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HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 401k Plan overview

Plan NameHARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN
Plan identification number 501

HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover

401k Sponsoring company profile

HARTZELL INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:HARTZELL INDUSTRIES, INC.
Employer identification number (EIN):310674874
NAIC Classification:321210

Additional information about HARTZELL INDUSTRIES, INC.

Jurisdiction of Incorporation: Ohio Secretary of State Business Services Division
Incorporation Date: 1964-01-27
Company Identification Number: 326960
Legal Registered Office Address: 1300 EAST NINTH STREET
-
CLEVELAND
United States of America (USA)
44114

More information about HARTZELL INDUSTRIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-06-01CASEY WEBSTER2023-10-25
5012021-06-01CASEY WEBSTER2022-10-13
5012020-06-01CASEY WEBSTER2021-10-18
5012019-06-01CASEY WEBSTER2020-09-18
5012018-06-01CASEY WEBSTER2019-12-17
5012017-06-01
5012017-06-01CASEY WEBSTER2019-12-17
5012016-06-01CASEY WEBSTER
5012015-06-01JANE FARLEY
5012014-06-01JANE FARLEY
5012013-06-01JANE FARLEY JANE FARLEY2015-03-16
5012012-06-01JANE FARLEY JANE FARLEY2014-03-14
5012011-06-01JANE FARLEY JANE FARLEY2013-03-14
5012009-06-01JAMES P. GRAY
5012009-06-01JAMES GRAY
5012009-06-01 JAMES P. GRAY2011-03-09

Plan Statistics for HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN

401k plan membership statisitcs for HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN

Measure Date Value
2022: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-06-01201
Total number of active participants reported on line 7a of the Form 55002022-06-01244
Number of retired or separated participants receiving benefits2022-06-010
Number of other retired or separated participants entitled to future benefits2022-06-010
Total of all active and inactive participants2022-06-01244
Number of employers contributing to the scheme2022-06-010
2021: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-06-01227
Total number of active participants reported on line 7a of the Form 55002021-06-01201
Number of retired or separated participants receiving benefits2021-06-010
Number of other retired or separated participants entitled to future benefits2021-06-010
Total of all active and inactive participants2021-06-01201
Number of employers contributing to the scheme2021-06-010
2020: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-06-01206
Total number of active participants reported on line 7a of the Form 55002020-06-01227
Number of retired or separated participants receiving benefits2020-06-013
Number of other retired or separated participants entitled to future benefits2020-06-010
Total of all active and inactive participants2020-06-01230
Number of employers contributing to the scheme2020-06-010
2019: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-06-01195
Total number of active participants reported on line 7a of the Form 55002019-06-01205
Number of retired or separated participants receiving benefits2019-06-011
Number of other retired or separated participants entitled to future benefits2019-06-010
Total of all active and inactive participants2019-06-01206
Number of employers contributing to the scheme2019-06-010
2018: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-06-01214
Total number of active participants reported on line 7a of the Form 55002018-06-01195
Number of retired or separated participants receiving benefits2018-06-010
Number of other retired or separated participants entitled to future benefits2018-06-010
Total of all active and inactive participants2018-06-01195
Number of employers contributing to the scheme2018-06-010
2017: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-06-01217
Total number of active participants reported on line 7a of the Form 55002017-06-01214
Number of retired or separated participants receiving benefits2017-06-010
Number of other retired or separated participants entitled to future benefits2017-06-010
Total of all active and inactive participants2017-06-01214
Number of employers contributing to the scheme2017-06-010
2016: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-06-01250
Total number of active participants reported on line 7a of the Form 55002016-06-01202
Number of retired or separated participants receiving benefits2016-06-0115
Number of other retired or separated participants entitled to future benefits2016-06-010
Total of all active and inactive participants2016-06-01217
2015: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-01282
Total number of active participants reported on line 7a of the Form 55002015-06-01235
Number of retired or separated participants receiving benefits2015-06-0115
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-01250
2014: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-01301
Total number of active participants reported on line 7a of the Form 55002014-06-01263
Number of retired or separated participants receiving benefits2014-06-0119
Number of other retired or separated participants entitled to future benefits2014-06-010
Total of all active and inactive participants2014-06-01282
2013: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-01326
Total number of active participants reported on line 7a of the Form 55002013-06-01281
Number of retired or separated participants receiving benefits2013-06-0120
Number of other retired or separated participants entitled to future benefits2013-06-010
Total of all active and inactive participants2013-06-01301
2012: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-01316
Total number of active participants reported on line 7a of the Form 55002012-06-01308
Number of retired or separated participants receiving benefits2012-06-0118
Total of all active and inactive participants2012-06-01326
2011: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-01289
Total number of active participants reported on line 7a of the Form 55002011-06-01296
Number of retired or separated participants receiving benefits2011-06-0120
Total of all active and inactive participants2011-06-01316
2009: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-01302
Total number of active participants reported on line 7a of the Form 55002009-06-01244
Number of retired or separated participants receiving benefits2009-06-0130
Number of other retired or separated participants entitled to future benefits2009-06-010
Total of all active and inactive participants2009-06-01274
Total participants2009-06-01274

