BOARD OF TRUSTEES OPCMIA LOCAL 526 WELFARE FUND has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2023 : OPCMIA LOCAL 526 WELFARE FUND 2023 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2023-05-31 | $-150,348 |
| Total unrealized appreciation/depreciation of assets | 2023-05-31 | $-150,348 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-05-31 | $9,248 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-05-31 | $15,245 |
| Total income from all sources (including contributions) | 2023-05-31 | $6,175,857 |
| Total loss/gain on sale of assets | 2023-05-31 | $0 |
| Total of all expenses incurred | 2023-05-31 | $5,491,686 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-05-31 | $5,039,850 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-05-31 | $6,010,578 |
| Value of total assets at end of year | 2023-05-31 | $14,580,404 |
| Value of total assets at beginning of year | 2023-05-31 | $13,902,230 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-05-31 | $451,836 |
| Total income from rents | 2023-05-31 | $47,420 |
| Total interest from all sources | 2023-05-31 | $170,711 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-05-31 | $157,787 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2023-05-31 | $157,787 |
| Administrative expenses professional fees incurred | 2023-05-31 | $76,749 |
| Was this plan covered by a fidelity bond | 2023-05-31 | Yes |
| Value of fidelity bond cover | 2023-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2023-05-31 | No |
| Contributions received from participants | 2023-05-31 | $416,043 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2023-05-31 | $16,792 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-05-31 | $4,084 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-05-31 | $1,278 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-05-31 | $447 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-05-31 | $5,489 |
| Administrative expenses (other) incurred | 2023-05-31 | $63,261 |
| Liabilities. Value of operating payables at end of year | 2023-05-31 | $8,801 |
| Liabilities. Value of operating payables at beginning of year | 2023-05-31 | $9,756 |
| Total non interest bearing cash at end of year | 2023-05-31 | $612,252 |
| Total non interest bearing cash at beginning of year | 2023-05-31 | $70,247 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-05-31 | No |
| Value of net income/loss | 2023-05-31 | $684,171 |
| Value of net assets at end of year (total assets less liabilities) | 2023-05-31 | $14,571,156 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-05-31 | $13,886,985 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-05-31 | No |
| Investment advisory and management fees | 2023-05-31 | $9,819 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2023-05-31 | $7,376,531 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2023-05-31 | $7,279,035 |
| Interest earned on other investments | 2023-05-31 | $132,636 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-05-31 | $744,776 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-05-31 | $949,086 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-05-31 | $949,086 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-05-31 | $38,075 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2023-05-31 | $4,553,610 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2023-05-31 | $4,420,974 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-05-31 | $4,998,438 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2023-05-31 | $-60,291 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2023-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-05-31 | No |
| Contributions received in cash from employer | 2023-05-31 | $5,594,535 |
| Employer contributions (assets) at end of year | 2023-05-31 | $865,836 |
| Employer contributions (assets) at beginning of year | 2023-05-31 | $783,307 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-05-31 | $24,620 |
| Contract administrator fees | 2023-05-31 | $302,007 |
| Liabilities. Value of benefit claims payable at end of year | 2023-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-05-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2023-05-31 | $423,315 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2023-05-31 | $398,303 |
| Did the plan have assets held for investment | 2023-05-31 | 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 | 2023-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-05-31 | Unqualified |
| Accountancy firm name | 2023-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2023-05-31 | 270889793 |
| 2022 : OPCMIA LOCAL 526 WELFARE FUND 2022 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2022-05-31 | $-3,200 |
| Total unrealized appreciation/depreciation of assets | 2022-05-31 | $-3,200 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-05-31 | $15,245 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-05-31 | $58,185 |
| Total income from all sources (including contributions) | 2022-05-31 | $5,588,842 |
| Total loss/gain on sale of assets | 2022-05-31 | $0 |
| Total of all expenses incurred | 2022-05-31 | $6,047,578 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-05-31 | $5,597,642 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-05-31 | $5,761,598 |
| Value of total assets at end of year | 2022-05-31 | $13,902,230 |
| Value of total assets at beginning of year | 2022-05-31 | $14,403,906 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-05-31 | $449,936 |
| Total income from rents | 2022-05-31 | $48,623 |
| Total interest from all sources | 2022-05-31 | $129,555 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-05-31 | $102,830 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-05-31 | $102,830 |
| Administrative expenses professional fees incurred | 2022-05-31 | $94,869 |
| Was this plan covered by a fidelity bond | 2022-05-31 | Yes |
| Value of fidelity bond cover | 2022-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-05-31 | No |
| Contributions received from participants | 2022-05-31 | $481,812 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2022-05-31 | $7,811 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-05-31 | $1,278 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-05-31 | $5,544 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-05-31 | $5,489 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-05-31 | $21,888 |
| Other income not declared elsewhere | 2022-05-31 | $10,347 |
| Administrative expenses (other) incurred | 2022-05-31 | $62,742 |
| Liabilities. Value of operating payables at end of year | 2022-05-31 | $9,756 |
| Liabilities. Value of operating payables at beginning of year | 2022-05-31 | $36,297 |
| Total non interest bearing cash at end of year | 2022-05-31 | $70,247 |
| Total non interest bearing cash at beginning of year | 2022-05-31 | $99,323 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-05-31 | No |
| Value of net income/loss | 2022-05-31 | $-458,736 |
| Value of net assets at end of year (total assets less liabilities) | 2022-05-31 | $13,886,985 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-05-31 | $14,345,721 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-05-31 | No |
| Investment advisory and management fees | 2022-05-31 | $9,494 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-05-31 | $7,279,035 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-05-31 | $8,317,116 |
| Interest earned on other investments | 2022-05-31 | $128,772 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-05-31 | $949,086 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-05-31 | $529,495 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-05-31 | $529,495 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-05-31 | $783 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2022-05-31 | $4,420,974 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2022-05-31 | $4,292,202 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-05-31 | $5,567,411 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-05-31 | $-460,911 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-05-31 | No |
| Contributions received in cash from employer | 2022-05-31 | $5,279,786 |
| Employer contributions (assets) at end of year | 2022-05-31 | $783,307 |
| Employer contributions (assets) at beginning of year | 2022-05-31 | $747,804 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-05-31 | $22,420 |
| Contract administrator fees | 2022-05-31 | $282,831 |
| Liabilities. Value of benefit claims payable at end of year | 2022-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-05-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2022-05-31 | $398,303 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2022-05-31 | $412,422 |
| Did the plan have assets held for investment | 2022-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-05-31 | Unqualified |
| Accountancy firm name | 2022-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2022-05-31 | 270889793 |
| 2021 : OPCMIA LOCAL 526 WELFARE FUND 2021 401k financial data |
|---|
| Unrealized appreciation/depreciation of real estate assets | 2021-05-31 | $-39,253 |
| Total unrealized appreciation/depreciation of assets | 2021-05-31 | $-39,253 |
| Total transfer of assets to this plan | 2021-05-31 | $487,949 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-05-31 | $58,185 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-05-31 | $7,759 |
| Total income from all sources (including contributions) | 2021-05-31 | $6,441,561 |
| Total loss/gain on sale of assets | 2021-05-31 | $0 |
| Total of all expenses incurred | 2021-05-31 | $5,966,110 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-05-31 | $5,599,512 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-05-31 | $5,347,244 |
| Value of total assets at end of year | 2021-05-31 | $14,403,906 |
| Value of total assets at beginning of year | 2021-05-31 | $13,390,080 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-05-31 | $366,598 |
| Total income from rents | 2021-05-31 | $7,903 |
| Total interest from all sources | 2021-05-31 | $127,409 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-05-31 | $164,733 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-05-31 | $164,733 |
| Administrative expenses professional fees incurred | 2021-05-31 | $75,770 |
| Was this plan covered by a fidelity bond | 2021-05-31 | Yes |
| Value of fidelity bond cover | 2021-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-05-31 | No |
| Contributions received from participants | 2021-05-31 | $470,872 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-05-31 | $5,544 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-05-31 | $69 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-05-31 | $21,888 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-05-31 | $4,425 |
| Other income not declared elsewhere | 2021-05-31 | $5,531 |
| Administrative expenses (other) incurred | 2021-05-31 | $19,186 |
| Liabilities. Value of operating payables at end of year | 2021-05-31 | $36,297 |
| Liabilities. Value of operating payables at beginning of year | 2021-05-31 | $3,334 |
| Total non interest bearing cash at end of year | 2021-05-31 | $99,323 |
| Total non interest bearing cash at beginning of year | 2021-05-31 | $62,618 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-05-31 | No |
