DELPHI SALARIED RETIREES ASSOCIATION BENEFIT TRUST has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2022 : DSRA BENEFIT TRUST PLAN 2022 401k financial data |
|---|
| Total income from all sources (including contributions) | 2022-12-31 | $11,869,909 |
| Total of all expenses incurred | 2022-12-31 | $12,193,856 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $11,094,228 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $11,958,173 |
| Value of total assets at end of year | 2022-12-31 | $805,926 |
| Value of total assets at beginning of year | 2022-12-31 | $1,129,873 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $1,099,628 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $47,490 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-12-31 | $47,490 |
| Administrative expenses professional fees incurred | 2022-12-31 | $27,000 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $11,958,173 |
| Other income not declared elsewhere | 2022-12-31 | $57,395 |
| Administrative expenses (other) incurred | 2022-12-31 | $192,453 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-323,947 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $805,926 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $1,129,873 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Investment advisory and management fees | 2022-12-31 | $16,230 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $265,931 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $332,397 |
| Value of interest in common/collective trusts at end of year | 2022-12-31 | $497,650 |
| Value of interest in common/collective trusts at beginning of year | 2022-12-31 | $793,327 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $42,345 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $4,149 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $4,149 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $11,094,228 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-193,149 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contract administrator fees | 2022-12-31 | $863,945 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-12-31 | No |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | SOMERSET CPAS, P.C. |
| Accountancy firm EIN | 2022-12-31 | 201717681 |
| 2021 : DSRA BENEFIT TRUST PLAN 2021 401k financial data |
|---|
| Total income from all sources (including contributions) | 2021-12-31 | $12,904,266 |
| Total of all expenses incurred | 2021-12-31 | $13,040,933 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $12,247,370 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $12,705,019 |
| Value of total assets at end of year | 2021-12-31 | $1,129,873 |
| Value of total assets at beginning of year | 2021-12-31 | $1,266,540 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $793,563 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $93,286 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-12-31 | $93,286 |
| Administrative expenses professional fees incurred | 2021-12-31 | $22,500 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $12,705,019 |
| Other income not declared elsewhere | 2021-12-31 | $55,410 |
| Administrative expenses (other) incurred | 2021-12-31 | $297,057 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $-136,667 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $1,129,873 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $1,266,540 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Investment advisory and management fees | 2021-12-31 | $16,357 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-12-31 | $332,397 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-12-31 | $441,357 |
| Value of interest in common/collective trusts at end of year | 2021-12-31 | $793,327 |
| Value of interest in common/collective trusts at beginning of year | 2021-12-31 | $793,473 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $4,149 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $31,710 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $31,710 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $12,247,370 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-12-31 | $50,551 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contract administrator fees | 2021-12-31 | $457,649 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-12-31 | No |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | SOMERSET CPAS, P.C. |
| Accountancy firm EIN | 2021-12-31 | 201717681 |
| 2020 : DSRA BENEFIT TRUST PLAN 2020 401k financial data |
|---|
| Total income from all sources (including contributions) | 2020-12-31 | $13,606,121 |
| Total of all expenses incurred | 2020-12-31 | $13,581,661 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $12,789,451 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $13,377,386 |
| Value of total assets at end of year | 2020-12-31 | $1,266,540 |
| Value of total assets at beginning of year | 2020-12-31 | $1,242,080 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $792,210 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-12-31 | $79,826 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-12-31 | $79,826 |
| Administrative expenses professional fees incurred | 2020-12-31 | $24,500 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $13,377,386 |
| Other income not declared elsewhere | 2020-12-31 | $94,445 |
| Administrative expenses (other) incurred | 2020-12-31 | $162,921 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $24,460 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $1,266,540 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $1,242,080 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Investment advisory and management fees | 2020-12-31 | $16,854 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-12-31 | $441,357 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-12-31 | $427,645 |
| Value of interest in common/collective trusts at end of year | 2020-12-31 | $793,473 |
| Value of interest in common/collective trusts at beginning of year | 2020-12-31 | $744,703 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $31,710 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $69,732 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $69,732 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $12,789,451 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-12-31 | $54,464 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contract administrator fees | 2020-12-31 | $587,935 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-12-31 | No |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | SOMERSET CPAS, P.C. |
| Accountancy firm EIN | 2020-12-31 | 201717681 |
| 2019 : DSRA BENEFIT TRUST PLAN 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-12-31 | $18,435,428 |