Financial Data on HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN

Measure Date Value
2017 : HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-05-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-05-31$121,035
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-05-31$215,017
Total income from all sources (including contributions)2017-05-31$2,269,322
Total loss/gain on sale of assets2017-05-31$0
Total of all expenses incurred2017-05-31$2,541,486
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-05-31$2,309,678
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-05-31$2,234,554
Value of total assets at end of year2017-05-31$0
Value of total assets at beginning of year2017-05-31$366,146
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-05-31$231,808
Total interest from all sources2017-05-31$17,116
Total dividends received (eg from common stock, registered investment company shares)2017-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-05-31No
Administrative expenses professional fees incurred2017-05-31$231,808
Was this plan covered by a fidelity bond2017-05-31Yes
Value of fidelity bond cover2017-05-31$500,000
Were there any nonexempt tranactions with any party-in-interest2017-05-31No
Contributions received from participants2017-05-31$735,102
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-05-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-05-31$10,109
Total non interest bearing cash at end of year2017-05-31$0
Total non interest bearing cash at beginning of year2017-05-31$29,070
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-05-31No
Value of net income/loss2017-05-31$-272,164
Value of net assets at end of year (total assets less liabilities)2017-05-31$-121,035
Value of net assets at beginning of year (total assets less liabilities)2017-05-31$151,129
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-05-31No
Were any leases to which the plan was party in default or uncollectible2017-05-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-05-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-05-31$284,524
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-05-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-05-31$20,552
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-05-31$20,552
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-05-31$17,116
Expenses. Payments to insurance carriers foe the provision of benefits2017-05-31$232,348
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-05-31$17,652
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-05-31Yes
Was there a failure to transmit to the plan any participant contributions2017-05-31No
Has the plan failed to provide any benefit when due under the plan2017-05-31No
Contributions received in cash from employer2017-05-31$1,499,452
Employer contributions (assets) at end of year2017-05-31$0
Employer contributions (assets) at beginning of year2017-05-31$32,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-05-31$2,077,330
Liabilities. Value of benefit claims payable at end of year2017-05-31$121,035
Liabilities. Value of benefit claims payable at beginning of year2017-05-31$204,908
Did the plan have assets held for investment2017-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-05-31Yes
Opinion of an independent qualified public accountant for this plan2017-05-31Disclaimer
Accountancy firm name2017-05-31RSM US LLP
Accountancy firm EIN2017-05-31420714325
2016 : HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-05-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-05-31$215,017
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-05-31$261,572
Total income from all sources (including contributions)2016-05-31$2,693,232
Total loss/gain on sale of assets2016-05-31$0
Total of all expenses incurred2016-05-31$2,660,743
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-05-31$2,452,433
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-05-31$2,698,290
Value of total assets at end of year2016-05-31$366,146
Value of total assets at beginning of year2016-05-31$380,212
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-05-31$208,310
Total interest from all sources2016-05-31$19,704
Total dividends received (eg from common stock, registered investment company shares)2016-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-05-31No
Administrative expenses professional fees incurred2016-05-31$208,310
Was this plan covered by a fidelity bond2016-05-31Yes
Value of fidelity bond cover2016-05-31$500,000
Were there any nonexempt tranactions with any party-in-interest2016-05-31No
Contributions received from participants2016-05-31$734,993
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-05-31$10,109
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-05-31$0
Total non interest bearing cash at end of year2016-05-31$29,070
Total non interest bearing cash at beginning of year2016-05-31$54,546
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-05-31No
Value of net income/loss2016-05-31$32,489
Value of net assets at end of year (total assets less liabilities)2016-05-31$151,129
Value of net assets at beginning of year (total assets less liabilities)2016-05-31$118,640
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-05-31No