| Value of net income/loss | 2021-05-31 | $475,451 |
| Value of net assets at end of year (total assets less liabilities) | 2021-05-31 | $14,345,721 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-05-31 | $13,382,321 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-05-31 | No |
| Investment advisory and management fees | 2021-05-31 | $9,549 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-05-31 | $8,317,116 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-05-31 | $8,224,388 |
| Interest earned on other investments | 2021-05-31 | $127,224 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-05-31 | $529,495 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-05-31 | $302,332 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-05-31 | $302,332 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-05-31 | $185 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2021-05-31 | $4,292,202 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2021-05-31 | $4,264,979 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-05-31 | $5,586,872 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-05-31 | $827,994 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2021-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-05-31 | No |
| Contributions received in cash from employer | 2021-05-31 | $4,876,372 |
| Employer contributions (assets) at end of year | 2021-05-31 | $747,804 |
| Employer contributions (assets) at beginning of year | 2021-05-31 | $458,644 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-05-31 | $12,640 |
| Contract administrator fees | 2021-05-31 | $262,093 |
| Liabilities. Value of benefit claims payable at end of year | 2021-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-05-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2021-05-31 | $412,422 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2021-05-31 | $77,050 |
| Did the plan have assets held for investment | 2021-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-05-31 | Unqualified |
| Accountancy firm name | 2021-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2021-05-31 | 270889793 |
| 2020 : OPCMIA LOCAL 526 WELFARE FUND 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-05-31 | $0 |
| Total unrealized appreciation/depreciation of assets | 2020-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-05-31 | $7,759 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-05-31 | $7,759 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-05-31 | $7,008 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-05-31 | $7,008 |
| Total income from all sources (including contributions) | 2020-05-31 | $5,392,518 |
| Total income from all sources (including contributions) | 2020-05-31 | $5,392,518 |
| Total loss/gain on sale of assets | 2020-05-31 | $0 |
| Total loss/gain on sale of assets | 2020-05-31 | $0 |
| Total of all expenses incurred | 2020-05-31 | $5,660,523 |
| Total of all expenses incurred | 2020-05-31 | $5,660,523 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-05-31 | $5,334,115 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-05-31 | $5,334,115 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-05-31 | $4,759,522 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-05-31 | $4,759,522 |
| Value of total assets at end of year | 2020-05-31 | $13,390,080 |
| Value of total assets at end of year | 2020-05-31 | $13,390,080 |
| Value of total assets at beginning of year | 2020-05-31 | $13,657,334 |
| Value of total assets at beginning of year | 2020-05-31 | $13,657,334 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-05-31 | $326,408 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-05-31 | $326,408 |
| Total interest from all sources | 2020-05-31 | $139,754 |
| Total interest from all sources | 2020-05-31 | $139,754 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-05-31 | $174,382 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-05-31 | $174,382 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-05-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-05-31 | $174,382 |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-05-31 | $174,382 |
| Administrative expenses professional fees incurred | 2020-05-31 | $40,303 |
| Administrative expenses professional fees incurred | 2020-05-31 | $40,303 |
| Was this plan covered by a fidelity bond | 2020-05-31 | Yes |
| Was this plan covered by a fidelity bond | 2020-05-31 | Yes |
| Value of fidelity bond cover | 2020-05-31 | $5,000,000 |
| Value of fidelity bond cover | 2020-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-05-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-05-31 | No |
| Contributions received from participants | 2020-05-31 | $423,526 |
| Contributions received from participants | 2020-05-31 | $423,526 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2020-05-31 | $14,266 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2020-05-31 | $14,266 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-05-31 | $69 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-05-31 | $69 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-05-31 | $3,040 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-05-31 | $3,040 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-05-31 | $4,425 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-05-31 | $4,425 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-05-31 | $1,217 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-05-31 | $1,217 |
| Other income not declared elsewhere | 2020-05-31 | $6,835 |
| Other income not declared elsewhere | 2020-05-31 | $6,835 |
| Administrative expenses (other) incurred | 2020-05-31 | $276,408 |
| Administrative expenses (other) incurred | 2020-05-31 | $276,408 |
| Liabilities. Value of operating payables at end of year | 2020-05-31 | $3,334 |
| Liabilities. Value of operating payables at end of year | 2020-05-31 | $3,334 |
| Liabilities. Value of operating payables at beginning of year | 2020-05-31 | $5,791 |
| Liabilities. Value of operating payables at beginning of year | 2020-05-31 | $5,791 |
| Total non interest bearing cash at end of year | 2020-05-31 | $62,618 |
| Total non interest bearing cash at end of year | 2020-05-31 | $62,618 |
| Total non interest bearing cash at beginning of year | 2020-05-31 | $18,464 |
| Total non interest bearing cash at beginning of year | 2020-05-31 | $18,464 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Value of net income/loss | 2020-05-31 | $-268,005 |
| Value of net income/loss | 2020-05-31 | $-268,005 |
| Value of net assets at end of year (total assets less liabilities) | 2020-05-31 | $13,382,321 |
| Value of net assets at end of year (total assets less liabilities) | 2020-05-31 | $13,382,321 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-05-31 | $13,650,326 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-05-31 | $13,650,326 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-05-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-05-31 | No |
| Investment advisory and management fees | 2020-05-31 | $9,697 |
| Investment advisory and management fees | 2020-05-31 | $9,697 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-05-31 | $8,224,388 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-05-31 | $8,224,388 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-05-31 | $7,537,980 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-05-31 | $7,537,980 |
| Interest earned on other investments | 2020-05-31 | $114,128 |
| Interest earned on other investments | 2020-05-31 | $114,128 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-05-31 | $302,332 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-05-31 | $302,332 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-05-31 | $1,303,087 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-05-31 | $1,303,087 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-05-31 | $1,303,087 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-05-31 | $1,303,087 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-05-31 | $25,626 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-05-31 | $25,626 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2020-05-31 | $4,264,979 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2020-05-31 | $4,264,979 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2020-05-31 | $3,650,851 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2020-05-31 | $3,650,851 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-05-31 | $5,297,906 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-05-31 | $5,297,906 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-05-31 | $312,025 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-05-31 | $312,025 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-05-31 | Yes |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2020-05-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-05-31 | No |
| Contributions received in cash from employer | 2020-05-31 | $4,335,996 |
| Contributions received in cash from employer | 2020-05-31 | $4,335,996 |
| Employer contributions (assets) at end of year | 2020-05-31 | $458,644 |
| Employer contributions (assets) at end of year | 2020-05-31 | $458,644 |
| Employer contributions (assets) at beginning of year | 2020-05-31 | $753,632 |
| Employer contributions (assets) at beginning of year | 2020-05-31 | $753,632 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-05-31 | $21,943 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-05-31 | $21,943 |
| Liabilities. Value of benefit claims payable at end of year | 2020-05-31 | $0 |
| Liabilities. Value of benefit claims payable at end of year | 2020-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-05-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2020-05-31 | $77,050 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2020-05-31 | $77,050 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2020-05-31 | $390,280 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2020-05-31 | $390,280 |
| Did the plan have assets held for investment | 2020-05-31 | Yes |
| Did the plan have assets held for investment | 2020-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-05-31 | Unqualified |
| Opinion of an independent qualified public accountant for this plan | 2020-05-31 | Unqualified |
| Accountancy firm name | 2020-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm name | 2020-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2020-05-31 | 270889793 |
| Accountancy firm EIN | 2020-05-31 | 270889793 |
| 2019 : OPCMIA LOCAL 526 WELFARE FUND 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-05-31 | $7,008 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-05-31 | $6,201 |
| Total income from all sources (including contributions) | 2019-05-31 | $6,286,238 |
| Total loss/gain on sale of assets | 2019-05-31 | $0 |
| Total of all expenses incurred | 2019-05-31 | $4,851,748 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-05-31 | $4,551,243 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-05-31 | $5,906,636 |
| Value of total assets at end of year | 2019-05-31 | $13,657,334 |
| Value of total assets at beginning of year | 2019-05-31 | $12,222,037 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-05-31 | $300,505 |
