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SHEET METAL WORKERS LOCAL 224 WELFARE PLAN 401k Plan overview

Plan NameSHEET METAL WORKERS LOCAL 224 WELFARE PLAN
Plan identification number 501

SHEET METAL WORKERS LOCAL 224 WELFARE PLAN Benefits

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

401k Sponsoring company profile

SHEET METAL WORKERS LOCAL 224 WELFARE FUND BD OF TRUSTEES has sponsored the creation of one or more 401k plans.

Company Name:SHEET METAL WORKERS LOCAL 224 WELFARE FUND BD OF TRUSTEES
Employer identification number (EIN):316171353
NAIC Classification:238100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SHEET METAL WORKERS LOCAL 224 WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012016-01-01GINA M ENGLEMAN
5012015-01-01GINA M ENGLEMAN
5012014-01-01GINA M ENGLEMAN
5012013-01-01GINA M ENGLEMAN
5012012-01-01GINA M ENGLEMAN
5012011-01-01GINA M ENGLEMAN
5012009-01-01NANCY BEHR

Plan Statistics for SHEET METAL WORKERS LOCAL 224 WELFARE PLAN

401k plan membership statisitcs for SHEET METAL WORKERS LOCAL 224 WELFARE PLAN

Measure Date Value
2016
Total participants, beginning-of-year2016-01-01395
Total number of active participants reported on line 7a of the Form 55002016-01-010
Total of all active and inactive participants2016-01-010
Number of employers contributing to the scheme2016-01-010
2015
Total participants, beginning-of-year2015-01-01359
Total number of active participants reported on line 7a of the Form 55002015-01-01300
Number of retired or separated participants receiving benefits2015-01-0195
Total of all active and inactive participants2015-01-01395
Number of employers contributing to the scheme2015-01-0135
2014
Total participants, beginning-of-year2014-01-01406
Total number of active participants reported on line 7a of the Form 55002014-01-01254
Number of retired or separated participants receiving benefits2014-01-01105
Total of all active and inactive participants2014-01-01359
Total participants2014-01-01359
Number of employers contributing to the scheme2014-01-0136
2013
Total participants, beginning-of-year2013-01-01415
Total number of active participants reported on line 7a of the Form 55002013-01-01284
Number of retired or separated participants receiving benefits2013-01-01122
Total of all active and inactive participants2013-01-01406
Total participants2013-01-01406
Number of employers contributing to the scheme2013-01-0140
2012
Total participants, beginning-of-year2012-01-01450
Total number of active participants reported on line 7a of the Form 55002012-01-01281
Number of retired or separated participants receiving benefits2012-01-01134
Total of all active and inactive participants2012-01-01415
Total participants2012-01-01415
Number of employers contributing to the scheme2012-01-0142
2011
Total participants, beginning-of-year2011-01-01423
Total number of active participants reported on line 7a of the Form 55002011-01-01300
Number of retired or separated participants receiving benefits2011-01-01150
Total of all active and inactive participants2011-01-01450
Total participants2011-01-01450
Number of employers contributing to the scheme2011-01-0143
2009
Total participants, beginning-of-year2009-01-01484
Total number of active participants reported on line 7a of the Form 55002009-01-01303
Number of retired or separated participants receiving benefits2009-01-01171
Total of all active and inactive participants2009-01-01474
Total participants2009-01-01474
Number of employers contributing to the scheme2009-01-0128