Were any leases to which the plan was party in default or uncollectible2016-05-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-05-31$284,524
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-05-31$295,666
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-05-31$20,552
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-05-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-05-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-05-31$19,704
Expenses. Payments to insurance carriers foe the provision of benefits2016-05-31$255,931
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-05-31$-24,762
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-05-31Yes
Was there a failure to transmit to the plan any participant contributions2016-05-31No
Has the plan failed to provide any benefit when due under the plan2016-05-31No
Contributions received in cash from employer2016-05-31$1,963,297
Employer contributions (assets) at end of year2016-05-31$32,000
Employer contributions (assets) at beginning of year2016-05-31$30,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-05-31$2,196,502
Liabilities. Value of benefit claims payable at end of year2016-05-31$204,908
Liabilities. Value of benefit claims payable at beginning of year2016-05-31$261,572
Did the plan have assets held for investment2016-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-05-31Yes
Opinion of an independent qualified public accountant for this plan2016-05-31Disclaimer
Accountancy firm name2016-05-31RSM US LLP
Accountancy firm EIN2016-05-31420714325
2015 : HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-05-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-05-31$261,572
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-05-31$0
Total income from all sources (including contributions)2015-05-31$2,379,878
Total loss/gain on sale of assets2015-05-31$0
Total of all expenses incurred2015-05-31$2,961,631
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-05-31$2,743,846
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-05-31$2,343,761
Value of total assets at end of year2015-05-31$380,212
Value of total assets at beginning of year2015-05-31$700,393
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-05-31$217,785
Total interest from all sources2015-05-31$18,372
Total dividends received (eg from common stock, registered investment company shares)2015-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-05-31No
Administrative expenses professional fees incurred2015-05-31$217,070
Was this plan covered by a fidelity bond2015-05-31Yes
Value of fidelity bond cover2015-05-31$500,000
Were there any nonexempt tranactions with any party-in-interest2015-05-31No
Contributions received from participants2015-05-31$707,096
Administrative expenses (other) incurred2015-05-31$715
Total non interest bearing cash at end of year2015-05-31$54,546
Total non interest bearing cash at beginning of year2015-05-31$273,642
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-05-31No
Value of net income/loss2015-05-31$-581,753
Value of net assets at end of year (total assets less liabilities)2015-05-31$118,640
Value of net assets at beginning of year (total assets less liabilities)2015-05-31$700,393
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-05-31No
Were any leases to which the plan was party in default or uncollectible2015-05-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-05-31$295,666
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-05-31$426,751
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-05-31$18,372
Expenses. Payments to insurance carriers foe the provision of benefits2015-05-31$246,499
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-05-31$17,745
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-05-31Yes
Was there a failure to transmit to the plan any participant contributions2015-05-31No
Has the plan failed to provide any benefit when due under the plan2015-05-31No
Contributions received in cash from employer2015-05-31$1,636,665
Employer contributions (assets) at end of year2015-05-31$30,000
Employer contributions (assets) at beginning of year2015-05-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-05-31$2,497,347
Liabilities. Value of benefit claims payable at end of year2015-05-31$261,572
Liabilities. Value of benefit claims payable at beginning of year2015-05-31$0
Did the plan have assets held for investment2015-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-05-31Yes
Opinion of an independent qualified public accountant for this plan2015-05-31Disclaimer
Accountancy firm name2015-05-31RSM US LLP
Accountancy firm EIN2015-05-31420714325
2014 : HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-05-31$49,371
Total unrealized appreciation/depreciation of assets2014-05-31$49,371
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-05-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-05-31$0
Total income from all sources (including contributions)2014-05-31$2,893,970
Total loss/gain on sale of assets2014-05-31$0
Total of all expenses incurred2014-05-31$2,877,029
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-05-31$2,659,301
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-05-31$2,814,236
Value of total assets at end of year2014-05-31$700,393
Value of total assets at beginning of year2014-05-31$683,452