| Total interest from all sources | 2019-05-31 | $144,786 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-05-31 | $161,588 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-05-31 | $161,588 |
| Administrative expenses professional fees incurred | 2019-05-31 | $44,123 |
| Was this plan covered by a fidelity bond | 2019-05-31 | Yes |
| Value of fidelity bond cover | 2019-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-05-31 | No |
| Contributions received from participants | 2019-05-31 | $493,725 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2019-05-31 | $4,106 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-05-31 | $3,040 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-05-31 | $9,071 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-05-31 | $1,217 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-05-31 | $821 |
| Administrative expenses (other) incurred | 2019-05-31 | $247,220 |
| Liabilities. Value of operating payables at end of year | 2019-05-31 | $5,791 |
| Liabilities. Value of operating payables at beginning of year | 2019-05-31 | $5,380 |
| Total non interest bearing cash at end of year | 2019-05-31 | $18,464 |
| Total non interest bearing cash at beginning of year | 2019-05-31 | $16,445 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-05-31 | No |
| Value of net income/loss | 2019-05-31 | $1,434,490 |
| Value of net assets at end of year (total assets less liabilities) | 2019-05-31 | $13,650,326 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-05-31 | $12,215,836 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-05-31 | No |
| Investment advisory and management fees | 2019-05-31 | $9,162 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-05-31 | $7,537,980 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-05-31 | $6,799,468 |
| Interest earned on other investments | 2019-05-31 | $106,341 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-05-31 | $1,303,087 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-05-31 | $1,093,938 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-05-31 | $1,093,938 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-05-31 | $38,445 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2019-05-31 | $3,650,851 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2019-05-31 | $3,544,510 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-05-31 | $4,539,466 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-05-31 | $73,228 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-05-31 | No |
| Contributions received in cash from employer | 2019-05-31 | $5,412,911 |
| Employer contributions (assets) at end of year | 2019-05-31 | $753,632 |
| Employer contributions (assets) at beginning of year | 2019-05-31 | $673,905 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-05-31 | $7,671 |
| Liabilities. Value of benefit claims payable at end of year | 2019-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-05-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2019-05-31 | $390,280 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2019-05-31 | $84,700 |
| Did the plan have assets held for investment | 2019-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-05-31 | Unqualified |
| Accountancy firm name | 2019-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2019-05-31 | 270889793 |
| 2018 : OPCMIA LOCAL 526 WELFARE FUND 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-05-31 | $6,201 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-05-31 | $43,592 |
| Total income from all sources (including contributions) | 2018-05-31 | $5,507,712 |
| Total loss/gain on sale of assets | 2018-05-31 | $0 |
| Total of all expenses incurred | 2018-05-31 | $4,579,544 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-05-31 | $4,296,171 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-05-31 | $5,131,435 |
| Value of total assets at end of year | 2018-05-31 | $12,222,037 |
| Value of total assets at beginning of year | 2018-05-31 | $11,331,260 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-05-31 | $283,373 |
| Total interest from all sources | 2018-05-31 | $105,764 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-05-31 | $118,264 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-05-31 | $118,264 |
| Administrative expenses professional fees incurred | 2018-05-31 | $58,036 |
| Was this plan covered by a fidelity bond | 2018-05-31 | Yes |
| Value of fidelity bond cover | 2018-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-05-31 | No |
| Contributions received from participants | 2018-05-31 | $555,566 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2018-05-31 | $3,835 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-05-31 | $9,071 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-05-31 | $6,960 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-05-31 | $821 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-05-31 | $609 |
| Administrative expenses (other) incurred | 2018-05-31 | $216,585 |
| Liabilities. Value of operating payables at end of year | 2018-05-31 | $5,380 |
| Liabilities. Value of operating payables at beginning of year | 2018-05-31 | $42,983 |
| Total non interest bearing cash at end of year | 2018-05-31 | $16,445 |
| Total non interest bearing cash at beginning of year | 2018-05-31 | $24,426 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Value of net income/loss | 2018-05-31 | $928,168 |
| Value of net assets at end of year (total assets less liabilities) | 2018-05-31 | $12,215,836 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-05-31 | $11,287,668 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-05-31 | No |
| Investment advisory and management fees | 2018-05-31 | $8,752 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-05-31 | $6,799,468 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-05-31 | $6,530,193 |
| Interest earned on other investments | 2018-05-31 | $91,910 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-05-31 | $1,093,938 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-05-31 | $1,135,819 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-05-31 | $1,135,819 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-05-31 | $13,854 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2018-05-31 | $3,544,510 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2018-05-31 | $2,702,600 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-05-31 | $4,284,150 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-05-31 | $152,249 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-05-31 | No |
| Contributions received in cash from employer | 2018-05-31 | $4,575,869 |
| Employer contributions (assets) at end of year | 2018-05-31 | $673,905 |
| Employer contributions (assets) at beginning of year | 2018-05-31 | $575,102 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-05-31 | $8,186 |
| Liabilities. Value of benefit claims payable at end of year | 2018-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-05-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2018-05-31 | $84,700 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2018-05-31 | $356,160 |
| Did the plan have assets held for investment | 2018-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-05-31 | Unqualified |
| Accountancy firm name | 2018-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2018-05-31 | 270889793 |
| 2017 : OPCMIA LOCAL 526 WELFARE FUND 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-05-31 | $43,592 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-05-31 | $70,008 |
| Total income from all sources (including contributions) | 2017-05-31 | $5,215,277 |
| Total loss/gain on sale of assets | 2017-05-31 | $0 |
| Total of all expenses incurred | 2017-05-31 | $4,705,755 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-05-31 | $4,355,450 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-05-31 | $4,797,203 |
| Value of total assets at end of year | 2017-05-31 | $11,331,260 |
| Value of total assets at beginning of year | 2017-05-31 | $10,848,154 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-05-31 | $350,305 |
| Total interest from all sources | 2017-05-31 | $312,046 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-05-31 | $106,028 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-05-31 | $106,028 |
| Administrative expenses professional fees incurred | 2017-05-31 | $59,441 |
| Was this plan covered by a fidelity bond | 2017-05-31 | Yes |
| Value of fidelity bond cover | 2017-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-05-31 | No |
| Contributions received from participants | 2017-05-31 | $640,494 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2017-05-31 | $6,570 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-05-31 | $6,960 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-05-31 | $5,662 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-05-31 | $609 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-05-31 | $652 |
| Administrative expenses (other) incurred | 2017-05-31 | $282,292 |
| Liabilities. Value of operating payables at end of year | 2017-05-31 | $42,983 |
| Liabilities. Value of operating payables at beginning of year | 2017-05-31 | $69,356 |
| Total non interest bearing cash at end of year | 2017-05-31 | $24,426 |
| Total non interest bearing cash at beginning of year | 2017-05-31 | $54,917 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Value of net income/loss | 2017-05-31 | $509,522 |
| Value of net assets at end of year (total assets less liabilities) | 2017-05-31 | $11,287,668 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-05-31 | $10,778,146 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-05-31 | No |
| Investment advisory and management fees | 2017-05-31 | $8,572 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-05-31 | $6,530,193 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-05-31 | $6,196,083 |
| Interest earned on other investments | 2017-05-31 | $78,720 |
| Income. Interest from corporate debt instruments | 2017-05-31 | $228,874 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-05-31 | $1,135,819 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-05-31 | $1,072,363 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-05-31 | $1,072,363 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-05-31 | $4,452 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2017-05-31 | $2,702,600 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2017-05-31 | $2,623,880 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-05-31 | $4,333,666 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-05-31 | $228,874 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-05-31 | No |
| Contributions received in cash from employer | 2017-05-31 | $4,156,709 |
| Employer contributions (assets) at end of year | 2017-05-31 | $575,102 |
| Employer contributions (assets) at beginning of year | 2017-05-31 | $519,124 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-05-31 | $15,214 |
| Liabilities. Value of benefit claims payable at end of year | 2017-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-05-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2017-05-31 | $356,160 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2017-05-31 | $376,125 |
