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I.A.T.S.E. LOCAL 857 WELFARE FUND 401k Plan overview

Plan NameI.A.T.S.E. LOCAL 857 WELFARE FUND
Plan identification number 501

I.A.T.S.E. LOCAL 857 WELFARE FUND Benefits

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

401k Sponsoring company profile

I.A.T.S.E. LOCAL 857 WELFARE FUND has sponsored the creation of one or more 401k plans.

Company Name:I.A.T.S.E. LOCAL 857 WELFARE FUND
Employer identification number (EIN):300042023
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan I.A.T.S.E. LOCAL 857 WELFARE FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-07-01
5012015-07-01
5012014-07-01
5012013-07-01
5012012-07-01SERGIO A MEDINA
5012011-07-01SERGIO A MEDINA
5012010-07-01SERGIO A MEDINA
5012009-07-01SERGIO A MEDINA

Plan Statistics for I.A.T.S.E. LOCAL 857 WELFARE FUND

401k plan membership statisitcs for I.A.T.S.E. LOCAL 857 WELFARE FUND

Measure Date Value
2016: I.A.T.S.E. LOCAL 857 WELFARE FUND 2016 401k membership
Total participants, beginning-of-year2016-07-01121
Total number of active participants reported on line 7a of the Form 55002016-07-010
Total of all active and inactive participants2016-07-010
Number of employers contributing to the scheme2016-07-0117
2015: I.A.T.S.E. LOCAL 857 WELFARE FUND 2015 401k membership
Total participants, beginning-of-year2015-07-01126
Total number of active participants reported on line 7a of the Form 55002015-07-01121
Total of all active and inactive participants2015-07-01121
Number of employers contributing to the scheme2015-07-0117
2014: I.A.T.S.E. LOCAL 857 WELFARE FUND 2014 401k membership
Total participants, beginning-of-year2014-07-01143
Total number of active participants reported on line 7a of the Form 55002014-07-01126
Total of all active and inactive participants2014-07-01126
Number of employers contributing to the scheme2014-07-0117
2013: I.A.T.S.E. LOCAL 857 WELFARE FUND 2013 401k membership
Total participants, beginning-of-year2013-07-01146
Total number of active participants reported on line 7a of the Form 55002013-07-01143
Total of all active and inactive participants2013-07-01143
Number of employers contributing to the scheme2013-07-0117
2012: I.A.T.S.E. LOCAL 857 WELFARE FUND 2012 401k membership
Total participants, beginning-of-year2012-07-01140
Total number of active participants reported on line 7a of the Form 55002012-07-01146
Total of all active and inactive participants2012-07-01146
Number of employers contributing to the scheme2012-07-0117
2011: I.A.T.S.E. LOCAL 857 WELFARE FUND 2011 401k membership
Total participants, beginning-of-year2011-07-01141
Total number of active participants reported on line 7a of the Form 55002011-07-01140
Total of all active and inactive participants2011-07-01140
Number of employers contributing to the scheme2011-07-0117
2010: I.A.T.S.E. LOCAL 857 WELFARE FUND 2010 401k membership
Total participants, beginning-of-year2010-07-01146
Total number of active participants reported on line 7a of the Form 55002010-07-01141
Total of all active and inactive participants2010-07-01141
Number of employers contributing to the scheme2010-07-0117
2009: I.A.T.S.E. LOCAL 857 WELFARE FUND 2009 401k membership
Total participants, beginning-of-year2009-07-01149
Total number of active participants reported on line 7a of the Form 55002009-07-01146
Total of all active and inactive participants2009-07-01146
Number of employers contributing to the scheme2009-07-0117