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-05-31$217,728
Total interest from all sources2014-05-31$30,363
Total dividends received (eg from common stock, registered investment company shares)2014-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-05-31No
Administrative expenses professional fees incurred2014-05-31$217,028
Was this plan covered by a fidelity bond2014-05-31Yes
Value of fidelity bond cover2014-05-31$500,000
Were there any nonexempt tranactions with any party-in-interest2014-05-31No
Contributions received from participants2014-05-31$728,970
Administrative expenses (other) incurred2014-05-31$700
Total non interest bearing cash at end of year2014-05-31$273,642
Total non interest bearing cash at beginning of year2014-05-31$242,851
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-05-31No
Value of net income/loss2014-05-31$16,941
Value of net assets at end of year (total assets less liabilities)2014-05-31$700,393
Value of net assets at beginning of year (total assets less liabilities)2014-05-31$683,452
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-05-31No
Were any leases to which the plan was party in default or uncollectible2014-05-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-05-31$426,751
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-05-31$440,601
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-05-31$30,363
Expenses. Payments to insurance carriers foe the provision of benefits2014-05-31$234,530
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-05-31Yes
Was there a failure to transmit to the plan any participant contributions2014-05-31No
Has the plan failed to provide any benefit when due under the plan2014-05-31No
Contributions received in cash from employer2014-05-31$2,085,266
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-05-31$2,424,771
Did the plan have assets held for investment2014-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-05-31Yes
Opinion of an independent qualified public accountant for this plan2014-05-31Disclaimer
Accountancy firm name2014-05-31MCGLADREY LLP
Accountancy firm EIN2014-05-31420714325
2013 : HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-05-31$96,502
Total unrealized appreciation/depreciation of assets2013-05-31$96,502
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-05-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-05-31$0
Total income from all sources (including contributions)2013-05-31$2,457,395
Total loss/gain on sale of assets2013-05-31$0
Total of all expenses incurred2013-05-31$2,410,968
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-05-31$2,193,484
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-05-31$2,345,444
Value of total assets at end of year2013-05-31$683,452
Value of total assets at beginning of year2013-05-31$637,025
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-05-31$217,484
Total interest from all sources2013-05-31$14,939
Total dividends received (eg from common stock, registered investment company shares)2013-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-05-31No
Administrative expenses professional fees incurred2013-05-31$216,793
Was this plan covered by a fidelity bond2013-05-31Yes
Value of fidelity bond cover2013-05-31$500,000
Were there any nonexempt tranactions with any party-in-interest2013-05-31No
Contributions received from participants2013-05-31$715,664
Other income not declared elsewhere2013-05-31$510
Administrative expenses (other) incurred2013-05-31$691
Total non interest bearing cash at end of year2013-05-31$242,851
Total non interest bearing cash at beginning of year2013-05-31$206,085
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-05-31No
Value of net income/loss2013-05-31$46,427
Value of net assets at end of year (total assets less liabilities)2013-05-31$683,452
Value of net assets at beginning of year (total assets less liabilities)2013-05-31$637,025
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-05-31No
Were any leases to which the plan was party in default or uncollectible2013-05-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-05-31$440,601
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-05-31$430,940
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-05-31$14,939
Expenses. Payments to insurance carriers foe the provision of benefits2013-05-31$199,170
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-05-31Yes
Was there a failure to transmit to the plan any participant contributions2013-05-31No
Has the plan failed to provide any benefit when due under the plan2013-05-31No
Contributions received in cash from employer2013-05-31$1,629,780
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-05-31$1,994,314
Did the plan have assets held for investment2013-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-05-31Yes
Opinion of an independent qualified public accountant for this plan2013-05-31Disclaimer
Accountancy firm name2013-05-31BATTELLE RIPPE KINGSTON LLP
Accountancy firm EIN2013-05-31310210560
2012 : HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-05-31$-60,483
Total unrealized appreciation/depreciation of assets2012-05-31$-60,483
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-05-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-05-31$0
Total income from all sources (including contributions)2012-05-31$2,280,964