| Total of all expenses incurred | 2019-12-31 | $18,283,204 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $16,942,544 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $17,870,307 |
| Value of total assets at end of year | 2019-12-31 | $1,242,080 |
| Value of total assets at beginning of year | 2019-12-31 | $1,089,856 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $1,340,660 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $105,970 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-12-31 | $105,970 |
| Administrative expenses professional fees incurred | 2019-12-31 | $24,500 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $17,870,307 |
| Other income not declared elsewhere | 2019-12-31 | $368,661 |
| Administrative expenses (other) incurred | 2019-12-31 | $371,802 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $152,224 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $1,242,080 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $1,089,856 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Investment advisory and management fees | 2019-12-31 | $16,595 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-12-31 | $427,645 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-12-31 | $412,381 |
| Value of interest in common/collective trusts at end of year | 2019-12-31 | $744,703 |
| Value of interest in common/collective trusts at beginning of year | 2019-12-31 | $634,577 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $69,732 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $42,898 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $42,898 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $16,942,544 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-12-31 | $90,490 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contract administrator fees | 2019-12-31 | $927,763 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | SOMERSET CPAS, P.C. |
| Accountancy firm EIN | 2019-12-31 | 201717681 |
| 2018 : DSRA BENEFIT TRUST PLAN 2018 401k financial data |
|---|
| Total income from all sources (including contributions) | 2018-12-31 | $20,586,158 |
| Total of all expenses incurred | 2018-12-31 | $20,907,091 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $19,656,569 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $20,429,769 |
| Value of total assets at end of year | 2018-12-31 | $1,089,856 |
| Value of total assets at beginning of year | 2018-12-31 | $1,410,789 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $1,250,522 |
| Total interest from all sources | 2018-12-31 | $433 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-12-31 | $34,083 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-12-31 | $34,083 |
| Administrative expenses professional fees incurred | 2018-12-31 | $32,835 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $20,429,769 |
| Other income not declared elsewhere | 2018-12-31 | $214,901 |
| Administrative expenses (other) incurred | 2018-12-31 | $428,046 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $-320,933 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $1,089,856 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $1,410,789 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Investment advisory and management fees | 2018-12-31 | $16,441 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-12-31 | $412,381 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-12-31 | $567,555 |
| Value of interest in common/collective trusts at end of year | 2018-12-31 | $634,577 |
| Value of interest in common/collective trusts at beginning of year | 2018-12-31 | $805,414 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $42,898 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $37,820 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $37,820 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-12-31 | $433 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $19,656,569 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-12-31 | $-74,261 |
| Net investment gain or loss from common/collective trusts | 2018-12-31 | $-18,767 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contract administrator fees | 2018-12-31 | $773,200 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-12-31 | No |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | SOMERSET CPAS, P.C. |
| Accountancy firm EIN | 2018-12-31 | 201717681 |
| 2017 : DSRA BENEFIT TRUST PLAN 2017 401k financial data |
|---|
| Total income from all sources (including contributions) | 2017-12-31 | $22,261,976 |
| Total of all expenses incurred | 2017-12-31 | $22,406,664 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $21,217,722 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $21,887,553 |
| Value of total assets at end of year | 2017-12-31 | $1,410,789 |
| Value of total assets at beginning of year | 2017-12-31 | $1,555,477 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $1,188,942 |
| Total interest from all sources | 2017-12-31 | $404 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-12-31 | $38,839 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-12-31 | $38,839 |
| Administrative expenses professional fees incurred | 2017-12-31 | $15,084 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $21,887,553 |
| Other income not declared elsewhere | 2017-12-31 | $171,571 |
| Administrative expenses (other) incurred | 2017-12-31 | $487,567 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $-144,688 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $1,410,789 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $1,555,477 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Investment advisory and management fees | 2017-12-31 | $16,460 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-12-31 | $567,555 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-12-31 | $628,204 |
| Value of interest in common/collective trusts at end of year | 2017-12-31 | $805,414 |
| Value of interest in common/collective trusts at beginning of year | 2017-12-31 | $868,518 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $37,820 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $58,755 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $58,755 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-12-31 | $404 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $21,217,722 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-12-31 | $46,506 |
| Net investment gain or loss from common/collective trusts | 2017-12-31 | $117,103 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contract administrator fees | 2017-12-31 | $669,831 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-12-31 | No |
| Did the plan have assets held for investment | 2017-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | SOMERSET CPAS, P.C. |