Financial Data on I.A.T.S.E. LOCAL 857 WELFARE FUND

Measure Date Value
2017 : I.A.T.S.E. LOCAL 857 WELFARE FUND 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-06-30$20,990
Total unrealized appreciation/depreciation of assets2017-06-30$20,990
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$431,117
Total income from all sources (including contributions)2017-06-30$21,957
Total of all expenses incurred2017-06-30$274,766
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$69,815
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$12,340
Value of total assets at beginning of year2017-06-30$683,926
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$204,951
Total interest from all sources2017-06-30$1,523
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-06-30Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2017-06-30$0
Administrative expenses professional fees incurred2017-06-30$48,526
Was this plan covered by a fidelity bond2017-06-30Yes
Value of fidelity bond cover2017-06-30$100,000
If this is an individual account plan, was there a blackout period2017-06-30No
Were there any nonexempt tranactions with any party-in-interest2017-06-30No
Contributions received from participants2017-06-30$9,393
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-06-30$2,104
Administrative expenses (other) incurred2017-06-30$68,503
Liabilities. Value of operating payables at beginning of year2017-06-30$79,071
Total non interest bearing cash at beginning of year2017-06-30$4,291
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Value of net income/loss2017-06-30$-252,809
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$252,809
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-06-30No
Were any leases to which the plan was party in default or uncollectible2017-06-30No
Investment advisory and management fees2017-06-30$812
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-06-30$461,384
Interest earned on other investments2017-06-30$1,083
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-06-30$134,394
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-06-30$134,394
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-06-30$440
Expenses. Payments to insurance carriers foe the provision of benefits2017-06-30$69,815
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-06-30$-12,896
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-06-30Yes
Was there a failure to transmit to the plan any participant contributions2017-06-30No
Has the plan failed to provide any benefit when due under the plan2017-06-30No
Contributions received in cash from employer2017-06-30$2,947
Employer contributions (assets) at beginning of year2017-06-30$81,753
Contract administrator fees2017-06-30$87,110
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-06-30No
Liabilities. Value of benefit claims payable at beginning of year2017-06-30$352,046
Did the plan have assets held for investment2017-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-06-30Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-06-30No
Opinion of an independent qualified public accountant for this plan2017-06-30Unqualified
Accountancy firm name2017-06-30BERNARD KOTKIN AND COMPANY
Accountancy firm EIN2017-06-30952556670
2016 : I.A.T.S.E. LOCAL 857 WELFARE FUND 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-06-30$-13,009
Total unrealized appreciation/depreciation of assets2016-06-30$-13,009
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$431,117
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$364,894
Total income from all sources (including contributions)2016-06-30$941,646
Total of all expenses incurred2016-06-30$917,188
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$836,258
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$943,450
Value of total assets at end of year2016-06-30$683,926
Value of total assets at beginning of year2016-06-30$593,245
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$80,930
Total interest from all sources2016-06-30$16,386
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-06-30$0
Administrative expenses professional fees incurred2016-06-30$30,861
Was this plan covered by a fidelity bond2016-06-30Yes
Value of fidelity bond cover2016-06-30$100,000
If this is an individual account plan, was there a blackout period2016-06-30No
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Contributions received from participants2016-06-30$27,685
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-06-30$2,104
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-06-30$2,652
Administrative expenses (other) incurred2016-06-30$7,573
Liabilities. Value of operating payables at end of year2016-06-30$79,071
Liabilities. Value of operating payables at beginning of year2016-06-30$4,220
Total non interest bearing cash at end of year2016-06-30$4,291
Total non interest bearing cash at beginning of year2016-06-30$586
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$24,458
Value of net assets at end of year (total assets less liabilities)2016-06-30$252,809
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$228,351
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Investment advisory and management fees2016-06-30$3,191
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-06-30$461,384
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-06-30$464,570
Interest earned on other investments2016-06-30$14,874
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-06-30$134,394
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-06-30$42,140
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-06-30$42,140
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-06-30$1,512
Expenses. Payments to insurance carriers foe the provision of benefits2016-06-30$836,258
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-06-30$-5,181
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30Yes
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$915,765
Employer contributions (assets) at end of year2016-06-30$81,753
Employer contributions (assets) at beginning of year2016-06-30$83,297
Contract administrator fees2016-06-30$39,305
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-06-30No
