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IRON WORKERS SHOPMEN'S LOCAL 468 INSURANCE TRUST FUND 401k Plan overview

Plan NameIRON WORKERS SHOPMEN'S LOCAL 468 INSURANCE TRUST FUND
Plan identification number 501

IRON WORKERS SHOPMEN'S LOCAL 468 INSURANCE TRUST FUND Benefits

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

401k Sponsoring company profile

IRON WORKERS SHOPMEN'S LOCAL 468 INSURANCE TRUST FUND has sponsored the creation of one or more 401k plans.

Company Name:IRON WORKERS SHOPMEN'S LOCAL 468 INSURANCE TRUST FUND
Employer identification number (EIN):340812024
NAIC Classification:332300

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IRON WORKERS SHOPMEN'S LOCAL 468 INSURANCE TRUST FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012017-01-01CHADWICK RINK
5012016-01-01CHADWICK RINK
5012015-01-01CHADWICK RINK
5012014-01-01CHADWICK RINK CHADWICK RINK
5012014-01-01CHADWICK RINK
5012013-01-01CHADWICK RINK
5012012-01-01WILLIAM E NIXON III
5012011-01-01ROBERT G. SCHIEBLI
5012010-01-01ROBERT G. SCHIEBLI ROBERT G. SCHIEBLI2011-10-13
5012009-01-01ROBERT G. SCHIEBLI

Plan Statistics for IRON WORKERS SHOPMEN'S LOCAL 468 INSURANCE TRUST FUND

401k plan membership statisitcs for IRON WORKERS SHOPMEN'S LOCAL 468 INSURANCE TRUST FUND

Measure Date Value
2017
Total participants, beginning-of-year2017-01-0188
Total number of active participants reported on line 7a of the Form 55002017-01-0190
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0190
Number of employers contributing to the scheme2017-01-015
2016
Total participants, beginning-of-year2016-01-0192
Total number of active participants reported on line 7a of the Form 55002016-01-0188
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0188
Number of employers contributing to the scheme2016-01-016
2015
Total participants, beginning-of-year2015-01-0193
Total number of active participants reported on line 7a of the Form 55002015-01-0192
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-0192
Number of employers contributing to the scheme2015-01-017
2014
Total participants, beginning-of-year2014-01-0191
Total number of active participants reported on line 7a of the Form 55002014-01-0193
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-0193
Number of employers contributing to the scheme2014-01-017
2013
Total participants, beginning-of-year2013-01-0197
Total number of active participants reported on line 7a of the Form 55002013-01-0191
Total of all active and inactive participants2013-01-0191
Number of employers contributing to the scheme2013-01-017
2012
Total participants, beginning-of-year2012-01-0184
Total number of active participants reported on line 7a of the Form 55002012-01-0197
Total of all active and inactive participants2012-01-0197
2011
Total participants, beginning-of-year2011-01-01107
Total number of active participants reported on line 7a of the Form 55002011-01-0184
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-0184
2010
Total participants, beginning-of-year2010-01-01129
Total number of active participants reported on line 7a of the Form 55002010-01-01107
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-010
Total of all active and inactive participants2010-01-01107
2009
Total participants, beginning-of-year2009-01-01133
Total number of active participants reported on line 7a of the Form 55002009-01-01129
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01129