| Accountancy firm EIN | 2017-12-31 | 201717681 |
| 2016 : DSRA BENEFIT TRUST PLAN 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $0 |
| Total income from all sources (including contributions) | 2016-12-31 | $22,224,298 |
| Total loss/gain on sale of assets | 2016-12-31 | $0 |
| Total of all expenses incurred | 2016-12-31 | $22,429,153 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $21,352,201 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $21,981,433 |
| Value of total assets at end of year | 2016-12-31 | $1,555,477 |
| Value of total assets at beginning of year | 2016-12-31 | $1,760,332 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $1,076,952 |
| Total interest from all sources | 2016-12-31 | $121 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $56,315 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-12-31 | $56,315 |
| Administrative expenses professional fees incurred | 2016-12-31 | $14,568 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $21,981,433 |
| Other income not declared elsewhere | 2016-12-31 | $181,307 |
| Administrative expenses (other) incurred | 2016-12-31 | $416,662 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $-204,855 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $1,555,477 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $1,760,332 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Investment advisory and management fees | 2016-12-31 | $16,490 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-12-31 | $628,204 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-12-31 | $0 |
| Value of interest in common/collective trusts at end of year | 2016-12-31 | $868,518 |
| Value of interest in common/collective trusts at beginning of year | 2016-12-31 | $1,736,859 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $58,755 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $23,473 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $23,473 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-12-31 | $121 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $21,352,201 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-12-31 | $-4,283 |
| Net investment gain or loss from common/collective trusts | 2016-12-31 | $9,405 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contract administrator fees | 2016-12-31 | $629,232 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-12-31 | No |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | KATZ SAPPER & MILLER, LLP |
| Accountancy firm EIN | 2016-12-31 | 351090346 |
| 2015 : DSRA BENEFIT TRUST PLAN 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-12-31 | $14,724,921 |
| Total loss/gain on sale of assets | 2015-12-31 | $217,881 |
| Total of all expenses incurred | 2015-12-31 | $16,643,683 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $16,169,971 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $14,675,036 |
| Value of total assets at end of year | 2015-12-31 | $1,760,332 |
| Value of total assets at beginning of year | 2015-12-31 | $3,679,094 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $473,712 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $54,420 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-12-31 | $54,420 |
| Administrative expenses professional fees incurred | 2015-12-31 | $17,103 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $14,437,776 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2015-12-31 | $237,260 |
| Administrative expenses (other) incurred | 2015-12-31 | $60,555 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $-1,918,762 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $1,760,332 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $3,679,094 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Investment advisory and management fees | 2015-12-31 | $22,657 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-12-31 | $1,760,332 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-12-31 | $3,679,094 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $16,149,871 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-12-31 | $-222,416 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $20,100 |
| Contract administrator fees | 2015-12-31 | $373,397 |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Aggregate proceeds on sale of assets | 2015-12-31 | $6,093,045 |
| Aggregate carrying amount (costs) on sale of assets | 2015-12-31 | $5,875,164 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | WITTLIN, CAIN & DRY, LLP |
| Accountancy firm EIN | 2015-12-31 | 161594374 |
| 2014 : DSRA BENEFIT TRUST PLAN 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-12-31 | $11,529,686 |
| Total loss/gain on sale of assets | 2014-12-31 | $318,293 |
| Total of all expenses incurred | 2014-12-31 | $14,191,711 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $13,634,089 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $11,340,387 |
| Value of total assets at end of year | 2014-12-31 | $3,679,094 |
| Value of total assets at beginning of year | 2014-12-31 | $6,341,119 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $557,622 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $151,353 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2014-12-31 | $151,353 |
| Administrative expenses professional fees incurred | 2014-12-31 | $18,845 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $11,128,559 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2014-12-31 | $211,828 |
| Administrative expenses (other) incurred | 2014-12-31 | $75,816 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-2,662,025 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $3,679,094 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $6,341,119 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Investment advisory and management fees | 2014-12-31 | $35,136 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-12-31 | $3,679,094 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-12-31 | $6,341,119 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $13,606,589 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2014-12-31 | $-280,347 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $27,500 |
| Contract administrator fees | 2014-12-31 | $427,825 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Aggregate proceeds on sale of assets | 2014-12-31 | $5,518,037 |
| Aggregate carrying amount (costs) on sale of assets | 2014-12-31 | $5,199,744 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | WITTLIN, CAIN & DRY, LLP |
| Accountancy firm EIN | 2014-12-31 | 161594374 |
| 2013 : DSRA BENEFIT TRUST PLAN 2013 401k financial data |
|---|
| Total income from all sources (including contributions) | 2013-12-31 | $37,612,600 |
| Total loss/gain on sale of assets | 2013-12-31 | $466,822 |
