401k Plan data: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN plan

M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 401k Plan overview

Plan Name	M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN
Plan identification number	501

M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN Benefits

401k Plan Type

Welfare Benefit

Plan Features/Benefits

Health (other than dental or vision)
Life insurance
Dental
Vision
Death benefits (include travel accident but not life insurance)
Other welfare benefit cover
Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

M & C TRUCKING COMPANY has sponsored the creation of one or more 401k plans.

Company Name: M & C TRUCKING COMPANY

Employer identification number (EIN): 251332393

NAIC Classification: 484120
NAIC Description: General Freight Trucking, Long-Distance

Form 5500 Filing Information

Submission information for form 5500 for 401k plan M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2022-07-01 JOHN P. MUCHESKO 2023-12-08
501 2021-07-01 JOHN P. MUCHESKO 2022-12-13
501 2020-07-01 JOHN P. MUCHESKO 2021-12-21
501 2019-07-01 JOHN P. MUCHESKO 2020-12-08
501 2018-07-01 ELEANOR JANE MUCHESKO 2019-12-11
501 2017-07-01 ELEANOR MUCHESKO ELEANOR MUCHESKO 2019-01-25
501 2016-07-01 ELEANOR MUCHESKO ELEANOR MUCHESKO 2018-01-31
501 2015-07-01 ELEANOR MUCHESKO
501 2014-07-01 ELEANOR MUCHESKO
501 2013-07-01 ELEANOR MUCHESKO

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2022-07-01	JOHN P. MUCHESKO	2023-12-08
501	2021-07-01	JOHN P. MUCHESKO	2022-12-13
501	2020-07-01	JOHN P. MUCHESKO	2021-12-21
501	2019-07-01	JOHN P. MUCHESKO	2020-12-08
501	2018-07-01	ELEANOR JANE MUCHESKO	2019-12-11
501	2017-07-01	ELEANOR MUCHESKO		ELEANOR MUCHESKO	2019-01-25
501	2016-07-01	ELEANOR MUCHESKO		ELEANOR MUCHESKO	2018-01-31
501	2015-07-01	ELEANOR MUCHESKO
501	2014-07-01	ELEANOR MUCHESKO
501	2013-07-01	ELEANOR MUCHESKO

Plan Statistics for M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN

401k plan membership statisitcs for M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN

Measure Date Value
2022: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year 2022-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2022-07-01 89
Number of retired or separated participants receiving benefits 2022-07-01 0
Number of other retired or separated participants entitled to future benefits 2022-07-01 0
Total of all active and inactive participants 2022-07-01 89
Number of employers contributing to the scheme 2022-07-01 0
2021: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year 2021-07-01 104
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 87
Number of retired or separated participants receiving benefits 2021-07-01 0
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 87
Number of employers contributing to the scheme 2021-07-01 0
2020: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year 2020-07-01 119
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 104
Number of retired or separated participants receiving benefits 2020-07-01 0
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 104
Number of employers contributing to the scheme 2020-07-01 0
2019: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year 2019-07-01 119
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 119
Number of retired or separated participants receiving benefits 2019-07-01 0
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 119
Number of employers contributing to the scheme 2019-07-01 0
2018: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year 2018-07-01 149
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 119
Number of retired or separated participants receiving benefits 2018-07-01 0
Number of other retired or separated participants entitled to future benefits 2018-07-01 0
Total of all active and inactive participants 2018-07-01 119
Number of employers contributing to the scheme 2018-07-01 0
2017: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year 2017-07-01 143
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 125
Total of all active and inactive participants 2017-07-01 125
Total participants 2017-07-01 125
2016: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year 2016-07-01 149
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 143
Total of all active and inactive participants 2016-07-01 143
Total participants 2016-07-01 143
2015: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year 2015-07-01 153
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 149
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 0
Total of all active and inactive participants 2015-07-01 149
2014: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year 2014-07-01 154
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 153
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 0
Total of all active and inactive participants 2014-07-01 153
2013: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year 2013-07-01 98
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 154
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 0
Total of all active and inactive participants 2013-07-01 154

Measure	Date	Value
2022: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year	2022-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2022-07-01	89
Number of retired or separated participants receiving benefits	2022-07-01	0
Number of other retired or separated participants entitled to future benefits	2022-07-01	0
Total of all active and inactive participants	2022-07-01	89
Number of employers contributing to the scheme	2022-07-01	0
2021: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year	2021-07-01	104
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	87
Number of retired or separated participants receiving benefits	2021-07-01	0
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	87
Number of employers contributing to the scheme	2021-07-01	0
2020: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year	2020-07-01	119
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	104
Number of retired or separated participants receiving benefits	2020-07-01	0
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	104
Number of employers contributing to the scheme	2020-07-01	0
2019: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year	2019-07-01	119
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	119
Number of retired or separated participants receiving benefits	2019-07-01	0
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	119
Number of employers contributing to the scheme	2019-07-01	0
2018: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year	2018-07-01	149
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	119
Number of retired or separated participants receiving benefits	2018-07-01	0
Number of other retired or separated participants entitled to future benefits	2018-07-01	0
Total of all active and inactive participants	2018-07-01	119
Number of employers contributing to the scheme	2018-07-01	0
2017: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year	2017-07-01	143
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	125
Total of all active and inactive participants	2017-07-01	125
Total participants	2017-07-01	125
2016: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year	2016-07-01	149
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	143
Total of all active and inactive participants	2016-07-01	143
Total participants	2016-07-01	143
2015: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year	2015-07-01	153
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	149
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	0
Total of all active and inactive participants	2015-07-01	149
2014: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year	2014-07-01	154
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	153
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	0
Total of all active and inactive participants	2014-07-01	153
2013: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year	2013-07-01	98
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	154
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	0
Total of all active and inactive participants	2013-07-01	154