Financial Data on IRON WORKERS SHOPMEN'S LOCAL 468 INSURANCE TRUST FUND

Measure Date Value
2018
Total transfer of assets from this plan2018-12-31$36,984
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$12,162
Total income from all sources (including contributions)2018-12-31$854,088
Total of all expenses incurred2018-12-31$867,571
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$829,768
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$854,088
Value of total assets at end of year2018-12-31$0
Value of total assets at beginning of year2018-12-31$62,629
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$37,803
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2018-12-31$0
Administrative expenses professional fees incurred2018-12-31$28,172
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$18,556
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$75
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-12-31$1,503
Administrative expenses (other) incurred2018-12-31$9,631
Liabilities. Value of operating payables at beginning of year2018-12-31$10,659
Total non interest bearing cash at beginning of year2018-12-31$62,392
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-13,483
Value of net assets at end of year (total assets less liabilities)2018-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$50,467
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$829,768
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$835,532
Employer contributions (assets) at beginning of year2018-12-31$162
Did the plan have assets held for investment2018-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31GALLOVIC, GRANITO & CO LTD
Accountancy firm EIN2018-12-31341723186
2017
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$12,162
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$15,312
Total income from all sources (including contributions)2017-12-31$1,105,560
Total of all expenses incurred2017-12-31$1,089,667
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$1,067,090
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$1,105,560
Value of total assets at end of year2017-12-31$62,629
Value of total assets at beginning of year2017-12-31$49,886
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$22,577
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$9,541
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$17,990
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$75
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$75
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$1,503
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$9,060
Administrative expenses (other) incurred2017-12-31$13,036
Liabilities. Value of operating payables at end of year2017-12-31$10,659
Liabilities. Value of operating payables at beginning of year2017-12-31$6,252
Total non interest bearing cash at end of year2017-12-31$62,392
Total non interest bearing cash at beginning of year2017-12-31$49,757
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$15,893
Value of net assets at end of year (total assets less liabilities)2017-12-31$50,467
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$34,574
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$1,067,090
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$1,087,570
Employer contributions (assets) at end of year2017-12-31$162
Employer contributions (assets) at beginning of year2017-12-31$54
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31GALLOVIC, GRANITO & CO LTD
Accountancy firm EIN2017-12-31341723186
2016
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$15,312
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$65,738
Total income from all sources (including contributions)2016-12-31$1,071,744
Total of all expenses incurred2016-12-31$1,051,867
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$1,032,404
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,071,744
Value of total assets at end of year2016-12-31$49,886
Value of total assets at beginning of year2016-12-31$80,435
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$19,463
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$9,605
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$4,533
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$75
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$75
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$9,060
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$60,389
Administrative expenses (other) incurred2016-12-31$9,858
Liabilities. Value of operating payables at end of year2016-12-31$6,252
Liabilities. Value of operating payables at beginning of year2016-12-31$5,349
Total non interest bearing cash at end of year2016-12-31$49,757
Total non interest bearing cash at beginning of year2016-12-31$80,264
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$19,877
Value of net assets at end of year (total assets less liabilities)2016-12-31$34,574
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$14,697
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$1,032,404
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$1,067,211
Employer contributions (assets) at end of year2016-12-31$54
Assets. Value of buildings and other operty used in plan operation at beginning of year2016-12-31$96
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31GALLOVIC, GRANITO & CO LTD
Accountancy firm EIN2016-12-31341723186
2015
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$65,738
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$12,412
Total income from all sources (including contributions)2015-12-31$1,146,984
Total of all expenses incurred2015-12-31$1,132,843
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$1,108,339
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,146,984
Value of total assets at end of year2015-12-31$80,435
Value of total assets at beginning of year2015-12-31$12,968
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$24,504
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$7,320
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
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$11,920
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$75
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$138
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$60,389
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$5,978
Administrative expenses (other) incurred2015-12-31$17,184
Liabilities. Value of operating payables at end of year2015-12-31$5,349
Liabilities. Value of operating payables at beginning of year2015-12-31$6,434
Total non interest bearing cash at end of year2015-12-31$80,264
Total non interest bearing cash at beginning of year2015-12-31$12,423
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$14,141
Value of net assets at end of year (total assets less liabilities)2015-12-31$14,697
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$556
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
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$1,108,339
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
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$1,135,064
Employer contributions (assets) at beginning of year2015-12-31$167
Assets. Value of buildings and other operty used in plan operation at end of year2015-12-31$96
Assets. Value of buildings and other operty used in plan operation at beginning of year2015-12-31$240
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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 name2015-12-31GALLOVIC, GRANITO & CO LTD
Accountancy firm EIN2015-12-31341723186
2014
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$12,412
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$109,399
Total income from all sources (including contributions)2014-12-31$1,219,720
Total of all expenses incurred2014-12-31$1,229,505
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,192,749
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,219,720
Value of total assets at end of year2014-12-31$12,968
Value of total assets at beginning of year2014-12-31$119,740
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$36,756
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$6,443
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$11,513
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$138
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$91,961
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$5,978
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$104,030
Administrative expenses (other) incurred2014-12-31$30,313
Liabilities. Value of operating payables at end of year2014-12-31$6,434
Liabilities. Value of operating payables at beginning of year2014-12-31$5,369
Total non interest bearing cash at end of year2014-12-31$12,423
Total non interest bearing cash at beginning of year2014-12-31$17,482
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-9,785
Value of net assets at end of year (total assets less liabilities)2014-12-31$556
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$10,341
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
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$1,192,749
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
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$1,208,207
Employer contributions (assets) at end of year2014-12-31$167
Employer contributions (assets) at beginning of year2014-12-31$9,912
Assets. Value of buildings and other operty used in plan operation at end of year2014-12-31$240
Assets. Value of buildings and other operty used in plan operation at beginning of year2014-12-31$385
Did the plan have assets held for investment2014-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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
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 name2014-12-31GALLOVIC, GRANITO & CO LTD
Accountancy firm EIN2014-12-31341723186