| Did the plan have assets held for investment | 2017-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-05-31 | Unqualified |
| Accountancy firm name | 2017-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2017-05-31 | 270889793 |
| 2016 : OPCMIA LOCAL 526 WELFARE FUND 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-05-31 | $70,008 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-05-31 | $12,196 |
| Total income from all sources (including contributions) | 2016-05-31 | $4,822,675 |
| Total loss/gain on sale of assets | 2016-05-31 | $0 |
| Total of all expenses incurred | 2016-05-31 | $4,584,155 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-05-31 | $4,275,525 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-05-31 | $4,682,280 |
| Value of total assets at end of year | 2016-05-31 | $10,848,154 |
| Value of total assets at beginning of year | 2016-05-31 | $10,551,822 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-05-31 | $308,630 |
| Total interest from all sources | 2016-05-31 | $77,035 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-05-31 | $95,384 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-05-31 | $95,384 |
| Administrative expenses professional fees incurred | 2016-05-31 | $63,954 |
| Was this plan covered by a fidelity bond | 2016-05-31 | Yes |
| Value of fidelity bond cover | 2016-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-05-31 | No |
| Contributions received from participants | 2016-05-31 | $670,771 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2016-05-31 | $8,133 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-05-31 | $5,662 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-05-31 | $4,945 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-05-31 | $652 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-05-31 | $512 |
| Administrative expenses (other) incurred | 2016-05-31 | $236,324 |
| Liabilities. Value of operating payables at end of year | 2016-05-31 | $69,356 |
| Liabilities. Value of operating payables at beginning of year | 2016-05-31 | $11,684 |
| Total non interest bearing cash at end of year | 2016-05-31 | $54,917 |
| Total non interest bearing cash at beginning of year | 2016-05-31 | $39,908 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-05-31 | No |
| Value of net income/loss | 2016-05-31 | $238,520 |
| Value of net assets at end of year (total assets less liabilities) | 2016-05-31 | $10,778,146 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-05-31 | $10,539,626 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-05-31 | No |
| Investment advisory and management fees | 2016-05-31 | $8,352 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-05-31 | $6,196,083 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-05-31 | $6,133,369 |
| Interest earned on other investments | 2016-05-31 | $76,427 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-05-31 | $1,072,363 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-05-31 | $826,268 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-05-31 | $826,268 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-05-31 | $608 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2016-05-31 | $2,623,880 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2016-05-31 | $2,547,453 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-05-31 | $4,245,063 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-05-31 | $-32,024 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-05-31 | No |
| Contributions received in cash from employer | 2016-05-31 | $4,011,509 |
| Employer contributions (assets) at end of year | 2016-05-31 | $519,124 |
| Employer contributions (assets) at beginning of year | 2016-05-31 | $634,096 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-05-31 | $22,329 |
| Liabilities. Value of benefit claims payable at end of year | 2016-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-05-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2016-05-31 | $376,125 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2016-05-31 | $365,783 |
| Did the plan have assets held for investment | 2016-05-31 | 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 | 2016-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-05-31 | Unqualified |
| Accountancy firm name | 2016-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2016-05-31 | 270889793 |
| 2015 : OPCMIA LOCAL 526 WELFARE FUND 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $12,196 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-05-31 | $13,747 |
| Total income from all sources (including contributions) | 2015-05-31 | $4,634,663 |
| Total loss/gain on sale of assets | 2015-05-31 | $0 |
| Total of all expenses incurred | 2015-05-31 | $4,512,737 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-05-31 | $4,232,229 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-05-31 | $4,300,480 |
| Value of total assets at end of year | 2015-05-31 | $10,551,822 |
| Value of total assets at beginning of year | 2015-05-31 | $10,431,447 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-05-31 | $280,508 |
| Total interest from all sources | 2015-05-31 | $74,258 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-05-31 | $95,407 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-05-31 | $95,407 |
| Administrative expenses professional fees incurred | 2015-05-31 | $64,362 |
| Was this plan covered by a fidelity bond | 2015-05-31 | Yes |
| Value of fidelity bond cover | 2015-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-05-31 | No |
| Contributions received from participants | 2015-05-31 | $721,744 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2015-05-31 | $5,186 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-05-31 | $4,945 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-05-31 | $4,508 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-05-31 | $512 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-05-31 | $5 |
| Administrative expenses (other) incurred | 2015-05-31 | $207,778 |
| Liabilities. Value of operating payables at end of year | 2015-05-31 | $11,684 |
| Liabilities. Value of operating payables at beginning of year | 2015-05-31 | $11,503 |
| Total non interest bearing cash at end of year | 2015-05-31 | $39,908 |
| Total non interest bearing cash at beginning of year | 2015-05-31 | $51,851 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-05-31 | No |
| Value of net income/loss | 2015-05-31 | $121,926 |
| Value of net assets at end of year (total assets less liabilities) | 2015-05-31 | $10,539,626 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-05-31 | $10,417,700 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-05-31 | No |
| Investment advisory and management fees | 2015-05-31 | $8,368 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-05-31 | $6,133,369 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-05-31 | $6,373,881 |
| Interest earned on other investments | 2015-05-31 | $74,201 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-05-31 | $826,268 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-05-31 | $746,723 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-05-31 | $746,723 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-05-31 | $57 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2015-05-31 | $2,547,453 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2015-05-31 | $2,473,251 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-05-31 | $4,209,160 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-05-31 | $164,518 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-05-31 | No |
| Contributions received in cash from employer | 2015-05-31 | $3,578,736 |
| Employer contributions (assets) at end of year | 2015-05-31 | $634,096 |
| Employer contributions (assets) at beginning of year | 2015-05-31 | $440,569 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-05-31 | $17,883 |
| Liabilities. Value of benefit claims payable at end of year | 2015-05-31 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-05-31 | $2,239 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2015-05-31 | $365,783 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2015-05-31 | $340,664 |
| Did the plan have assets held for investment | 2015-05-31 | 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 | 2015-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-05-31 | Unqualified |
| Accountancy firm name | 2015-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2015-05-31 | 270889793 |
| 2014 : OPCMIA LOCAL 526 WELFARE FUND 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $13,747 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-05-31 | $9,475 |
| Total income from all sources (including contributions) | 2014-05-31 | $4,304,134 |
| Total loss/gain on sale of assets | 2014-05-31 | $0 |
| Total of all expenses incurred | 2014-05-31 | $4,006,212 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-05-31 | $3,734,380 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-05-31 | $3,855,752 |
| Value of total assets at end of year | 2014-05-31 | $10,431,447 |
| Value of total assets at beginning of year | 2014-05-31 | $10,129,253 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-05-31 | $271,832 |
| Total interest from all sources | 2014-05-31 | $72,081 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-05-31 | $90,370 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2014-05-31 | $90,370 |
| Administrative expenses professional fees incurred | 2014-05-31 | $63,541 |
| Was this plan covered by a fidelity bond | 2014-05-31 | Yes |
| Value of fidelity bond cover | 2014-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-05-31 | No |
| Contributions received from participants | 2014-05-31 | $429,132 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2014-05-31 | $2,839 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-05-31 | $4,508 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-05-31 | $5,859 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-05-31 | $5 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-05-31 | $260 |
| Administrative expenses (other) incurred | 2014-05-31 | $199,929 |
| Liabilities. Value of operating payables at end of year | 2014-05-31 | $11,503 |
| Liabilities. Value of operating payables at beginning of year | 2014-05-31 | $5,535 |
| Total non interest bearing cash at end of year | 2014-05-31 | $51,851 |
| Total non interest bearing cash at beginning of year | 2014-05-31 | $17,233 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-05-31 | No |
| Value of net income/loss | 2014-05-31 | $297,922 |
| Value of net assets at end of year (total assets less liabilities) | 2014-05-31 | $10,417,700 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-05-31 | $10,119,778 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-05-31 | No |
| Investment advisory and management fees | 2014-05-31 | $8,362 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-05-31 | $6,373,881 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-05-31 | $5,597,986 |
