FRANCISCAN UNIVERSITY OF STEUBENVILLE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan FRANCISCAN UNIVERSITY OF STEUBENVILLE WELFARE BENEFIT PLAN
401k plan membership statisitcs for FRANCISCAN UNIVERSITY OF STEUBENVILLE WELFARE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2020 |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 367 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 361 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 364 |
| 2019 |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 370 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 365 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 367 |
| 2018 |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 344 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 370 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 370 |
| 2017 |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 356 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 340 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 344 |
| 2016 |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 354 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 355 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 356 |
| 2015 |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 582 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 352 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 354 |
| 2014 |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 323 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 580 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 2 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 582 |
| 2013 |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 311 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 323 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 323 |
| 2012 |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 313 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 310 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 311 |
| 2011 |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 309 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 309 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 313 |
| 2009 |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 313 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 305 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 3 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 308 |
| Measure | Date | Value |
|---|
| 2020 |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $540,705 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $177,503 |
| Total income from all sources (including contributions) | 2020-12-31 | $6,704,363 |
| Total of all expenses incurred | 2020-12-31 | $6,583,929 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $6,490,763 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $6,704,363 |
| Value of total assets at end of year | 2020-12-31 | $872,148 |
| Value of total assets at beginning of year | 2020-12-31 | $388,512 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $93,166 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Administrative expenses professional fees incurred | 2020-12-31 | $57,500 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $1,571,468 |
| Administrative expenses (other) incurred | 2020-12-31 | $23,042 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $57,747 |
| Total non interest bearing cash at end of year | 2020-12-31 | $872,148 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $388,512 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $120,434 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $331,443 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $211,009 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $1,724,962 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $5,132,895 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $4,765,801 |
| Contract administrator fees | 2020-12-31 | $12,624 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $540,705 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $119,756 |
| Did the plan have assets held for investment | 2020-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | SCHNEIDER DOWNS & CO., INC. |
| Accountancy firm EIN | 2020-12-31 | 251408703 |
| 2019 |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $177,503 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $177,503 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $176,617 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $176,617 |
| Total income from all sources (including contributions) | 2019-12-31 | $5,657,452 |
| Total income from all sources (including contributions) | 2019-12-31 | $5,657,452 |
| Total of all expenses incurred | 2019-12-31 | $6,014,825 |
| Total of all expenses incurred | 2019-12-31 | $6,014,825 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $5,936,309 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $5,936,309 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $5,657,452 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $5,657,452 |
| Value of total assets at end of year | 2019-12-31 | $388,512 |
| Value of total assets at end of year | 2019-12-31 | $388,512 |
| Value of total assets at beginning of year | 2019-12-31 | $744,999 |
| Value of total assets at beginning of year | 2019-12-31 | $744,999 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $78,516 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $78,516 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $38,450 |
| Administrative expenses professional fees incurred | 2019-12-31 | $38,450 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $1,114,482 |
| Contributions received from participants | 2019-12-31 | $1,114,482 |
| Administrative expenses (other) incurred | 2019-12-31 | $40,066 |
| Administrative expenses (other) incurred | 2019-12-31 | $40,066 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $57,747 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $57,747 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $61,982 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $61,982 |
| Total non interest bearing cash at end of year | 2019-12-31 | $388,512 |
| Total non interest bearing cash at end of year | 2019-12-31 | $388,512 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $744,999 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $744,999 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $-357,373 |
| Value of net income/loss | 2019-12-31 | $-357,373 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $211,009 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $211,009 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $568,382 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $568,382 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $1,187,339 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $1,187,339 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $4,542,970 |
| Contributions received in cash from employer | 2019-12-31 | $4,542,970 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $4,748,970 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $4,748,970 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $119,756 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $119,756 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $114,635 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $114,635 |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | SCHNEIDER DOWNS & CO., INC. |
| Accountancy firm name | 2019-12-31 | SCHNEIDER DOWNS & CO., INC. |
| Accountancy firm EIN | 2019-12-31 | 251408703 |
| Accountancy firm EIN | 2019-12-31 | 251408703 |
| 2018 |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $176,617 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $582,250 |
| Total income from all sources (including contributions) | 2018-12-31 | $6,284,577 |
| Total of all expenses incurred | 2018-12-31 | $6,392,075 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $6,251,702 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $6,284,577 |
| Value of total assets at end of year | 2018-12-31 | $744,999 |
| Value of total assets at beginning of year | 2018-12-31 | $1,258,130 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $140,373 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Administrative expenses professional fees incurred | 2018-12-31 | $69,000 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $1,124,064 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-12-31 | $527,756 |
| Administrative expenses (other) incurred | 2018-12-31 | $71,373 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $61,982 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $36,125 |
| Total non interest bearing cash at end of year | 2018-12-31 | $744,999 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $1,258,130 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $-107,498 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $568,382 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $675,880 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $6,251,702 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $5,160,513 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $114,635 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $18,369 |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | SCHNEIDER DOWNS & CO., INC. |