Financial Data on SHEET METAL WORKERS LOCAL 224 WELFARE PLAN

Measure Date Value
2016
Total unrealized appreciation/depreciation of assets2016-09-02$0
Total transfer of assets from this plan2016-09-02$1,408,534
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-02$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-02$14,230
Total income from all sources (including contributions)2016-09-02$0
Total loss/gain on sale of assets2016-09-02$0
Total of all expenses incurred2016-09-02$506,959
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-09-02$402,997
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-09-02$0
Value of total assets at end of year2016-09-02$0
Value of total assets at beginning of year2016-09-02$1,929,723
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-09-02$103,962
Total interest from all sources2016-09-02$0
Total dividends received (eg from common stock, registered investment company shares)2016-09-02$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-09-02Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-09-02$0
Administrative expenses professional fees incurred2016-09-02$20,405
Was this plan covered by a fidelity bond2016-09-02Yes
Value of fidelity bond cover2016-09-02$1,000,000
Were there any nonexempt tranactions with any party-in-interest2016-09-02No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-09-02$5,802
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-09-02$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-09-02$45,509
Administrative expenses (other) incurred2016-09-02$2,369
Liabilities. Value of operating payables at end of year2016-09-02$0
Liabilities. Value of operating payables at beginning of year2016-09-02$14,230
Total non interest bearing cash at end of year2016-09-02$0
Total non interest bearing cash at beginning of year2016-09-02$1,640,195
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-02No
Value of net income/loss2016-09-02$-506,959
Value of net assets at end of year (total assets less liabilities)2016-09-02$0
Value of net assets at beginning of year (total assets less liabilities)2016-09-02$1,915,493
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-09-02No
Were any loans by the plan or fixed income obligations due to the plan in default2016-09-02No
Were any leases to which the plan was party in default or uncollectible2016-09-02No
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-09-02$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-09-02No
Was there a failure to transmit to the plan any participant contributions2016-09-02No
Has the plan failed to provide any benefit when due under the plan2016-09-02No
Employer contributions (assets) at end of year2016-09-02$0
Employer contributions (assets) at beginning of year2016-09-02$232,469
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-09-02$397,195
Contract administrator fees2016-09-02$81,188
Assets. Value of buildings and other operty used in plan operation at end of year2016-09-02$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2016-09-02$11,550
Did the plan have assets held for investment2016-09-02No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-02No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-09-02Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-09-02No
Opinion of an independent qualified public accountant for this plan2016-09-02Unqualified
Accountancy firm name2016-09-02CLARK, SCHAEFER, HACKETT & CO.
Accountancy firm EIN2016-09-02310800053
2015
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total transfer of assets from this plan2015-12-31$243,996
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$14,230
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$389,522
Total income from all sources (including contributions)2015-12-31$3,222,226
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$3,838,489
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$3,287,519
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$3,182,119
Value of total assets at end of year2015-12-31$1,929,723
Value of total assets at beginning of year2015-12-31$3,165,274
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$550,970
Total interest from all sources2015-12-31$1
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$31,520
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$31,520
Administrative expenses professional fees incurred2015-12-31$122,707
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$1,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$333,566
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$45,509
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$2,816
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$4,738
Administrative expenses (other) incurred2015-12-31$224,414
Liabilities. Value of operating payables at end of year2015-12-31$14,230
Liabilities. Value of operating payables at beginning of year2015-12-31$59,850
Total non interest bearing cash at end of year2015-12-31$1,640,195
Total non interest bearing cash at beginning of year2015-12-31$173,607
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-616,263
Value of net assets at end of year (total assets less liabilities)2015-12-31$1,915,493
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$2,775,752
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$2,774,671
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$1
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$200,618
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$8,586
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$2,848,553
Employer contributions (assets) at end of year2015-12-31$232,469
Employer contributions (assets) at beginning of year2015-12-31$207,801
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$3,086,901
Contract administrator fees2015-12-31$203,849
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$324,934
Assets. Value of buildings and other operty used in plan operation at end of year2015-12-31$11,550
Assets. Value of buildings and other operty used in plan operation at beginning of year2015-12-31$6,379
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31CLARK, SCAHEFER, HACKETT & CO.
Accountancy firm EIN2015-12-31310800053
2014
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$30,515
Total unrealized appreciation/depreciation of assets2014-12-31$30,515
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$389,522
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$265,929
Total income from all sources (including contributions)2014-12-31$3,443,254
Total loss/gain on sale of assets2014-12-31$14,277
Total of all expenses incurred2014-12-31$4,509,483
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$4,172,494
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$3,172,911
Value of total assets at end of year2014-12-31$3,165,274
Value of total assets at beginning of year2014-12-31$4,107,910
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$336,989
Total interest from all sources2014-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$56,094
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$56,094
Administrative expenses professional fees incurred2014-12-31$91,036
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$388,465