| Total of all expenses incurred | 2013-12-31 | $43,867,475 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $43,214,905 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $36,965,903 |
| Value of total assets at end of year | 2013-12-31 | $6,341,119 |
| Value of total assets at beginning of year | 2013-12-31 | $12,595,994 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $652,570 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-12-31 | $228,649 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2013-12-31 | $228,649 |
| Administrative expenses professional fees incurred | 2013-12-31 | $37,508 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $10,517,167 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2013-12-31 | $26,448,736 |
| Administrative expenses (other) incurred | 2013-12-31 | $71,374 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $-6,254,875 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $6,341,119 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $12,595,994 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Investment advisory and management fees | 2013-12-31 | $55,473 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2013-12-31 | $6,341,119 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2013-12-31 | $12,595,994 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $37,039,344 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2013-12-31 | $-48,774 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $6,175,561 |
| Contract administrator fees | 2013-12-31 | $488,215 |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Aggregate proceeds on sale of assets | 2013-12-31 | $12,366,022 |
| Aggregate carrying amount (costs) on sale of assets | 2013-12-31 | $11,899,200 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | WITTLIN, CAIN & DRY, LLP |
| Accountancy firm EIN | 2013-12-31 | 161594374 |
| 2012 : DSRA BENEFIT TRUST PLAN 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-12-31 | $42,462,028 |
| Total loss/gain on sale of assets | 2012-12-31 | $120,655 |
| Total of all expenses incurred | 2012-12-31 | $46,356,062 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $45,017,301 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $41,446,162 |
| Value of total assets at end of year | 2012-12-31 | $12,595,994 |
| Value of total assets at beginning of year | 2012-12-31 | $16,490,028 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $1,338,761 |
| Total interest from all sources | 2012-12-31 | $865 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $378,637 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2012-12-31 | $378,637 |
| Administrative expenses professional fees incurred | 2012-12-31 | $290,982 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $14,803,676 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2012-12-31 | $26,642,486 |
| Administrative expenses (other) incurred | 2012-12-31 | $361,947 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-3,894,034 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $12,595,994 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $16,490,028 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Investment advisory and management fees | 2012-12-31 | $64,636 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2012-12-31 | $12,595,994 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2012-12-31 | $16,490,028 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $865 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $41,047,296 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2012-12-31 | $515,709 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $3,970,005 |
| Contract administrator fees | 2012-12-31 | $621,196 |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Aggregate proceeds on sale of assets | 2012-12-31 | $10,176,909 |
| Aggregate carrying amount (costs) on sale of assets | 2012-12-31 | $10,056,254 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | GAINES KRINER ELLIOTT |
| Accountancy firm EIN | 2012-12-31 | 160773396 |
| 2011 : DSRA BENEFIT TRUST PLAN 2011 401k financial data |
|---|
| Total income from all sources (including contributions) | 2011-12-31 | $64,203,337 |
| Total loss/gain on sale of assets | 2011-12-31 | $5,410 |
| Total of all expenses incurred | 2011-12-31 | $55,490,493 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $53,656,467 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $63,947,980 |
| Value of total assets at end of year | 2011-12-31 | $16,490,028 |
| Value of total assets at beginning of year | 2011-12-31 | $7,777,184 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $1,834,026 |
| Total interest from all sources | 2011-12-31 | $574 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $349,387 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2011-12-31 | $349,387 |
| Administrative expenses professional fees incurred | 2011-12-31 | $306,396 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $19,968,172 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2011-12-31 | $43,979,808 |
| Administrative expenses (other) incurred | 2011-12-31 | $835,485 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $8,712,844 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $16,490,028 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $7,777,184 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Investment advisory and management fees | 2011-12-31 | $46,252 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-12-31 | $16,490,028 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2011-12-31 | $7,777,184 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $574 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $53,611,885 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2011-12-31 | $-100,014 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $44,582 |
| Contract administrator fees | 2011-12-31 | $645,893 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Aggregate proceeds on sale of assets | 2011-12-31 | $10,045,475 |
| Aggregate carrying amount (costs) on sale of assets | 2011-12-31 | $10,040,065 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | GAINES KRINER ELLIOTT LLP |
| Accountancy firm EIN | 2011-12-31 | 160773396 |
| 2010 : DSRA BENEFIT TRUST PLAN 2010 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $0 |
| Total income from all sources (including contributions) | 2010-12-31 | $129,113 |
| Total loss/gain on sale of assets | 2010-12-31 | $0 |
| Total of all expenses incurred | 2010-12-31 | $964,786 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $27,878 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $5,250 |
| Value of total assets at end of year | 2010-12-31 | $7,681,684 |
| Value of total assets at beginning of year | 2010-12-31 | $8,517,357 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $936,908 |