Total loss/gain on sale of assets2012-05-31$0
Total of all expenses incurred2012-05-31$2,364,061
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-05-31$2,160,509
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-05-31$2,325,202
Value of total assets at end of year2012-05-31$637,025
Value of total assets at beginning of year2012-05-31$720,122
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-05-31$203,552
Total interest from all sources2012-05-31$13,912
Total dividends received (eg from common stock, registered investment company shares)2012-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-05-31No
Administrative expenses professional fees incurred2012-05-31$202,518
Was this plan covered by a fidelity bond2012-05-31Yes
Value of fidelity bond cover2012-05-31$500,000
Were there any nonexempt tranactions with any party-in-interest2012-05-31No
Contributions received from participants2012-05-31$652,066
Other income not declared elsewhere2012-05-31$2,333
Administrative expenses (other) incurred2012-05-31$1,034
Total non interest bearing cash at end of year2012-05-31$206,085
Total non interest bearing cash at beginning of year2012-05-31$203,154
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Value of net income/loss2012-05-31$-83,097
Value of net assets at end of year (total assets less liabilities)2012-05-31$637,025
Value of net assets at beginning of year (total assets less liabilities)2012-05-31$720,122
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-05-31No
Were any leases to which the plan was party in default or uncollectible2012-05-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-05-31$430,940
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-05-31$516,968
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-05-31$13,912
Expenses. Payments to insurance carriers foe the provision of benefits2012-05-31$183,167
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-05-31Yes
Was there a failure to transmit to the plan any participant contributions2012-05-31No
Has the plan failed to provide any benefit when due under the plan2012-05-31No
Contributions received in cash from employer2012-05-31$1,673,136
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-05-31$1,977,342
Did the plan have assets held for investment2012-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-05-31Yes
Opinion of an independent qualified public accountant for this plan2012-05-31Disclaimer
Accountancy firm name2012-05-31BATELLE & BATELLE
Accountancy firm EIN2012-05-31310210560
2011 : HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-05-31$60,509
Total unrealized appreciation/depreciation of assets2011-05-31$60,509
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$0
Total income from all sources (including contributions)2011-05-31$2,358,355
Total loss/gain on sale of assets2011-05-31$0
Total of all expenses incurred2011-05-31$2,328,224
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-05-31$2,109,794
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-05-31$2,265,344
Value of total assets at end of year2011-05-31$720,122
Value of total assets at beginning of year2011-05-31$689,991
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-05-31$218,430
Total interest from all sources2011-05-31$10,655
Total dividends received (eg from common stock, registered investment company shares)2011-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-05-31No
Administrative expenses professional fees incurred2011-05-31$218,430
Was this plan covered by a fidelity bond2011-05-31Yes
Value of fidelity bond cover2011-05-31$500,000
Were there any nonexempt tranactions with any party-in-interest2011-05-31No
Contributions received from participants2011-05-31$591,344
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-05-31$112
Other income not declared elsewhere2011-05-31$21,847
Total non interest bearing cash at end of year2011-05-31$203,154
Total non interest bearing cash at beginning of year2011-05-31$689,879
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Value of net income/loss2011-05-31$30,131
Value of net assets at end of year (total assets less liabilities)2011-05-31$720,122
Value of net assets at beginning of year (total assets less liabilities)2011-05-31$689,991
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-05-31No
Were any leases to which the plan was party in default or uncollectible2011-05-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-05-31$516,968
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-05-31$10,655
Expenses. Payments to insurance carriers foe the provision of benefits2011-05-31$148,720
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-05-31No
Was there a failure to transmit to the plan any participant contributions2011-05-31No
Has the plan failed to provide any benefit when due under the plan2011-05-31No
Contributions received in cash from employer2011-05-31$1,674,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-05-31$1,961,074
Did the plan have assets held for investment2011-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-05-31Yes
Opinion of an independent qualified public accountant for this plan2011-05-31Disclaimer
Accountancy firm name2011-05-31BATELLE & BATELLE
Accountancy firm EIN2011-05-31310210560