Liabilities. Value of benefit claims payable at end of year2016-06-30$352,046
Liabilities. Value of benefit claims payable at beginning of year2016-06-30$360,674
Did the plan have assets held for investment2016-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30No
Opinion of an independent qualified public accountant for this plan2016-06-30Unqualified
Accountancy firm name2016-06-30BERNARD KOTKIN AND COMPANY LLP
Accountancy firm EIN2016-06-30952556670
2015 : I.A.T.S.E. LOCAL 857 WELFARE FUND 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-06-30$-72,231
Total unrealized appreciation/depreciation of assets2015-06-30$-72,231
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$364,894
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$420,927
Total income from all sources (including contributions)2015-06-30$953,614
Total of all expenses incurred2015-06-30$1,098,532
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$1,009,599
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$946,042
Value of total assets at end of year2015-06-30$593,245
Value of total assets at beginning of year2015-06-30$794,196
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$88,933
Total interest from all sources2015-06-30$8,765
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-06-30No
Administrative expenses professional fees incurred2015-06-30$35,057
Was this plan covered by a fidelity bond2015-06-30Yes
Value of fidelity bond cover2015-06-30$100,000
If this is an individual account plan, was there a blackout period2015-06-30No
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Contributions received from participants2015-06-30$67,298
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-06-30$2,652
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-06-30$1,790
Other income not declared elsewhere2015-06-30$5,704
Administrative expenses (other) incurred2015-06-30$13,387
Liabilities. Value of operating payables at end of year2015-06-30$4,220
Liabilities. Value of operating payables at beginning of year2015-06-30$4,768
Total non interest bearing cash at end of year2015-06-30$586
Total non interest bearing cash at beginning of year2015-06-30$2,437
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$-144,918
Value of net assets at end of year (total assets less liabilities)2015-06-30$228,351
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$373,269
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Investment advisory and management fees2015-06-30$2,489
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-06-30$464,570
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-06-30$498,818
Interest earned on other investments2015-06-30$8,525
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-06-30$42,140
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-06-30$216,745
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-06-30$216,745
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-06-30$240
Expenses. Payments to insurance carriers foe the provision of benefits2015-06-30$1,009,599
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-06-30$65,334
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30Yes
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Contributions received in cash from employer2015-06-30$878,744
Employer contributions (assets) at end of year2015-06-30$83,297
Employer contributions (assets) at beginning of year2015-06-30$74,406
Contract administrator fees2015-06-30$38,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-06-30No
Liabilities. Value of benefit claims payable at end of year2015-06-30$360,674
Liabilities. Value of benefit claims payable at beginning of year2015-06-30$416,159
Did the plan have assets held for investment2015-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30No
Opinion of an independent qualified public accountant for this plan2015-06-30Unqualified
Accountancy firm name2015-06-30BERNARD KOTKIN AND COMPANY LLP
Accountancy firm EIN2015-06-30952556670
2014 : I.A.T.S.E. LOCAL 857 WELFARE FUND 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-06-30$16,927
Total unrealized appreciation/depreciation of assets2014-06-30$16,927
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$420,927
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$397,660
Total income from all sources (including contributions)2014-06-30$1,042,263
Total of all expenses incurred2014-06-30$1,255,317
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$1,199,924
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$977,899
Value of total assets at end of year2014-06-30$794,196
Value of total assets at beginning of year2014-06-30$983,983
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$55,393
Total interest from all sources2014-06-30$18,010
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-06-30No
Administrative expenses professional fees incurred2014-06-30$7,862
Was this plan covered by a fidelity bond2014-06-30Yes
Value of fidelity bond cover2014-06-30$100,000
If this is an individual account plan, was there a blackout period2014-06-30No
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Contributions received from participants2014-06-30$104,442
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-06-30$1,790
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-06-30$1,981
Other income not declared elsewhere2014-06-30$3,320
Administrative expenses (other) incurred2014-06-30$10,360
Liabilities. Value of operating payables at end of year2014-06-30$4,768
Liabilities. Value of operating payables at beginning of year2014-06-30$4,062
Total non interest bearing cash at end of year2014-06-30$2,437
Total non interest bearing cash at beginning of year2014-06-30$456
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Value of net income/loss2014-06-30$-213,054
Value of net assets at end of year (total assets less liabilities)2014-06-30$373,269
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$586,323
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-06-30$498,818
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-06-30$617,829
Interest earned on other investments2014-06-30$17,955