2013
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$109,399
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$96,896
Total income from all sources (including contributions)2013-12-31$1,093,970
Total of all expenses incurred2013-12-31$1,129,000
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$1,078,199
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,093,969
Value of total assets at end of year2013-12-31$119,740
Value of total assets at beginning of year2013-12-31$142,267
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$50,801
Total interest from all sources2013-12-31$1
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$14,952
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$25,042
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$91,961
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$80,020
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$104,030
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$86,510
Administrative expenses (other) incurred2013-12-31$35,849
Liabilities. Value of operating payables at end of year2013-12-31$5,369
Liabilities. Value of operating payables at beginning of year2013-12-31$10,386
Total non interest bearing cash at end of year2013-12-31$17,482
Total non interest bearing cash at beginning of year2013-12-31$36,003
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-35,030
Value of net assets at end of year (total assets less liabilities)2013-12-31$10,341
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$45,371
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
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$2,552
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$2,552
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$1
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$1,078,199
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
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$1,068,927
Employer contributions (assets) at end of year2013-12-31$9,912
Employer contributions (assets) at beginning of year2013-12-31$23,163
Assets. Value of buildings and other operty used in plan operation at end of year2013-12-31$385
Assets. Value of buildings and other operty used in plan operation at beginning of year2013-12-31$529
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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
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 name2013-12-31GALLOVIC, GRANITO & CO LTD
Accountancy firm EIN2013-12-31341723186
2012
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$96,896
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$78,776
Total income from all sources (including contributions)2012-12-31$947,086
Total of all expenses incurred2012-12-31$1,083,081
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$930,871
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$947,082
Value of total assets at end of year2012-12-31$142,267
Value of total assets at beginning of year2012-12-31$260,142
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$152,210
Total interest from all sources2012-12-31$1
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$17,558
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31Yes
Amount of non-exempt transactions with any party-in-interest2012-12-31$48,257
Contributions received from participants2012-12-31$14,654
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$80,020
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$47,762
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$86,510
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$65,953
Other income not declared elsewhere2012-12-31$3
Administrative expenses (other) incurred2012-12-31$134,652
Liabilities. Value of operating payables at end of year2012-12-31$10,386
Liabilities. Value of operating payables at beginning of year2012-12-31$12,823
Total non interest bearing cash at end of year2012-12-31$36,003
Total non interest bearing cash at beginning of year2012-12-31$103,801
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-135,995
Value of net assets at end of year (total assets less liabilities)2012-12-31$45,371
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$181,366
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 bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$2,552
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$2,550
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$2,550
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$1
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$930,871
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
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$932,428
Employer contributions (assets) at end of year2012-12-31$23,163
Employer contributions (assets) at beginning of year2012-12-31$105,356
Assets. Value of buildings and other operty used in plan operation at end of year2012-12-31$529
Assets. Value of buildings and other operty used in plan operation at beginning of year2012-12-31$673
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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
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 name2012-12-31GALLOVIC, GRANITO & CO LTD
Accountancy firm EIN2012-12-31341723186
2011
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$78,776
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$29,754
Total income from all sources (including contributions)2011-12-31$1,051,044
Total of all expenses incurred2011-12-31$1,001,313
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$961,285
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$1,051,036
Value of total assets at end of year2011-12-31$260,142
Value of total assets at beginning of year2011-12-31$161,389
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$40,028
Total interest from all sources2011-12-31$8
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$13,037
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$22,535
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$47,762
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$5,953
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$65,953
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$19,414
Administrative expenses (other) incurred2011-12-31$26,991
Liabilities. Value of operating payables at end of year2011-12-31$12,823
Liabilities. Value of operating payables at beginning of year2011-12-31$10,340
Total non interest bearing cash at end of year2011-12-31$103,801
Total non interest bearing cash at beginning of year2011-12-31$4,487
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$49,731
Value of net assets at end of year (total assets less liabilities)2011-12-31$181,366
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$131,635
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 bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$2,550
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$35,640
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$35,640
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$8
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$961,285
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
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$1,028,501
Employer contributions (assets) at end of year2011-12-31$105,356
Employer contributions (assets) at beginning of year2011-12-31$115,309
Assets. Value of buildings and other operty used in plan operation at end of year2011-12-31$673
Did the plan have assets held for investment2011-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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
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 name2011-12-31GALLOVIC, GRANITO & CO LTD
Accountancy firm EIN2011-12-31341723186
2010
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$29,754
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$45,103
Total income from all sources (including contributions)2010-12-31$1,174,440
Total of all expenses incurred2010-12-31$1,130,354
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,095,211
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$1,174,270
Value of total assets at end of year2010-12-31$161,389
Value of total assets at beginning of year2010-12-31$132,652
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$35,143
Total interest from all sources2010-12-31$170
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$16,939
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$62,925
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$5,953
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$1,231
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$19,414
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$31,993
Administrative expenses (other) incurred2010-12-31$18,204
Liabilities. Value of operating payables at end of year2010-12-31$10,340
Liabilities. Value of operating payables at beginning of year2010-12-31$13,110
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$44,086
Value of net assets at end of year (total assets less liabilities)2010-12-31$131,635
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$87,549
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 bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$40,127
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$105,574
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$105,574
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$170
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$1,095,211
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$1,111,345
Employer contributions (assets) at end of year2010-12-31$115,309
Employer contributions (assets) at beginning of year2010-12-31$25,847
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
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 name2010-12-31GALLOVIC, GRANITO & CO LTD
Accountancy firm EIN2010-12-31341723186