Form 5500 Responses for M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN

2022: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2022 form 5500 responses
2022-07-01	Type of plan entity	Single employer plan
2022-07-01	Plan funding arrangement – Insurance	Yes
2022-07-01	Plan benefit arrangement – Insurance	Yes
2021: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2021 form 5500 responses
2021-07-01	Type of plan entity	Single employer plan
2021-07-01	Plan funding arrangement – Insurance	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2020 form 5500 responses
2020-07-01	Type of plan entity	Single employer plan
2020-07-01	Plan funding arrangement – Insurance	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Submission has been amended	No
2017-07-01	This submission is the final filing	No
2017-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-07-01	Plan is a collectively bargained plan	No
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Submission has been amended	No
2016-07-01	This submission is the final filing	No
2016-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-07-01	Plan is a collectively bargained plan	No
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Submission has been amended	No
2015-07-01	This submission is the final filing	No
2015-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-07-01	Plan is a collectively bargained plan	No
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Submission has been amended	No
2014-07-01	This submission is the final filing	No
2014-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-07-01	Plan is a collectively bargained plan	No
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: M & C TRUCKING COMPANY EMPLOYEE BENEFIT PLAN 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	First time form 5500 has been submitted	Yes
2013-07-01	Submission has been amended	No
2013-07-01	This submission is the final filing	No
2013-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-07-01	Plan is a collectively bargained plan	No
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F015766

Policy instance

Insurance contract or identification number	F015766
Number of Individuals Covered	89
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $15,582
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907330-000

Policy instance

Insurance contract or identification number	907330-000
Number of Individuals Covered	142
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $81
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	81
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

19524

Policy instance

Insurance contract or identification number	19524
Number of Individuals Covered	151
Insurance policy start date	2022-07-01
Insurance policy end date	2023-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,034,555
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F015766

Policy instance

Insurance contract or identification number	F015766
Number of Individuals Covered	93
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $15,162
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907330-000

Policy instance

Insurance contract or identification number	907330-000
Number of Individuals Covered	140
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $255
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $32,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Amount paid for insurance broker fees	255
Additional information about fees paid to insurance broker	BONUS
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

19524

Policy instance

Insurance contract or identification number	19524
Number of Individuals Covered	149
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,093,073
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F015766

Policy instance

Insurance contract or identification number	F015766
Number of Individuals Covered	104
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $17,084
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907330-000

Policy instance

Insurance contract or identification number	907330-000
Number of Individuals Covered	149
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $37,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

19524

Policy instance

Insurance contract or identification number	19524
Number of Individuals Covered	169
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,226,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F015766

Policy instance

Insurance contract or identification number	F015766
Number of Individuals Covered	119
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $802
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $18,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	802
Additional information about fees paid to insurance broker	ADDITIONAL COMPENSATION
Insurance broker organization code?	3

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907330-000

Policy instance

Insurance contract or identification number	907330-000
Number of Individuals Covered	186
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $42,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

19524

Policy instance

Insurance contract or identification number	19524
Number of Individuals Covered	199
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,551,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F015766

Policy instance

Insurance contract or identification number	F015766
Number of Individuals Covered	123
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $19,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907330-000

Policy instance

Insurance contract or identification number	907330-000
Number of Individuals Covered	208
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $5,794
Total amount of fees paid to insurance company	USD $0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes
Commission paid to Insurance Broker	USD $5,794
Amount paid for insurance broker fees	0
Insurance broker organization code?	3

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

19524

Policy instance

Insurance contract or identification number	19524
Number of Individuals Covered	221
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,327,981
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 )

Policy contract number

907330-000,9073

Policy instance

Insurance contract or identification number	907330-000,9073
Number of Individuals Covered	227
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $22
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	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 $57,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )

Policy contract number

01290700

Policy instance

Insurance contract or identification number	01290700
Number of Individuals Covered	236
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $436
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	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 $1,423,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )

Policy contract number

F015766

Policy instance

Insurance contract or identification number	F015766
Number of Individuals Covered	125
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $2,847
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 AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Welfare Benefit Premiums Paid to Carrier	USD $20,973
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	M & C TRUCKING COMPANY
Employer identification number (EIN):	251332393
NAIC Classification:	484120
NAIC Description:	General Freight Trucking, Long-Distance