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-06-30$216,745
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-06-30$281,177
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-06-30$281,177
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-06-30$55
Expenses. Payments to insurance carriers foe the provision of benefits2014-06-30$1,199,924
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-06-30$26,107
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30Yes
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Contributions received in cash from employer2014-06-30$873,457
Employer contributions (assets) at end of year2014-06-30$74,406
Employer contributions (assets) at beginning of year2014-06-30$82,540
Contract administrator fees2014-06-30$37,171
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-06-30No
Liabilities. Value of benefit claims payable at end of year2014-06-30$416,159
Liabilities. Value of benefit claims payable at beginning of year2014-06-30$393,598
Did the plan have assets held for investment2014-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30No
Opinion of an independent qualified public accountant for this plan2014-06-30Unqualified
Accountancy firm name2014-06-30BERNARD KOTKIN AND COMPANY LLP
Accountancy firm EIN2014-06-30952556670
2013 : I.A.T.S.E. LOCAL 857 WELFARE FUND 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-06-30$24,942
Total unrealized appreciation/depreciation of assets2013-06-30$24,942
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$397,660
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$379,317
Total income from all sources (including contributions)2013-06-30$1,053,939
Total of all expenses incurred2013-06-30$1,166,473
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$1,113,971
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$991,225
Value of total assets at end of year2013-06-30$983,983
Value of total assets at beginning of year2013-06-30$1,078,174
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$52,502
Total interest from all sources2013-06-30$20,686
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-06-30No
Administrative expenses professional fees incurred2013-06-30$5,799
Was this plan covered by a fidelity bond2013-06-30Yes
Value of fidelity bond cover2013-06-30$100,000
If this is an individual account plan, was there a blackout period2013-06-30No
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Contributions received from participants2013-06-30$97,611
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-06-30$1,981
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-06-30$4,120
Administrative expenses (other) incurred2013-06-30$10,288
Liabilities. Value of operating payables at end of year2013-06-30$4,062
Liabilities. Value of operating payables at beginning of year2013-06-30$3,828
Total non interest bearing cash at end of year2013-06-30$456
Total non interest bearing cash at beginning of year2013-06-30$837
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Value of net income/loss2013-06-30$-112,534
Value of net assets at end of year (total assets less liabilities)2013-06-30$586,323
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$698,857
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-06-30No
Were any leases to which the plan was party in default or uncollectible2013-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-06-30$617,829
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-06-30$875,177
Interest earned on other investments2013-06-30$20,594
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-06-30$281,177
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-06-30$111,551
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-06-30$111,551
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-06-30$92
Expenses. Payments to insurance carriers foe the provision of benefits2013-06-30$1,113,971
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-06-30$17,086
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-06-30Yes
Was there a failure to transmit to the plan any participant contributions2013-06-30No
Has the plan failed to provide any benefit when due under the plan2013-06-30No
Contributions received in cash from employer2013-06-30$893,614
Employer contributions (assets) at end of year2013-06-30$82,540
Employer contributions (assets) at beginning of year2013-06-30$86,489
Contract administrator fees2013-06-30$36,415
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-06-30No
Liabilities. Value of benefit claims payable at end of year2013-06-30$393,598
Liabilities. Value of benefit claims payable at beginning of year2013-06-30$375,489
Did the plan have assets held for investment2013-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30No
Opinion of an independent qualified public accountant for this plan2013-06-30Unqualified
Accountancy firm name2013-06-30BERNARD KOTKIN AND COMPANY LLP
Accountancy firm EIN2013-06-30952556670
2012 : I.A.T.S.E. LOCAL 857 WELFARE FUND 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-06-30$-348
Total unrealized appreciation/depreciation of assets2012-06-30$-348
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$379,317
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$372,342
Total income from all sources (including contributions)2012-06-30$1,030,099
Total of all expenses incurred2012-06-30$1,110,943
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$1,047,037
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$990,878
Value of total assets at end of year2012-06-30$1,078,174
Value of total assets at beginning of year2012-06-30$1,152,043
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$63,906
Total interest from all sources2012-06-30$30,230
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-06-30No
Administrative expenses professional fees incurred2012-06-30$7,100
Was this plan covered by a fidelity bond2012-06-30Yes
Value of fidelity bond cover2012-06-30$100,000
If this is an individual account plan, was there a blackout period2012-06-30No
Were there any nonexempt tranactions with any party-in-interest2012-06-30No
Contributions received from participants2012-06-30$95,954