| Accountancy firm EIN | 2018-12-31 | 251408703 |
| 2017 |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $582,250 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $478,222 |
| Total income from all sources (including contributions) | 2017-12-31 | $5,978,620 |
| Total of all expenses incurred | 2017-12-31 | $5,302,740 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $5,190,064 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $5,978,620 |
| Value of total assets at end of year | 2017-12-31 | $1,258,130 |
| Value of total assets at beginning of year | 2017-12-31 | $478,222 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $112,676 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Administrative expenses professional fees incurred | 2017-12-31 | $69,000 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $1,095,776 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-12-31 | $527,756 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-12-31 | $339,776 |
| Administrative expenses (other) incurred | 2017-12-31 | $43,676 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $36,125 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $43,680 |
| Total non interest bearing cash at end of year | 2017-12-31 | $1,258,130 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $675,880 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $675,880 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $478,222 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $478,222 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $5,190,064 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $4,882,844 |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $18,369 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $94,766 |
| Did the plan have assets held for investment | 2017-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | SCHNEIDER DOWNS & CO., INC. |
| Accountancy firm EIN | 2017-12-31 | 251408703 |
| 2016 |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $478,222 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $0 |
| Total income from all sources (including contributions) | 2016-12-31 | $5,305,819 |
| Total of all expenses incurred | 2016-12-31 | $5,305,819 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $5,103,822 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $5,305,523 |
| Value of total assets at end of year | 2016-12-31 | $478,222 |
| Value of total assets at beginning of year | 2016-12-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $201,997 |
| Total interest from all sources | 2016-12-31 | $296 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Administrative expenses professional fees incurred | 2016-12-31 | $74,349 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $948,395 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-12-31 | $339,776 |
| Administrative expenses (other) incurred | 2016-12-31 | $127,648 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $43,680 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $0 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $478,222 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-12-31 | $296 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $5,103,822 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $4,357,128 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $94,766 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $0 |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | SCHNEIDER DOWNS & CO., INC. |
| Accountancy firm EIN | 2016-12-31 | 251408703 |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-014808-000 |
| Policy instance | 5 |
| Insurance contract or identification number | 16-014808-000 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $24,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 24456 | | Additional information about fees paid to insurance broker | GROUP ADMINISTRATIVE SUPPORT FEE |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-6820-19 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-6820-19 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $149 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 149 | | Insurance broker organization code? | 0 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4214 |
| Policy instance | 3 |
| Insurance contract or identification number | 4214 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 921202 AND SUBS |
| Policy instance | 2 |
| Insurance contract or identification number | 921202 AND SUBS | | Number of Individuals Covered | 687 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $136,985 | | 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 number | AL00005358 |
| Policy instance | 1 |
| Insurance contract or identification number | AL00005358 | | Number of Individuals Covered | 364 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $15,610 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $151,062 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,610 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 921202 AND SUBS |
| Policy instance | 2 |
| Insurance contract or identification number | 921202 AND SUBS | | Number of Individuals Covered | 619 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $124,914 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4214 |
| Policy instance | 3 |
| Insurance contract or identification number | 4214 | | Number of Individuals Covered | 305 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-6820-19 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-6820-19 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $149 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 149 | | Additional information about fees paid to insurance broker | ACCESS FEES | | Insurance broker organization code? | 0 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | 405779 |
| Policy instance | 5 |
| Insurance contract or identification number | 405779 | | Number of Individuals Covered | 302 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $861,181 | | 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 number | AL00005358 |
| Policy instance | 1 |
| Insurance contract or identification number | AL00005358 | | Number of Individuals Covered | 357 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $17,863 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $153,834 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $17,863 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | 921202 AND SUBS |
| Policy instance | 2 |
| Insurance contract or identification number | 921202 AND SUBS | | Number of Individuals Covered | 617 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $122,968 | | 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 number | AL00005358 |
| Policy instance | 1 |
| Insurance contract or identification number | AL00005358 | | Number of Individuals Covered | 354 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $14,561 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $148,896 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,561 | | Insurance broker organization code? | 3 |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4214 |
| Policy instance | 3 |
| Insurance contract or identification number | 4214 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-6820-18 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-6820-18 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $149 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 149 | | Additional information about fees paid to insurance broker | ACCESS FEE | | Insurance broker organization code? | 0 |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | AL00005358 |
| Policy instance | 1 |
| Insurance contract or identification number | AL00005358 | | Number of Individuals Covered | 342 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $16,079 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $146,990 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,079 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AND FINANCIAL SERV |
|
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4214 |
| Policy instance | 3 |
| Insurance contract or identification number | 4214 | | Number of Individuals Covered | 308 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05912680 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05912680 | | Number of Individuals Covered | 342 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $3,988 | | Total amount of fees paid to insurance company | USD $53 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $133,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,824 | | Amount paid for insurance broker fees | 53 | | Additional information about fees paid to insurance broker | NON-MONETARY COMPENSATION | | Insurance broker organization code? | 3 | | Insurance broker name | TRACY MCMANAMON |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7266-15 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-7266-15 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $149 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 149 | | Additional information about fees paid to insurance broker | ACCESS FEE | | Insurance broker organization code? | 0 | | Insurance broker name | HIGHMARK BLUE SHIELD |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7266-15 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-7266-15 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $554 | | Total amount of fees paid to insurance company | USD $277 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,930 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $554 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 277 | | Additional information about fees paid to insurance broker | ACCESS FEE | | Insurance broker name | HIGHMARK BLUE SHIELD |