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-12-31$689,339
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$2,816
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$5,097
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$4,738
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$5,190
Other income not declared elsewhere2014-12-31$169,457
Administrative expenses (other) incurred2014-12-31$245,953
Liabilities. Value of operating payables at end of year2014-12-31$59,850
Liabilities. Value of operating payables at beginning of year2014-12-31$69,893
Total non interest bearing cash at end of year2014-12-31$173,607
Total non interest bearing cash at beginning of year2014-12-31$205,819
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-1,066,229
Value of net assets at end of year (total assets less liabilities)2014-12-31$2,775,752
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$3,841,981
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$2,774,671
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$3,723,785
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$290,394
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$2,784,446
Employer contributions (assets) at end of year2014-12-31$207,801
Employer contributions (assets) at beginning of year2014-12-31$166,292
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$3,192,761
Liabilities. Value of benefit claims payable at end of year2014-12-31$324,934
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$190,846
Assets. Value of buildings and other operty used in plan operation at end of year2014-12-31$6,379
Assets. Value of buildings and other operty used in plan operation at beginning of year2014-12-31$6,917
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Aggregate proceeds on sale of assets2014-12-31$2,328,756
Aggregate carrying amount (costs) on sale of assets2014-12-31$2,314,479
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31SWORDS & WILLIAMS
Accountancy firm EIN2014-12-31311116327
2013
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$96,420
Total unrealized appreciation/depreciation of assets2013-12-31$96,420
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$265,929
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$277,301
Total income from all sources (including contributions)2013-12-31$3,134,935
Total loss/gain on sale of assets2013-12-31$29,202
Total of all expenses incurred2013-12-31$4,250,218
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$3,864,261
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$2,706,687
Value of total assets at end of year2013-12-31$4,107,910
Value of total assets at beginning of year2013-12-31$5,234,565
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$385,957
Total interest from all sources2013-12-31$372
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$89,707
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$89,707
Administrative expenses professional fees incurred2013-12-31$83,896
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$404,617
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-12-31$720,651
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$5,097
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$2,719
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$5,190
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$2,957
Other income not declared elsewhere2013-12-31$212,547
Administrative expenses (other) incurred2013-12-31$302,061
Liabilities. Value of operating payables at end of year2013-12-31$69,893
Liabilities. Value of operating payables at beginning of year2013-12-31$79,283
Total non interest bearing cash at end of year2013-12-31$205,819
Total non interest bearing cash at beginning of year2013-12-31$322,156
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-1,115,283
Value of net assets at end of year (total assets less liabilities)2013-12-31$3,841,981
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$4,957,264
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$3,723,785
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$4,708,456
Interest earned on other investments2013-12-31$372
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$291,146
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$2,302,070
Employer contributions (assets) at end of year2013-12-31$166,292
Employer contributions (assets) at beginning of year2013-12-31$193,748
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$2,852,464
Liabilities. Value of benefit claims payable at end of year2013-12-31$190,846
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$195,061
Assets. Value of buildings and other operty used in plan operation at end of year2013-12-31$6,917
Assets. Value of buildings and other operty used in plan operation at beginning of year2013-12-31$7,486
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$5,297,727
Aggregate carrying amount (costs) on sale of assets2013-12-31$5,268,525
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31SWORDS & WILLIAMS
Accountancy firm EIN2013-12-31311116327
2012
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$72,656
Total unrealized appreciation/depreciation of assets2012-12-31$72,656
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$277,301
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$466,901
Total income from all sources (including contributions)2012-12-31$3,161,477
Total loss/gain on sale of assets2012-12-31$-440
Total of all expenses incurred2012-12-31$3,809,737
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$3,496,523
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$2,738,246
Value of total assets at end of year2012-12-31$5,234,565
Value of total assets at beginning of year2012-12-31$6,072,425
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$313,214
Total interest from all sources2012-12-31$33
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$174,029
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$174,029
Administrative expenses professional fees incurred2012-12-31$59,175
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$416,719
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-12-31$688,227
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$2,719
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$34,943
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$2,957
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$2,640
Other income not declared elsewhere2012-12-31$176,953
Administrative expenses (other) incurred2012-12-31$254,039
Liabilities. Value of operating payables at end of year2012-12-31$79,283
Liabilities. Value of operating payables at beginning of year2012-12-31$54,786
Total non interest bearing cash at end of year2012-12-31$322,156
Total non interest bearing cash at beginning of year2012-12-31$344,001
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-648,260
Value of net assets at end of year (total assets less liabilities)2012-12-31$4,957,264
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$5,605,524
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$4,708,456
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$5,462,210