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-06-30$4,120
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-06-30$1,743
Other income not declared elsewhere2012-06-30$8,494
Administrative expenses (other) incurred2012-06-30$12,803
Liabilities. Value of operating payables at end of year2012-06-30$3,828
Liabilities. Value of operating payables at beginning of year2012-06-30$7,573
Total non interest bearing cash at end of year2012-06-30$837
Total non interest bearing cash at beginning of year2012-06-30$2,236
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Value of net income/loss2012-06-30$-80,844
Value of net assets at end of year (total assets less liabilities)2012-06-30$698,857
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$779,701
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-06-30No
Were any leases to which the plan was party in default or uncollectible2012-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-06-30$875,177
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-06-30$992,482
Interest earned on other investments2012-06-30$30,197
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-06-30$111,551
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-06-30$86,568
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-06-30$86,568
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-06-30$33
Expenses. Payments to insurance carriers foe the provision of benefits2012-06-30$1,047,037
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-06-30$845
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-06-30Yes
Was there a failure to transmit to the plan any participant contributions2012-06-30No
Has the plan failed to provide any benefit when due under the plan2012-06-30No
Contributions received in cash from employer2012-06-30$894,924
Employer contributions (assets) at end of year2012-06-30$86,489
Employer contributions (assets) at beginning of year2012-06-30$69,014
Contract administrator fees2012-06-30$44,003
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-06-30No
Liabilities. Value of benefit claims payable at end of year2012-06-30$375,489
Liabilities. Value of benefit claims payable at beginning of year2012-06-30$364,769
Did the plan have assets held for investment2012-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-06-30No
Opinion of an independent qualified public accountant for this plan2012-06-30Unqualified
Accountancy firm name2012-06-30BERNARD KOTKIN AND COMPANY LLP
Accountancy firm EIN2012-06-30952556670
2011 : I.A.T.S.E. LOCAL 857 WELFARE FUND 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-06-30$40,570
Total unrealized appreciation/depreciation of assets2011-06-30$40,570
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$372,342
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$361,870
Total income from all sources (including contributions)2011-06-30$1,041,963
Total of all expenses incurred2011-06-30$1,058,529
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$994,075
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$942,089
Value of total assets at end of year2011-06-30$1,152,043
Value of total assets at beginning of year2011-06-30$1,158,137
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$64,454
Total interest from all sources2011-06-30$25,974
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-06-30No
Administrative expenses professional fees incurred2011-06-30$4,661
Was this plan covered by a fidelity bond2011-06-30Yes
Value of fidelity bond cover2011-06-30$100,000
If this is an individual account plan, was there a blackout period2011-06-30No
Were there any nonexempt tranactions with any party-in-interest2011-06-30No
Contributions received from participants2011-06-30$112,466
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-06-30$1,743
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-06-30$7,116
Administrative expenses (other) incurred2011-06-30$23,799
Liabilities. Value of operating payables at end of year2011-06-30$7,573
Liabilities. Value of operating payables at beginning of year2011-06-30$3,406
Total non interest bearing cash at end of year2011-06-30$2,236
Total non interest bearing cash at beginning of year2011-06-30$12,174
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Value of net income/loss2011-06-30$-16,566
Value of net assets at end of year (total assets less liabilities)2011-06-30$779,701
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$796,267
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-06-30No
Were any leases to which the plan was party in default or uncollectible2011-06-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-06-30$992,482
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-06-30$1,062,644
Interest earned on other investments2011-06-30$25,937
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-06-30$86,568
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-06-30$10,654
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-06-30$10,654
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-06-30$37
Expenses. Payments to insurance carriers foe the provision of benefits2011-06-30$994,075
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-06-30$33,330
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-06-30Yes
Was there a failure to transmit to the plan any participant contributions2011-06-30No
Has the plan failed to provide any benefit when due under the plan2011-06-30No
Contributions received in cash from employer2011-06-30$829,623
Employer contributions (assets) at end of year2011-06-30$69,014
Employer contributions (assets) at beginning of year2011-06-30$65,549
Contract administrator fees2011-06-30$35,994
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-06-30No
Liabilities. Value of benefit claims payable at end of year2011-06-30$364,769
Liabilities. Value of benefit claims payable at beginning of year2011-06-30$358,464
Did the plan have assets held for investment2011-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-06-30No
Opinion of an independent qualified public accountant for this plan2011-06-30Unqualified
Accountancy firm name2011-06-30BERNARD KOTKIN AND COMPANY LLP
Accountancy firm EIN2011-06-30952556670