| Total interest from all sources | 2010-12-31 | $123,863 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2010-12-31 | $105,199 |
| Administrative expenses professional fees incurred | 2010-12-31 | $277,280 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $17,910,903 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2010-12-31 | $42,547,846 |
| Other income not declared elsewhere | 2010-12-31 | $5,533 |
| Administrative expenses (other) incurred | 2010-12-31 | $37,410 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-835,673 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $7,681,684 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $8,517,357 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Investment advisory and management fees | 2010-12-31 | $4,291 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2010-12-31 | $7,777,184 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2010-12-31 | $8,509,261 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $7,681,684 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $8,517,357 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $8,517,357 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $123,863 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $60,421,893 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2010-12-31 | $113,882 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $5,250 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $27,878 |
| Contract administrator fees | 2010-12-31 | $617,927 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | GRANT THORNTON LLP |
| Accountancy firm EIN | 2010-12-31 | 366055558 |
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 7050-7054 |
| Policy instance | 2 |
| Insurance contract or identification number | 7050-7054 | | Number of Individuals Covered | 407 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,379,816 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 421178 |
| Policy instance | 1 |
| Insurance contract or identification number | 421178 | | Number of Individuals Covered | 2496 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $401,607 | | Total amount of fees paid to insurance company | USD $20,544 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $401,607 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 20544 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0238565 |
| Policy instance | 3 |
| Insurance contract or identification number | 0238565 | | Number of Individuals Covered | 1741 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $48,298 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,445,186 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,298 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 278939 |
| Policy instance | 1 |
| Insurance contract or identification number | 278939 | | Number of Individuals Covered | 361 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $189,135 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $189,135 | | Insurance broker organization code? | 3 |
|
| AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 799 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $923,537 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 407 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,830,231 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149752 |
| Policy instance | 4 |
| Insurance contract or identification number | 0149752 | | Number of Individuals Covered | 4006 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | 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 | 00554118 |
| Policy instance | 5 |
| Insurance contract or identification number | 00554118 | | Number of Individuals Covered | 1163 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $30,647 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,478,719 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 30647 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 278939 |
| Policy instance | 1 |
| Insurance contract or identification number | 278939 | | Number of Individuals Covered | 444 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $196,603 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $196,603 | | Insurance broker organization code? | 3 |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 833 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,239,210 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 476 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,697,836 | | 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 | 00554118 |
| Policy instance | 5 |
| Insurance contract or identification number | 00554118 | | Number of Individuals Covered | 1225 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $46,712 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,418,121 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 46712 | | Insurance broker organization code? | 3 |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149752 |
| Policy instance | 4 |
| Insurance contract or identification number | 0149752 | | Number of Individuals Covered | 4165 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 149752 |
| Policy instance | 4 |
| Insurance contract or identification number | 149752 | | Number of Individuals Covered | 4407 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 516 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,657,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 888 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,251,457 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 278939 |
| Policy instance | 1 |
| Insurance contract or identification number | 278939 | | Number of Individuals Covered | 2924 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | 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 | 00554118 |
| Policy instance | 5 |
| Insurance contract or identification number | 00554118 | | Number of Individuals Covered | 1323 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,328,475 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 930 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $27,905 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,244,403 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,905 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 278939 |
| Policy instance | 1 |
| Insurance contract or identification number | 278939 | | Number of Individuals Covered | 3080 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 554 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,621,628 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 149752 |
| Policy instance | 4 |
| Insurance contract or identification number | 149752 | | Number of Individuals Covered | 4585 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 150478 |