Form 5500 Responses for HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN

2022: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2022 form 5500 responses
2022-06-01Type of plan entitySingle employer plan
2022-06-01Plan funding arrangement – InsuranceYes
2022-06-01Plan funding arrangement – General assets of the sponsorYes
2022-06-01Plan benefit arrangement – InsuranceYes
2022-06-01Plan benefit arrangement – General assets of the sponsorYes
2021: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2021 form 5500 responses
2021-06-01Type of plan entitySingle employer plan
2021-06-01Plan funding arrangement – InsuranceYes
2021-06-01Plan funding arrangement – General assets of the sponsorYes
2021-06-01Plan benefit arrangement – InsuranceYes
2021-06-01Plan benefit arrangement – General assets of the sponsorYes
2020: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2020 form 5500 responses
2020-06-01Type of plan entitySingle employer plan
2020-06-01Plan funding arrangement – InsuranceYes
2020-06-01Plan funding arrangement – General assets of the sponsorYes
2020-06-01Plan benefit arrangement – InsuranceYes
2020-06-01Plan benefit arrangement – General assets of the sponsorYes
2019: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2019 form 5500 responses
2019-06-01Type of plan entitySingle employer plan
2019-06-01Plan funding arrangement – InsuranceYes
2019-06-01Plan funding arrangement – General assets of the sponsorYes
2019-06-01Plan benefit arrangement – InsuranceYes
2019-06-01Plan benefit arrangement – General assets of the sponsorYes
2018: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2018 form 5500 responses
2018-06-01Type of plan entitySingle employer plan
2018-06-01Plan funding arrangement – InsuranceYes
2018-06-01Plan funding arrangement – General assets of the sponsorYes
2018-06-01Plan benefit arrangement – InsuranceYes
2018-06-01Plan benefit arrangement – General assets of the sponsorYes
2017: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2017 form 5500 responses
2017-06-01Type of plan entitySingle employer plan
2017-06-01Submission has been amendedYes
2017-06-01Plan funding arrangement – InsuranceYes
2017-06-01Plan funding arrangement – General assets of the sponsorYes
2017-06-01Plan benefit arrangement – InsuranceYes
2017-06-01Plan benefit arrangement – General assets of the sponsorYes
2016: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2016 form 5500 responses
2016-06-01Type of plan entitySingle employer plan
2016-06-01Submission has been amendedNo
2016-06-01This submission is the final filingNo
2016-06-01This return/report is a short plan year return/report (less than 12 months)No
2016-06-01Plan is a collectively bargained planNo
2016-06-01Plan funding arrangement – InsuranceYes
2016-06-01Plan funding arrangement – TrustYes
2016-06-01Plan benefit arrangement – InsuranceYes
2016-06-01Plan benefit arrangement - TrustYes
2015: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2015 form 5500 responses
2015-06-01Type of plan entitySingle employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingNo
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planNo
2015-06-01Plan funding arrangement – InsuranceYes
2015-06-01Plan funding arrangement – TrustYes
2015-06-01Plan benefit arrangement – InsuranceYes
2015-06-01Plan benefit arrangement - TrustYes
2014: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2014 form 5500 responses
2014-06-01Type of plan entitySingle employer plan
2014-06-01Submission has been amendedNo
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planNo
2014-06-01Plan funding arrangement – InsuranceYes
2014-06-01Plan funding arrangement – TrustYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-06-01Plan benefit arrangement - TrustYes
2013: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2013 form 5500 responses
2013-06-01Type of plan entitySingle employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planNo
2013-06-01Plan funding arrangement – InsuranceYes
2013-06-01Plan funding arrangement – TrustYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-06-01Plan benefit arrangement - TrustYes
2012: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2012 form 5500 responses
2012-06-01Type of plan entitySingle employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planNo
2012-06-01Plan funding arrangement – InsuranceYes
2012-06-01Plan funding arrangement – TrustYes
2012-06-01Plan benefit arrangement – InsuranceYes
2012-06-01Plan benefit arrangement - TrustYes
2011: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2011 form 5500 responses
2011-06-01Type of plan entitySingle employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planNo
2011-06-01Plan funding arrangement – InsuranceYes
2011-06-01Plan funding arrangement – TrustYes
2011-06-01Plan benefit arrangement – InsuranceYes
2011-06-01Plan benefit arrangement - TrustYes
2009: HARTZELL INDUSTRIES, INC. & AFFILIATED COMPANIES GROUP MEDICAL BENEFITS PLAN 2009 form 5500 responses
2009-06-01Type of plan entitySingle employer plan
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planNo
2009-06-01Plan funding arrangement – InsuranceYes
2009-06-01Plan funding arrangement – TrustYes
2009-06-01Plan benefit arrangement – InsuranceYes
2009-06-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BPK7
Policy instance 3
Insurance contract or identification numberGLUG0BPK7
Number of Individuals Covered244
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $5,183
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $65,575