Form 5500 Responses for I.A.T.S.E. LOCAL 857 WELFARE FUND

2016: I.A.T.S.E. LOCAL 857 WELFARE FUND 2016 form 5500 responses
2016-07-01Type of plan entityMulti-employer plan
2016-07-01This submission is the final filingYes
2016-07-01Plan is a collectively bargained planYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2015: I.A.T.S.E. LOCAL 857 WELFARE FUND 2015 form 5500 responses
2015-07-01Type of plan entityMulti-employer plan
2015-07-01Plan is a collectively bargained planYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2014: I.A.T.S.E. LOCAL 857 WELFARE FUND 2014 form 5500 responses
2014-07-01Type of plan entityMulti-employer plan
2014-07-01Plan is a collectively bargained planYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2013: I.A.T.S.E. LOCAL 857 WELFARE FUND 2013 form 5500 responses
2013-07-01Type of plan entityMulti-employer plan
2013-07-01Plan is a collectively bargained planYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2012: I.A.T.S.E. LOCAL 857 WELFARE FUND 2012 form 5500 responses
2012-07-01Type of plan entityMulti-employer plan
2012-07-01Plan is a collectively bargained planYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2011: I.A.T.S.E. LOCAL 857 WELFARE FUND 2011 form 5500 responses
2011-07-01Type of plan entityMulti-employer plan
2011-07-01Plan is a collectively bargained planYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2010: I.A.T.S.E. LOCAL 857 WELFARE FUND 2010 form 5500 responses
2010-07-01Type of plan entityMulti-employer plan
2010-07-01Plan is a collectively bargained planYes
2010-07-01Plan funding arrangement – TrustYes
2010-07-01Plan benefit arrangement – InsuranceYes
2009: I.A.T.S.E. LOCAL 857 WELFARE FUND 2009 form 5500 responses
2009-07-01Type of plan entityMulti-employer plan
2009-07-01This submission is the final filingNo
2009-07-01Plan is a collectively bargained planYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12150052
Policy instance 2
Insurance contract or identification number12150052
Number of Individuals Covered114
Insurance policy start date2015-03-01
Insurance policy end date2016-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $14,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number93876000002
Policy instance 6
Insurance contract or identification number93876000002
Number of Individuals Covered121
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,985
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number
Policy instance 3
Number of Individuals Covered0
Insurance policy start date2015-07-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedCHIROPRACTIC
Welfare Benefit Premiums Paid to CarrierUSD $759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number870042-000
Policy instance 1
Insurance contract or identification number870042-000
Number of Individuals Covered111
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $66,484
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number47665
Policy instance 4
Insurance contract or identification number47665
Number of Individuals Covered121
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,631
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number
Policy instance 5
Number of Individuals Covered121
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedBEHAVIORAL HEALTH
Welfare Benefit Premiums Paid to CarrierUSD $2,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number95-4402957
Policy instance 7
Insurance contract or identification number95-4402957
Number of Individuals Covered119
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $745,230
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12150052
Policy instance 2
Insurance contract or identification number12150052
Number of Individuals Covered119
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $17,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number
Policy instance 3
Number of Individuals Covered126
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedCHIROPRACTIC
Welfare Benefit Premiums Paid to CarrierUSD $5,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 )
Policy contract number95-4402957
Policy instance 8
Insurance contract or identification number95-4402957
Number of Individuals Covered125
Insurance policy start date2015-01-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $310,419
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number432794
Policy instance 5
Insurance contract or identification number432794
Number of Individuals Covered0
Insurance policy start date2014-07-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $636,790
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number
Policy instance 6
Number of Individuals Covered126
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBEHAVIORAL HEALTH
Welfare Benefit Premiums Paid to CarrierUSD $3,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number93876000002
Policy instance 7
Insurance contract or identification number93876000002
Number of Individuals Covered126
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $6,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number47665
Policy instance 4
Insurance contract or identification number47665
Number of Individuals Covered126
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number870042-000
Policy instance 1
Insurance contract or identification number870042-000
Number of Individuals Covered119
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,585
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number93876000002
Policy instance 7
Insurance contract or identification number93876000002
Number of Individuals Covered133
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,327
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number
Policy instance 6
Number of Individuals Covered133
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBEHAVIORAL HEALTH
Welfare Benefit Premiums Paid to CarrierUSD $2,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number432794
Policy instance 5
Insurance contract or identification number432794
Number of Individuals Covered143
Insurance policy start date2014-02-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,049,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LANDMARK HEALTHPLAN (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract number
Policy instance 3
Number of Individuals Covered130
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedCHIROPRACTIC
Welfare Benefit Premiums Paid to CarrierUSD $5,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12150052
Policy instance 2
Insurance contract or identification number12150052