| Interest earned on other investments | 2014-05-31 | $72,039 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-05-31 | $746,723 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-05-31 | $1,242,657 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-05-31 | $1,242,657 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-05-31 | $42 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2014-05-31 | $2,473,251 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2014-05-31 | $2,401,212 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-05-31 | $3,723,441 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2014-05-31 | $285,931 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-05-31 | No |
| Contributions received in cash from employer | 2014-05-31 | $3,426,620 |
| Employer contributions (assets) at end of year | 2014-05-31 | $440,569 |
| Employer contributions (assets) at beginning of year | 2014-05-31 | $562,159 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-05-31 | $8,100 |
| Liabilities. Value of benefit claims payable at end of year | 2014-05-31 | $2,239 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-05-31 | $3,680 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2014-05-31 | $340,664 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2014-05-31 | $302,147 |
| Did the plan have assets held for investment | 2014-05-31 | 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 | 2014-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-05-31 | Unqualified |
| Accountancy firm name | 2014-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2014-05-31 | 270889793 |
| 2013 : OPCMIA LOCAL 526 WELFARE FUND 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $9,475 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-05-31 | $3,520 |
| Total income from all sources (including contributions) | 2013-05-31 | $4,491,054 |
| Total loss/gain on sale of assets | 2013-05-31 | $0 |
| Total of all expenses incurred | 2013-05-31 | $3,680,865 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-05-31 | $3,422,400 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-05-31 | $4,059,301 |
| Value of total assets at end of year | 2013-05-31 | $10,129,253 |
| Value of total assets at beginning of year | 2013-05-31 | $9,313,109 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-05-31 | $258,465 |
| Total interest from all sources | 2013-05-31 | $69,978 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-05-31 | $80,833 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2013-05-31 | $80,833 |
| Administrative expenses professional fees incurred | 2013-05-31 | $51,861 |
| Was this plan covered by a fidelity bond | 2013-05-31 | Yes |
| Value of fidelity bond cover | 2013-05-31 | $5,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-05-31 | No |
| Contributions received from participants | 2013-05-31 | $387,186 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-05-31 | $1,020 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-05-31 | $5,859 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-05-31 | $1,757 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-05-31 | $260 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-05-31 | $991 |
| Administrative expenses (other) incurred | 2013-05-31 | $198,526 |
| Liabilities. Value of operating payables at end of year | 2013-05-31 | $5,535 |
| Liabilities. Value of operating payables at beginning of year | 2013-05-31 | $2,529 |
| Total non interest bearing cash at end of year | 2013-05-31 | $17,233 |
| Total non interest bearing cash at beginning of year | 2013-05-31 | $102,800 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
| Value of net income/loss | 2013-05-31 | $810,189 |
| Value of net assets at end of year (total assets less liabilities) | 2013-05-31 | $10,119,778 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-05-31 | $9,309,589 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-05-31 | No |
| Investment advisory and management fees | 2013-05-31 | $8,078 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2013-05-31 | $5,597,986 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2013-05-31 | $1,240,313 |
| Interest earned on other investments | 2013-05-31 | $69,942 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-05-31 | $1,242,657 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-05-31 | $4,650,756 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-05-31 | $4,650,756 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-05-31 | $36 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2013-05-31 | $2,401,212 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2013-05-31 | $2,331,270 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-05-31 | $3,415,423 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-05-31 | $280,942 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-05-31 | No |
| Contributions received in cash from employer | 2013-05-31 | $3,672,115 |
| Employer contributions (assets) at end of year | 2013-05-31 | $562,159 |
| Employer contributions (assets) at beginning of year | 2013-05-31 | $550,349 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-05-31 | $5,957 |
| Liabilities. Value of benefit claims payable at end of year | 2013-05-31 | $3,680 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-05-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2013-05-31 | $302,147 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2013-05-31 | $435,864 |
| Did the plan have assets held for investment | 2013-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-05-31 | Unqualified |
| Accountancy firm name | 2013-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2013-05-31 | 270889793 |
| 2012 : OPCMIA LOCAL 526 WELFARE FUND 2012 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2012-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $3,520 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-05-31 | $7,728 |
| Total income from all sources (including contributions) | 2012-05-31 | $4,899,116 |
| Total loss/gain on sale of assets | 2012-05-31 | $0 |
| Total of all expenses incurred | 2012-05-31 | $3,878,275 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-05-31 | $3,669,070 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-05-31 | $4,853,635 |
| Value of total assets at end of year | 2012-05-31 | $9,313,109 |
| Value of total assets at beginning of year | 2012-05-31 | $8,296,476 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-05-31 | $209,205 |
| Total interest from all sources | 2012-05-31 | $68,037 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-05-31 | $22,884 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-05-31 | $22,884 |
| Administrative expenses professional fees incurred | 2012-05-31 | $34,482 |
| Was this plan covered by a fidelity bond | 2012-05-31 | Yes |
| Value of fidelity bond cover | 2012-05-31 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-05-31 | No |
| Contributions received from participants | 2012-05-31 | $709,024 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-05-31 | $1,555 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-05-31 | $1,757 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-05-31 | $5,750 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-05-31 | $991 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-05-31 | $991 |
| Administrative expenses (other) incurred | 2012-05-31 | $167,148 |
| Liabilities. Value of operating payables at end of year | 2012-05-31 | $2,529 |
| Liabilities. Value of operating payables at beginning of year | 2012-05-31 | $6,737 |
| Total non interest bearing cash at end of year | 2012-05-31 | $102,800 |
| Total non interest bearing cash at beginning of year | 2012-05-31 | $306,237 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
| Value of net income/loss | 2012-05-31 | $1,020,841 |
| Value of net assets at end of year (total assets less liabilities) | 2012-05-31 | $9,309,589 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-05-31 | $8,288,748 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-05-31 | No |
| Investment advisory and management fees | 2012-05-31 | $7,575 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-05-31 | $1,240,313 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-05-31 | $1,262,868 |
| Interest earned on other investments | 2012-05-31 | $67,904 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-05-31 | $4,650,756 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-05-31 | $3,709,556 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-05-31 | $3,709,556 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-05-31 | $133 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2012-05-31 | $2,331,270 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2012-05-31 | $2,263,366 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-05-31 | $3,660,744 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-05-31 | $-45,440 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-05-31 | No |
| Contributions received in cash from employer | 2012-05-31 | $4,144,611 |
| Employer contributions (assets) at end of year | 2012-05-31 | $550,349 |
| Employer contributions (assets) at beginning of year | 2012-05-31 | $436,091 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-05-31 | $6,771 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2012-05-31 | $435,864 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2012-05-31 | $312,608 |
| Did the plan have assets held for investment | 2012-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-05-31 | Unqualified |
| Accountancy firm name | 2012-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2012-05-31 | 270889793 |
| 2011 : OPCMIA LOCAL 526 WELFARE FUND 2011 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2011-05-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-05-31 | $7,728 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-05-31 | $144,467 |
| Total income from all sources (including contributions) | 2011-05-31 | $4,856,260 |
| Total loss/gain on sale of assets | 2011-05-31 | $0 |
| Total of all expenses incurred | 2011-05-31 | $4,483,086 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-05-31 | $4,151,908 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-05-31 | $4,517,524 |
| Value of total assets at end of year | 2011-05-31 | $8,296,476 |
| Value of total assets at beginning of year | 2011-05-31 | $8,060,041 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-05-31 | $331,178 |
| Total interest from all sources | 2011-05-31 | $66,270 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-05-31 | $22,550 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-05-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-05-31 | $22,550 |
| Administrative expenses professional fees incurred | 2011-05-31 | $42,650 |
| Was this plan covered by a fidelity bond | 2011-05-31 | Yes |
| Value of fidelity bond cover | 2011-05-31 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-05-31 | No |
| Contributions received from participants | 2011-05-31 | $843,598 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-05-31 | $184 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-05-31 | $5,750 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-05-31 | $3,553 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-05-31 | $991 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-05-31 | $142,932 |
| Administrative expenses (other) incurred | 2011-05-31 | $2,651 |
| Liabilities. Value of operating payables at end of year | 2011-05-31 | $6,737 |