Interest earned on other investments2012-12-31$33
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$301,652
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$2,321,527
Employer contributions (assets) at end of year2012-12-31$193,748
Employer contributions (assets) at beginning of year2012-12-31$220,636
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$2,506,644
Liabilities. Value of benefit claims payable at end of year2012-12-31$195,061
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$409,475
Assets. Value of buildings and other operty used in plan operation at end of year2012-12-31$7,486
Assets. Value of buildings and other operty used in plan operation at beginning of year2012-12-31$10,635
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$1,000,000
Aggregate carrying amount (costs) on sale of assets2012-12-31$1,000,440
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31SWORDS & WILLIAMS
Accountancy firm EIN2012-12-31311116327
2011
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$123,960
Total unrealized appreciation/depreciation of assets2011-12-31$123,960
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$466,901
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$305,706
Total income from all sources (including contributions)2011-12-31$3,517,794
Total loss/gain on sale of assets2011-12-31$8,024
Total of all expenses incurred2011-12-31$3,904,662
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$3,544,729
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$2,960,165
Value of total assets at end of year2011-12-31$6,072,425
Value of total assets at beginning of year2011-12-31$6,298,098
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$359,933
Total interest from all sources2011-12-31$181
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$225,681
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$225,681
Administrative expenses professional fees incurred2011-12-31$79,409
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$423,159
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-12-31$666,172
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$34,943
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$76,767
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$2,640
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$3,017
Other income not declared elsewhere2011-12-31$199,783
Administrative expenses (other) incurred2011-12-31$280,524
Liabilities. Value of operating payables at end of year2011-12-31$54,786
Liabilities. Value of operating payables at beginning of year2011-12-31$55,083
Total non interest bearing cash at end of year2011-12-31$344,001
Total non interest bearing cash at beginning of year2011-12-31$186,323
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-386,868
Value of net assets at end of year (total assets less liabilities)2011-12-31$5,605,524
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$5,992,392
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$5,462,210
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$5,804,545
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$181
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$280,406
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$2,537,006
Employer contributions (assets) at end of year2011-12-31$220,636
Employer contributions (assets) at beginning of year2011-12-31$223,030
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$2,598,151
Liabilities. Value of benefit claims payable at end of year2011-12-31$409,475
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$247,606
Assets. Value of buildings and other operty used in plan operation at end of year2011-12-31$10,635
Assets. Value of buildings and other operty used in plan operation at beginning of year2011-12-31$7,433
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$700,000
Aggregate carrying amount (costs) on sale of assets2011-12-31$691,976
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31SWORDS & WILLIAMS
Accountancy firm EIN2011-12-31311116327
2010
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$155,764
Total unrealized appreciation/depreciation of assets2010-12-31$155,764
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$305,706
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$325,661
Total income from all sources (including contributions)2010-12-31$3,429,848
Total loss/gain on sale of assets2010-12-31$14,750
Total of all expenses incurred2010-12-31$3,711,910
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$3,349,655
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$2,745,457
Value of total assets at end of year2010-12-31$6,298,098
Value of total assets at beginning of year2010-12-31$6,600,115
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$362,255
Total interest from all sources2010-12-31$406
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$310,878
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$310,878
Administrative expenses professional fees incurred2010-12-31$72,006
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$1,000,000
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$464,213
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2010-12-31$598,880
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$76,767
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$94,973
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$3,017
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$6,828
Other income not declared elsewhere2010-12-31$202,593
Administrative expenses (other) incurred2010-12-31$290,249
Liabilities. Value of operating payables at end of year2010-12-31$55,083
Liabilities. Value of operating payables at beginning of year2010-12-31$55,914
Total non interest bearing cash at end of year2010-12-31$186,323
Total non interest bearing cash at beginning of year2010-12-31$160,560
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-282,062
Value of net assets at end of year (total assets less liabilities)2010-12-31$5,992,392
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$6,274,454
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$5,804,545
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$6,073,154
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$406
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$267,268
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$2,281,244
Employer contributions (assets) at end of year2010-12-31$223,030
Employer contributions (assets) at beginning of year2010-12-31$261,950
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$2,483,507
Liabilities. Value of benefit claims payable at end of year2010-12-31$247,606
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$262,919
Assets. Value of buildings and other operty used in plan operation at end of year2010-12-31$7,433
Assets. Value of buildings and other operty used in plan operation at beginning of year2010-12-31$9,478
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Aggregate proceeds on sale of assets2010-12-31$450,000
Aggregate carrying amount (costs) on sale of assets2010-12-31$435,250
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31BREIDENBACH & SWORDS
Accountancy firm EIN2010-12-31311116327