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees5183
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberGMDC0BPK7
Policy instance 2
Insurance contract or identification numberGMDC0BPK7
Number of Individuals Covered108
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $148
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,544
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees148
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99321121001
Policy instance 1
Insurance contract or identification number99321121001
Number of Individuals Covered351
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 $13,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED OF OMAHA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BPK7
Policy instance 3
Insurance contract or identification numberGLUG0BPK7
Number of Individuals Covered201
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $3,978
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $64,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees3978
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberGMDC0BPK7
Policy instance 2
Insurance contract or identification numberGMDC0BPK7
Number of Individuals Covered73
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $81
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $1,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees81
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99321121001
Policy instance 1
Insurance contract or identification number99321121001
Number of Individuals Covered310
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 $12,209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberGMDC0BPK7
Policy instance 2
Insurance contract or identification numberGMDC0BPK7
Number of Individuals Covered107
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $3,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0BPK7
Policy instance 3
Insurance contract or identification numberGLUG0BPK7
Number of Individuals Covered227
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $70,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99321121001
Policy instance 1
Insurance contract or identification number99321121001
Number of Individuals Covered323
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 $12,067
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99321121001
Policy instance 2
Insurance contract or identification number99321121001
Number of Individuals Covered329
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
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 $12,238
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 number877112
Policy instance 1
Insurance contract or identification number877112
Number of Individuals Covered205
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $409
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $84,742
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees409
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract number877112G
Policy instance 1
Insurance contract or identification number877112G
Number of Individuals Covered195
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $325
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $81,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees325
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99321121001
Policy instance 2
Insurance contract or identification number99321121001
Number of Individuals Covered314
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 $11,680
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number99321121001
Policy instance 2
Insurance contract or identification number99321121001
Number of Individuals Covered296
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 $12,925
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 number877112G
Policy instance 1
Insurance contract or identification number877112G
Number of Individuals Covered214
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $15,429
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $76,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberG1728
Policy instance 1
Insurance contract or identification numberG1728
Number of Individuals Covered453
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $264,308
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberG1728
Policy instance 1
Insurance contract or identification numberG1728
Number of Individuals Covered483
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $266,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberG1728
Policy instance 1
Insurance contract or identification numberG1728
Number of Individuals Covered574
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $18,283
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberG1728
Policy instance 1
Insurance contract or identification numberG1728
Number of Individuals Covered549
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $156,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberG1728
Policy instance 1
Insurance contract or identification numberG1728
Number of Individuals Covered532
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 CarrierUSD $174,101
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberG1728
Policy instance 1
Insurance contract or identification numberG1728
Number of Individuals Covered457
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
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 BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No

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