| Liabilities. Value of operating payables at beginning of year | 2011-05-31 | $1,535 |
| Total non interest bearing cash at end of year | 2011-05-31 | $306,237 |
| Total non interest bearing cash at beginning of year | 2011-05-31 | $23,310 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
| Value of net income/loss | 2011-05-31 | $373,174 |
| Value of net assets at end of year (total assets less liabilities) | 2011-05-31 | $8,288,748 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-05-31 | $7,915,574 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-05-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-05-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-05-31 | No |
| Investment advisory and management fees | 2011-05-31 | $7,322 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-05-31 | $1,262,868 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2011-05-31 | $991,569 |
| Interest earned on other investments | 2011-05-31 | $65,926 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-05-31 | $3,709,556 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-05-31 | $4,097,564 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-05-31 | $4,097,564 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-05-31 | $344 |
| Value of funds held in insurance company general accounts (unallocated contracts) at end of year | 2011-05-31 | $2,263,366 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2011-05-31 | $2,197,440 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-05-31 | $4,150,631 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2011-05-31 | $249,916 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-05-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-05-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-05-31 | No |
| Contributions received in cash from employer | 2011-05-31 | $3,673,926 |
| Employer contributions (assets) at end of year | 2011-05-31 | $436,091 |
| Employer contributions (assets) at beginning of year | 2011-05-31 | $560,582 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-05-31 | $1,093 |
| Contract administrator fees | 2011-05-31 | $278,555 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2011-05-31 | $312,608 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2011-05-31 | $186,023 |
| Did the plan have assets held for investment | 2011-05-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-05-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-05-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-05-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-05-31 | Unqualified |
| Accountancy firm name | 2011-05-31 | DICLAUDIO & KRAMER, LLC |
| Accountancy firm EIN | 2011-05-31 | 270889793 |
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 495 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | 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? | Yes | | 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 $0 | | 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 | 022940 |
| Policy instance | 1 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | 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 $163,680 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 3 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 335 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $8,521 | | Total amount of fees paid to insurance company | USD $637 | | 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 | | 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 $71,678 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,521 | | Amount paid for insurance broker fees | 637 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 4 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $16,016 | | Total amount of fees paid to insurance company | USD $425 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $128,464 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,720 | | Amount paid for insurance broker fees | 111 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 022940 |
| Policy instance | 5 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 554 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | 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 | 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 $3,340,204 | | 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 | 022940 |
| Policy instance | 6 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 577 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | 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 $1,003,566 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC6347508 |
| Policy instance | 7 |
| Insurance contract or identification number | MC6347508 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | 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 $122,313 | | 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 | 022940 |
| Policy instance | 8 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 423 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | 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 $151,091 | | 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 | 022940 |
| Policy instance | 9 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 423 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | 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 $25,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 4 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $17,539 | | Total amount of fees paid to insurance company | USD $322 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $154,493 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,407 | | Amount paid for insurance broker fees | 153 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 022940 |
| Policy instance | 5 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 596 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | 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 | 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 $3,948,016 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC6347508 |
| Policy instance | 7 |
| Insurance contract or identification number | MC6347508 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | 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 $130,050 | | 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 | 022940 |
| Policy instance | 6 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 630 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | 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 $877,070 | | 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 | 022940 |
| Policy instance | 8 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 376 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | 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 $95,968 | | 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 | 022940 |
| Policy instance | 9 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 381 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | 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 $16,060 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 520 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | 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? | Yes | | 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 $0 | | 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 | 01435900 |
| Policy instance | 1 |
| Insurance contract or identification number | 01435900 | | Number of Individuals Covered | 41 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | 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 $179,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 3 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 442 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $23,146 | | 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 | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $283,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,302 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 022940 |
| Policy instance | 5 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 681 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $57,669 | | 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 $3,943,140 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,669 | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 4 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $20,724 | | Total amount of fees paid to insurance company | USD $334 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $173,900 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,041 | | Amount paid for insurance broker fees | 225 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 627 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | 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? | Yes | | 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 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01435900 |
| Policy instance | 1 |
| Insurance contract or identification number | 01435900 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | 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 $205,836 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC6347508 |
| Policy instance | 7 |
| Insurance contract or identification number | MC6347508 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | 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 $135,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 3 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 425 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $20,487 | | 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 | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $347,460 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,755 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 022940 |
| Policy instance | 6 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 707 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $12,504 | | 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 | 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 $829,969 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,504 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 022940 |
| Policy instance | 5 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 703 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $70,390 | | 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 $3,519,521 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $70,390 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC6347508 |
| Policy instance | 7 |
| Insurance contract or identification number | MC6347508 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | 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 $140,044 | | 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 | 022940 |