Number of Individuals Covered122
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,636
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number870042-000
Policy instance 1
Insurance contract or identification number870042-000
Number of Individuals Covered120
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,351
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number47665
Policy instance 4
Insurance contract or identification number47665
Number of Individuals Covered133
Insurance policy start date2014-01-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,833
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number
Policy instance 6
Number of Individuals Covered148
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBEHAVIORAL HEALTH
Welfare Benefit Premiums Paid to CarrierUSD $2,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number870042-000
Policy instance 1
Insurance contract or identification number870042-000
Number of Individuals Covered127
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,476
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number93876000002
Policy instance 7
Insurance contract or identification number93876000002
Number of Individuals Covered146
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,387
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number432794
Policy instance 5
Insurance contract or identification number432794
Number of Individuals Covered138
Insurance policy start date2013-02-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $963,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number47665
Policy instance 4
Insurance contract or identification number47665
Number of Individuals Covered147
Insurance policy start date2013-01-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,999
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN SPECIALTY HEALTH PLANS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number13477
Policy instance 3
Insurance contract or identification number13477
Number of Individuals Covered145
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedCHIROPRACTIC
Welfare Benefit Premiums Paid to CarrierUSD $7,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12150052
Policy instance 2
Insurance contract or identification number12150052
Number of Individuals Covered128
Insurance policy start date2012-03-01
Insurance policy end date2013-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12150052
Policy instance 2
Insurance contract or identification number12150052
Number of Individuals Covered130
Insurance policy start date2011-03-01
Insurance policy end date2012-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN SPECIALTY HEALTH PLANS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number13477
Policy instance 3
Insurance contract or identification number13477
Number of Individuals Covered135
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedCHIROPRACTIC
Welfare Benefit Premiums Paid to CarrierUSD $6,434
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number47665
Policy instance 4
Insurance contract or identification number47665
Number of Individuals Covered140
Insurance policy start date2012-01-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,953
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number432794
Policy instance 5
Insurance contract or identification number432794
Number of Individuals Covered140
Insurance policy start date2012-02-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $905,032
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number
Policy instance 6
Number of Individuals Covered139
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedBEHAVIORAL HEALTH
Welfare Benefit Premiums Paid to CarrierUSD $2,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number870042-000
Policy instance 1
Insurance contract or identification number870042-000
Number of Individuals Covered130
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,604
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number93876000002
Policy instance 7
Insurance contract or identification number93876000002
Number of Individuals Covered140
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,781
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number47665
Policy instance 7
Insurance contract or identification number47665
Number of Individuals Covered147
Insurance policy start date2011-01-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,258
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number432794
Policy instance 8
Insurance contract or identification number432794
Number of Individuals Covered319
Insurance policy start date2011-02-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $360,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERICAN SPECIALTY HEALTH PLANS OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number13477
Policy instance 6
Insurance contract or identification number13477
Number of Individuals Covered147
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedCHIROPRACTIC
Welfare Benefit Premiums Paid to CarrierUSD $9,170
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number148430
Policy instance 4
Insurance contract or identification number148430
Number of Individuals Covered0
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $491,882
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PRUDENTIAL ANNUITIES SERVICE (National Association of Insurance Commissioners NAIC id number: 68241 )
Policy contract number93876000002
Policy instance 3
Insurance contract or identification number93876000002
Number of Individuals Covered141
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,436
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number12150052
Policy instance 2
Insurance contract or identification number12150052
Number of Individuals Covered125
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,219
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )
Policy contract number870042-000
Policy instance 1
Insurance contract or identification number870042-000
Number of Individuals Covered125
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,148
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MANAGED HEALTH NETWORK (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number8834
Policy instance 5
Insurance contract or identification number8834
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Other welfare benefits providedEAP PLAN PREMIUMS
Welfare Benefit Premiums Paid to CarrierUSD $2,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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