
| Policy instance | 1 |
| Insurance contract or identification number | 013076;036072 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2010-09-01 | | Insurance policy end date | 2011-08-31 | | 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 |
|
| BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 ) |
| Policy contract number | 013076;036072 |
| Policy instance | 1 |
| Insurance contract or identification number | 013076;036072 | | Number of Individuals Covered | 117 | | Insurance policy start date | 2009-09-01 | | Insurance policy end date | 2010-08-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | 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 |
|