| Policy instance | 6 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 737 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $17,918 | | 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 | 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 $895,909 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,918 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 3 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 418 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $20,105 | | 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 | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $325,131 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,105 | | Insurance broker organization code? | 3 |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 592 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | 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? | Yes | | 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 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 4 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $27,018 | | Total amount of fees paid to insurance company | USD $789 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $162,288 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,165 | | Amount paid for insurance broker fees | 361 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01435900 |
| Policy instance | 1 |
| Insurance contract or identification number | 01435900 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | 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 $238,719 | | 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 | 022940 |
| Policy instance | 6 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 726 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $15,214 | | 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 | 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 $760,709 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,214 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 022940 |
| Policy instance | 5 |
| Insurance contract or identification number | 022940 | | Number of Individuals Covered | 705 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $57,762 | | 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 $2,888,123 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $57,762 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | COMMISSIONS | | Insurance broker organization code? | 3 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 4 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $17,561 | | Total amount of fees paid to insurance company | USD $184 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $148,212 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,913 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01435900 |
| Policy instance | 1 |
| Insurance contract or identification number | 01435900 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | 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 $305,520 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 633 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | 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? | Yes | | 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 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 3 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 381 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $18,866 | | 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 | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $302,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,866 | | Insurance broker organization code? | 3 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584 801, 905 |
| Policy instance | 3 |
| Insurance contract or identification number | 10584 801, 905 | | Number of Individuals Covered | 116 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | 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 $606,417 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 4 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 374 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | Total amount of commissions paid to insurance broker | USD $16,728 | | 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 | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $284,629 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584 800,904 |
| Policy instance | 6 |
| Insurance contract or identification number | 10584 800,904 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | 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 $258,030 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 639 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | 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? | Yes | | 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 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01435900 |
| Policy instance | 1 |
| Insurance contract or identification number | 01435900 | | Number of Individuals Covered | 88 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | 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 $370,285 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 7 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $22,051 | | Total amount of fees paid to insurance company | USD $966 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $147,244 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584 802,906 |
| Policy instance | 8 |
| Insurance contract or identification number | 10584 802,906 | | Number of Individuals Covered | 447 | | Insurance policy start date | 2016-10-01 | | Insurance policy end date | 2017-09-30 | | 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 $2,614,525 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC6347500, 508 |
| Policy instance | 5 |
| Insurance contract or identification number | MC6347500, 508 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | 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 | 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 $100,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584 902 |
| Policy instance | 9 |
| Insurance contract or identification number | 10584 902 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $110,599 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 8 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Total amount of commissions paid to insurance broker | USD $16,026 | | Total amount of fees paid to insurance company | USD $1,084 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $137,761 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,527 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | LISA M BRYER |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584 800,904 |
| Policy instance | 7 |
| Insurance contract or identification number | 10584 800,904 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $186,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584-302 |
| Policy instance | 6 |
| Insurance contract or identification number | 10584-302 | | Number of Individuals Covered | 410 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,344,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584 801, 905 |
| Policy instance | 3 |
| Insurance contract or identification number | 10584 801, 905 | | Number of Individuals Covered | 148 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $725,306 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC6347500, 508 |
| Policy instance | 5 |
| Insurance contract or identification number | MC6347500, 508 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $101,304 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 562 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | 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? | Yes | | 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 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 4 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 359 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $17,367 | | Total amount of fees paid to insurance company | USD $7,616 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $279,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,367 | | Amount paid for insurance broker fees | 7616 | | Additional information about fees paid to insurance broker | PLACEMENT OF POLICY | | Insurance broker organization code? | 3 | | Insurance broker name | PATRICIA M CUMMINGS |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01435900 |
| Policy instance | 1 |
| Insurance contract or identification number | 01435900 | | Number of Individuals Covered | 100 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | 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 | 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 $437,479 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584-302,303 |
| Policy instance | 6 |
| Insurance contract or identification number | 10584-302,303 | | Number of Individuals Covered | 426 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,068,715 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 8 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $18,842 | | Total amount of fees paid to insurance company | USD $643 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $142,765 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,114 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | ROBERT A EWING |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584 800,904 |
| Policy instance | 7 |
| Insurance contract or identification number | 10584 800,904 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $156,331 | | 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 | 01435900 |
| Policy instance | 1 |
| Insurance contract or identification number | 01435900 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | 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 | 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 $508,300 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 554 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | 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? | Yes | | 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 |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584 801, 905 |
| Policy instance | 3 |
| Insurance contract or identification number | 10584 801, 905 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $530,306 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 ) |
| Policy contract number | 10584 902,903 |
| Policy instance | 9 |
| Insurance contract or identification number | 10584 902,903 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $94,865 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC6347500, 508 |
| Policy instance | 5 |
| Insurance contract or identification number | MC6347500, 508 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $84,158 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 4 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 370 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $13,174 | | Total amount of fees paid to insurance company | USD $7,680 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $245,806 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,174 | | Amount paid for insurance broker fees | 7680 | | Additional information about fees paid to insurance broker | PLACEMENT OF POLICY | | Insurance broker organization code? | 3 | | Insurance broker name | PATRICIA M CUMMINGS |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 4 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 360 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $15,943 | | Total amount of fees paid to insurance company | USD $9,375 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $259,263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,943 | | Amount paid for insurance broker fees | 9375 | | Additional information about fees paid to insurance broker | PLACEMENT OF POLICY | | Insurance broker organization code? | 3 | | Insurance broker name | PATRICIA M CUMMINGS |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01436070 |