| Policy instance | 5 |
| Insurance contract or identification number | GL 150478 | | Number of Individuals Covered | 1432 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,194,366 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | 278939 |
| Policy instance | 1 |
| Insurance contract or identification number | 278939 | | Number of Individuals Covered | 3193 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | |
| Policy instance | 2 |
| Number of Individuals Covered | 945 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $28,348 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $1,207,264 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $28,348 | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | |
| Policy instance | 3 |
| Number of Individuals Covered | 1005 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,434,132 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 149752 |
| Policy instance | 4 |
| Insurance contract or identification number | 149752 | | Number of Individuals Covered | 5308 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 150478 |
| Policy instance | 5 |
| Insurance contract or identification number | GL 150478 | | Number of Individuals Covered | 1453 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,215,297 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 967 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $29,020 | | Welfare Benefit Premiums Paid to Carrier | USD $1,103,831 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,020 | | Additional information about fees paid to insurance broker | BILLING FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-010201 |
| Policy instance | 9 |
| Insurance contract or identification number | AGP-010201 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ACP-003192 |
| Policy instance | 4 |
| Insurance contract or identification number | ACP-003192 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $23,404 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003845 |
| Policy instance | 3 |
| Insurance contract or identification number | AGP-003845 | | Number of Individuals Covered | 636 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $787,404 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 150478 |
| Policy instance | 6 |
| Insurance contract or identification number | GL 150478 | | Number of Individuals Covered | 1546 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of fees paid to insurance company | USD $12,209 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,024,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 12209 | | Insurance broker name | FIRST PERSON |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003862 |
| Policy instance | 8 |
| Insurance contract or identification number | AGP-003862 | | Number of Individuals Covered | 269 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $411,904 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003230 |
| Policy instance | 7 |
| Insurance contract or identification number | AGP-003230 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $789 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003846 |
| Policy instance | 2 |
| Insurance contract or identification number | AGP-003846 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $84,671 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | CLUSTER 0257 |
| Policy instance | 1 |
| Insurance contract or identification number | CLUSTER 0257 | | Number of Individuals Covered | 3045 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 150478 |
| Policy instance | 6 |
| Insurance contract or identification number | GL 150478 | | Number of Individuals Covered | 1601 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of fees paid to insurance company | USD $32,904 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $976,757 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 32904 | | Insurance broker name | FIRST PERSON |
|
| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | |
| Policy instance | 5 |
| Number of Individuals Covered | 934 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of fees paid to insurance company | USD $28,033 | | Welfare Benefit Premiums Paid to Carrier | USD $1,005,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 28033 | | Additional information about fees paid to insurance broker | BILLING FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ACP-003192 |
| Policy instance | 4 |
| Insurance contract or identification number | ACP-003192 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $25,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003845 |
| Policy instance | 3 |
| Insurance contract or identification number | AGP-003845 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $803,415 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | CLUSTER 0257 |
| Policy instance | 1 |
| Insurance contract or identification number | CLUSTER 0257 | | Number of Individuals Covered | 3167 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003846 |
| Policy instance | 2 |
| Insurance contract or identification number | AGP-003846 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $87,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | 0149752 |
| Policy instance | 5 |
| Insurance contract or identification number | 0149752 | | Number of Individuals Covered | 6051 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ADD | | Welfare Benefit Premiums Paid to Carrier | USD $56,858 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | CLUSTER 0257 |
| Policy instance | 1 |
| Insurance contract or identification number | CLUSTER 0257 | | Number of Individuals Covered | 4839 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003846 |
| Policy instance | 2 |
| Insurance contract or identification number | AGP-003846 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $80,577 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003845 |
| Policy instance | 3 |
| Insurance contract or identification number | AGP-003845 | | Number of Individuals Covered | 678 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $1,008,147 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | ACP-003192 |
| Policy instance | 4 |
| Insurance contract or identification number | ACP-003192 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $14,249 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | |
| Policy instance | 6 |
| Number of Individuals Covered | 902 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $43,308 | | Welfare Benefit Premiums Paid to Carrier | USD $859,828 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 43308 | | Additional information about fees paid to insurance broker | BILLING FEES | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH |
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| NATIONAL GUARDIAN LIFE (SUPERIOR VISION PLAN) (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 29352 |
| Policy instance | 7 |
| Insurance contract or identification number | 29352 | | Number of Individuals Covered | 5280 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $893 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $345,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $893 | | Insurance broker name | FIRST PERSON |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 150478 |
| Policy instance | 8 |
| Insurance contract or identification number | GL 150478 | | Number of Individuals Covered | 1641 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $832,330 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker name | FIRST PERSON |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003845 |
| Policy instance | 3 |
| Insurance contract or identification number | AGP-003845 | | Number of Individuals Covered | 807 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $729,161 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 29352 |
| Policy instance | 6 |
| Insurance contract or identification number | 29352 | | Number of Individuals Covered | 5357 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $13,400 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $370,911 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,400 | | Insurance broker organization code? | 3 | | Insurance broker name | FIRST PERSON, INC. |
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| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 10061 |
| Policy instance | 7 |
| Insurance contract or identification number | 10061 | | Number of Individuals Covered | 773 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $37,084 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $744,771 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 37084 | | Additional information about fees paid to insurance broker | BILLING FEE | | Insurance broker organization code? | 3 | | Insurance broker name | MARSH U.S. CONSUMER |
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| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TS05343407 |
| Policy instance | 5 |
| Insurance contract or identification number | TS05343407 | | Number of Individuals Covered | 1298 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $27,152 | | Total amount of fees paid to insurance company | USD $9,050 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $534,466 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,576 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 9050 | | Additional information about fees paid to insurance broker | GROSS DEALER CONCESSION | | Insurance broker name | METLIFE FINANCIAL/METLIFE SECURITIE |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003846 |
| Policy instance | 4 |
| Insurance contract or identification number | AGP-003846 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $31,603 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | CLUSTER 0257 |
| Policy instance | 1 |
| Insurance contract or identification number | CLUSTER 0257 | | Number of Individuals Covered | 5323 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-003192 |
| Policy instance | 2 |
| Insurance contract or identification number | AGP-003192 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $6,573 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395285G |
| Policy instance | 2 |
| Insurance contract or identification number | 395285G | | Number of Individuals Covered | 1301 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $62,356 | | Total amount of fees paid to insurance company | USD $18,062 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $519,632 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | CLUSTER 0257 |
| Policy instance | 1 |
| Insurance contract or identification number | CLUSTER 0257 | | Number of Individuals Covered | 5733 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $87,952 | | Total amount of fees paid to insurance company | USD $162,950 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 ) |
| Policy contract number | AGP-006038 |
| Policy instance | 4 |
| Insurance contract or identification number | AGP-006038 | | Number of Individuals Covered | 683 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $8,259 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | SUPPLEMENTAL MEDICARE | | Welfare Benefit Premiums Paid to Carrier | USD $587,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 ) |
| Policy contract number | 01090 |
| Policy instance | 5 |
| Insurance contract or identification number | 01090 | | Number of Individuals Covered | 548 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $12,544 | | Welfare Benefit Premiums Paid to Carrier | USD $539,589 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 29352 |
| Policy instance | 3 |
| Insurance contract or identification number | 29352 | | Number of Individuals Covered | 5806 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $10,279 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $413,243 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | AGP-006038 |
| Policy instance | 4 |
| Insurance contract or identification number | AGP-006038 | | Number of Individuals Covered | 491 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $32,546 | | 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 | | Other welfare benefits provided | SUPPLEMENTAL MEDICARE | | 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 $325,462 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 395285G |
| Policy instance | 2 |
| Insurance contract or identification number | 395285G | | Number of Individuals Covered | 1301 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $41,570 | | Total amount of fees paid to insurance company | USD $12,040 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $346,421 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 ) |
| Policy contract number | 29352 |
| Policy instance | 3 |
| Insurance contract or identification number | 29352 | | Number of Individuals Covered | 6600 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $13,724 | | 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 | 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 $448,998 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 ) |
| Policy contract number | CLUSTER 0257 |
| Policy instance | 1 |
| Insurance contract or identification number | CLUSTER 0257 | | Number of Individuals Covered | 6523 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $1,732,264 | | 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 | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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