Form 5500 Responses

2016
2016-01-01Type of plan entityMulti-employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingYes
2016-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015
2015-01-01Type of plan entityMulti-employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014
2014-01-01Type of plan entityMulti-employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013
2013-01-01Type of plan entityMulti-employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012
2012-01-01Type of plan entityMulti-employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011
2011-01-01Type of plan entityMulti-employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009
2009-01-01Type of plan entityMulti-employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00001394
Policy instance 1
Insurance contract or identification numberAL00001394
Number of Individuals Covered269
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $15,424
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 number00104428
Policy instance 2
Insurance contract or identification number00104428
Number of Individuals Covered318
Insurance policy start date2014-04-01
Insurance policy end date2015-03-31
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 $176,317
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 number00104428
Policy instance 1
Insurance contract or identification number00104428
Number of Individuals Covered315
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
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 BenefitYes
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 $153,078
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00001394
Policy instance 2
Insurance contract or identification numberAL00001394
Number of Individuals Covered247
Insurance policy start date2013-04-01
Insurance policy end date2014-03-31
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $10,045
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 number00104428
Policy instance 1
Insurance contract or identification number00104428
Number of Individuals Covered330
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
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 BenefitYes
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 $116,137
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00001394
Policy instance 2
Insurance contract or identification numberAL00001394
Number of Individuals Covered267
Insurance policy start date2012-04-01
Insurance policy end date2013-03-31
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,963
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 number00104428
Policy instance 1
Insurance contract or identification number00104428
Number of Individuals Covered300
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00001394
Policy instance 2
Insurance contract or identification numberAL00001394
Number of Individuals Covered270
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,837
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 number00104428
Policy instance 1
Insurance contract or identification number00104428
Number of Individuals Covered278
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $101,100
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00001394
Policy instance 2
Insurance contract or identification numberAL00001394
Number of Individuals Covered229
Insurance policy start date2010-04-10
Insurance policy end date2011-03-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,583
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 number00104428
Policy instance 1
Insurance contract or identification number00104428
Number of Individuals Covered331
Insurance policy start date2009-04-01
Insurance policy end date2010-03-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $134,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract numberAL00001394
Policy instance 2
Insurance contract or identification numberAL00001394
Number of Individuals Covered252
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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