| Policy instance | 1 |
| Insurance contract or identification number | 01436070 | | Number of Individuals Covered | 122 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | 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 | 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 $229,041 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 2 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 525 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | 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? | Yes | | 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 |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584 801, 905 |
| Policy instance | 3 |
| Insurance contract or identification number | 10584 801, 905 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $493,054 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 8 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $16,863 | | Total amount of fees paid to insurance company | USD $213 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $138,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,823 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | TIMOTHY SLATER |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC6347500, 508 |
| Policy instance | 5 |
| Insurance contract or identification number | MC6347500, 508 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $33,002 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584 800,904 |
| Policy instance | 7 |
| Insurance contract or identification number | 10584 800,904 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $151,225 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584-302,303 |
| Policy instance | 6 |
| Insurance contract or identification number | 10584-302,303 | | Number of Individuals Covered | 447 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,115,860 | | 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 | 01436070 |
| Policy instance | 1 |
| Insurance contract or identification number | 01436070 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $620 | | 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 | 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 $327,206 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $620 | | Insurance broker organization code? | 3 | | Insurance broker name | M. SUZANNE TRACEY & ASSOCIATES |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 8 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | 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? | Yes | | 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 |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 7 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $17,891 | | Total amount of fees paid to insurance company | USD $637 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $137,886 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,876 | | Amount paid for insurance broker fees | 0 | | Additional information about fees paid to insurance broker | FINDER FEES | | Insurance broker organization code? | 3 | | Insurance broker name | TIMOTHY SLATER |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584 800,904 |
| Policy instance | 6 |
| Insurance contract or identification number | 10584 800,904 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $1,677 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $167,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,677 | | Insurance broker organization code? | 3 | | Insurance broker name | M. SUZANNE TRACEY & ASSOCIATES |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584302-03,902 |
| Policy instance | 5 |
| Insurance contract or identification number | 10584302-03,902 | | Number of Individuals Covered | 427 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $18,160 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $1,815,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $18,160 | | Insurance broker organization code? | 3 | | Insurance broker name | M. SUZANNE TRACEY & ASSOCIATES |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584 801, 905 |
| Policy instance | 2 |
| Insurance contract or identification number | 10584 801, 905 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $4,881 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $488,074 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $4,881 | | Insurance broker organization code? | 3 | | Insurance broker name | M. SUZANNE TRACEY & ASSOCIATES |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC0010515,10524 |
| Policy instance | 4 |
| Insurance contract or identification number | MC0010515,10524 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $28,070 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 3 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 360 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $13,190 | | Total amount of fees paid to insurance company | USD $10,387 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $222,364 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,190 | | Amount paid for insurance broker fees | 10387 | | Additional information about fees paid to insurance broker | PLACEMENT OF POLICY | | Insurance broker organization code? | 3 | | Insurance broker name | PATRICIA M CUMMINGS |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01436070 |
| Policy instance | 1 |
| Insurance contract or identification number | 01436070 | | Number of Individuals Covered | 150 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | 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 | 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 $590,935 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584 801, 905 |
| Policy instance | 2 |
| Insurance contract or identification number | 10584 801, 905 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $772,272 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 3 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $12,557 | | Total amount of fees paid to insurance company | USD $6,881 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $222,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584302-03,902 |
| Policy instance | 5 |
| Insurance contract or identification number | 10584302-03,902 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,097,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 7 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $45,794 | | Total amount of fees paid to insurance company | USD $5,907 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $153,905 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584 800,904 |
| Policy instance | 6 |
| Insurance contract or identification number | 10584 800,904 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $290,908 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 8 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 517 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | 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? | Yes | | 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 |
|
| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC0010515 |
| Policy instance | 4 |
| Insurance contract or identification number | MC0010515 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $44,910 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 04181770 |
| Policy instance | 1 |
| Insurance contract or identification number | 04181770 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $773 | | 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 | 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 $601,684 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HEALTHAMERICA OF PENNSYLVANIA, INC. HMO (National Association of Insurance Commissioners NAIC id number: 95060 ) |
| Policy contract number | 2185140000 |
| Policy instance | 10 |
| Insurance contract or identification number | 2185140000 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $19,260 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC0010 524 |
| Policy instance | 9 |
| Insurance contract or identification number | MC0010 524 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $4,635 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| PRUDENTIAL RETIREMENT INSURANCE AND ANNUITY COMPANY (National Association of Insurance Commissioners NAIC id number: 93629 ) |
| Policy contract number | 36738-001 |
| Policy instance | 8 |
| Insurance contract or identification number | 36738-001 | | Number of Individuals Covered | 345 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | 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? | Yes | | 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 |
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| COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 ) |
| Policy contract number | E3588274 |
| Policy instance | 7 |
| Insurance contract or identification number | E3588274 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2010-10-22 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $46,969 | | Total amount of fees paid to insurance company | USD $14,318 | | 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 | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $84,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584 800,904 |
| Policy instance | 6 |
| Insurance contract or identification number | 10584 800,904 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2009-10-01 | | Insurance policy end date | 2010-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $283,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584302-03 |
| Policy instance | 5 |
| Insurance contract or identification number | 10584302-03 | | Number of Individuals Covered | 396 | | Insurance policy start date | 2009-10-01 | | Insurance policy end date | 2010-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,234,102 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00430493 |
| Policy instance | 3 |
| Insurance contract or identification number | 00430493 | | Number of Individuals Covered | 399 | | Insurance policy start date | 2009-10-01 | | Insurance policy end date | 2010-09-30 | | Total amount of commissions paid to insurance broker | USD $10,254 | | Total amount of fees paid to insurance company | USD $3,734 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $200,383 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UPMC HEALTH NETWORK, INC. (National Association of Insurance Commissioners NAIC id number: 11994 ) |
| Policy contract number | 10584 300-1,900 |
| Policy instance | 2 |
| Insurance contract or identification number | 10584 300-1,900 | | Number of Individuals Covered | 180 | | Insurance policy start date | 2009-10-01 | | Insurance policy end date | 2010-09-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $774,247 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UPMC HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95216 ) |
| Policy contract number | MC0010515 |
| Policy instance | 4 |
| Insurance contract or identification number | MC0010515 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $23,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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