|
| METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 ) |
| Policy contract number | TM05912680 |
| Policy instance | 2 |
| Insurance contract or identification number | TM05912680 | | Number of Individuals Covered | 348 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $3,323 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $95,583 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,323 | | Insurance broker organization code? | 3 | | Insurance broker name | TRACY MCMANAMON |
|
| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | AL00005358 |
| Policy instance | 1 |
| Insurance contract or identification number | AL00005358 | | Number of Individuals Covered | 329 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $12,963 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $133,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,963 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AND FINANCIAL SERV |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01031100 |
| Policy instance | 3 |
| Insurance contract or identification number | 01031100 | | Number of Individuals Covered | 898 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $54,532 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7266-13 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-7266-13 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $1,795 | | Total amount of fees paid to insurance company | USD $897 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,795 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 897 | | Additional information about fees paid to insurance broker | ACCESS FEE | | Insurance broker name | HIGHMARK BLUE SHIELD |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01031100 |
| Policy instance | 3 |
| Insurance contract or identification number | 01031100 | | Number of Individuals Covered | 582 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,755 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 133497 |
| Policy instance | 2 |
| Insurance contract or identification number | 133497 | | Number of Individuals Covered | 147 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $5,564 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $37,091 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,564 | | Insurance broker organization code? | 3 | | 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 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Insurance broker name | MCBANE INSURANCE AND FINANCIAL |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 563429 |
| Policy instance | 1 |
| Insurance contract or identification number | 563429 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $10,755 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $91,147 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,168 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AND FINANCIAL |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 563429 |
| Policy instance | 1 |
| Insurance contract or identification number | 563429 | | Number of Individuals Covered | 323 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $11,715 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $81,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,959 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AND FINANCIAL |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01031100 |
| Policy instance | 3 |
| Insurance contract or identification number | 01031100 | | Number of Individuals Covered | 283 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,066 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FOUR EVER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 80985 ) |
| Policy contract number | 4EL-7266-13 |
| Policy instance | 4 |
| Insurance contract or identification number | 4EL-7266-13 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $529 | | Total amount of fees paid to insurance company | USD $265 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $529 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 265 | | Additional information about fees paid to insurance broker | ACCESS FEES | | Insurance broker name | HIGHMARK |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 133497 |
| Policy instance | 2 |
| Insurance contract or identification number | 133497 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2012-11-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $6,162 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $38,173 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,162 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AND FINANCIAL |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01031010 |
| Policy instance | 3 |
| Insurance contract or identification number | 01031010 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $51,581 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 563429 |
| Policy instance | 1 |
| Insurance contract or identification number | 563429 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2011-12-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $9,592 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $67,376 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,285 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AND FINANCIAL |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 133497 |
| Policy instance | 2 |
| Insurance contract or identification number | 133497 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $5,213 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $37,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,213 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AND FINANCIAL |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01031010 |
| Policy instance | 3 |
| Insurance contract or identification number | 01031010 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 563429 |
| Policy instance | 1 |
| Insurance contract or identification number | 563429 | | Number of Individuals Covered | 309 | | Insurance policy start date | 2010-12-01 | | Insurance policy end date | 2011-11-30 | | Total amount of commissions paid to insurance broker | USD $10,075 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $69,215 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 133497 |
| Policy instance | 2 |
| Insurance contract or identification number | 133497 | | Number of Individuals Covered | 110 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $4,661 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $31,074 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 563429 |
| Policy instance | 1 |
| Insurance contract or identification number | 563429 | | Number of Individuals Covered | 308 | | Insurance policy start date | 2009-12-01 | | Insurance policy end date | 2010-11-30 | | Total amount of commissions paid to insurance broker | USD $3,938 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $38,628 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,938 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AGENCY, INC. |
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| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 133497 |
| Policy instance | 2 |
| Insurance contract or identification number | 133497 | | Number of Individuals Covered | 104 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $3,936 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $26,239 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,936 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AGENCY, INC. |
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| ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 ) |
| Policy contract number | AL00003480 |
| Policy instance | 3 |
| Insurance contract or identification number | AL00003480 | | Number of Individuals Covered | 306 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $2,272 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $27,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,272 | | Insurance broker organization code? | 3 | | Insurance broker name | MCBANE INSURANCE AGENCY, INC. |
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| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 01662048 |
| Policy instance | 4 |
| Insurance contract or identification number | 01662048 | | Number of Individuals Covered | 271 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $52,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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