Form 5500 Responses

2017
2017-01-01Type of plan entityMulti-employer plan
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016
2016-01-01Type of plan entityMulti-employer plan
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015
2015-01-01Type of plan entityMulti-employer plan
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
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 amendedYes
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
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 amendedYes
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010
2010-01-01Type of plan entityMulitple employer plan
2010-01-01Plan is a collectively bargained planYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009
2009-01-01Type of plan entityMulitple employer plan
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00249006
Policy instance 2
Insurance contract or identification number00249006
Number of Individuals Covered188
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $29,087
Total amount of fees paid to insurance companyUSD $1,587
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,057,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $29,087
Amount paid for insurance broker fees1587
Additional information about fees paid to insurance brokerSALES COMMISSION
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD COMPANY
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00171623
Policy instance 1
Insurance contract or identification number00171623
Number of Individuals Covered41
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $9,820
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Additional information about fees paid to insurance brokerSALES COMMISSION
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD COMPANY
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number05U2065
Policy instance 3
Insurance contract or identification number05U2065
Number of Individuals Covered84
Insurance policy start date2015-04-01
Insurance policy end date2015-12-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $801,295
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00171623
Policy instance 2
Insurance contract or identification number00171623
Number of Individuals Covered45
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $11,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Additional information about fees paid to insurance brokerSALES COMMISSION
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD COMPANY
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00171623
Policy instance 1
Insurance contract or identification number00171623
Insurance policy start date2015-01-01
Insurance policy end date2015-03-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $295,710
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Additional information about fees paid to insurance brokerSALES COMMISSION
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD COMPANY
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00171623
Policy instance 2
Insurance contract or identification number00171623
Number of Individuals Covered42
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $1,280
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $10,644
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,280
Additional information about fees paid to insurance brokerSALES COMMISSION
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD COMPANY
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00171623
Policy instance 1
Insurance contract or identification number00171623
Number of Individuals Covered88
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $25,536
Total amount of fees paid to insurance companyUSD $1,096
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,182,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,536
Amount paid for insurance broker fees1096
Additional information about fees paid to insurance brokerSALES COMMISSION
Insurance broker organization code?3
Insurance broker nameTHE JAMES B OSWALD COMPANY
ANTHEM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61069 )
Policy contract number00171623
Policy instance 2
Insurance contract or identification number00171623
Number of Individuals Covered40
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $1,105
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $12,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $783
Additional information about fees paid to insurance brokerSALES COMMISSION
Insurance broker organization code?3
Insurance broker nameRM BENEFIT CONSULTANTS INC
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00171623
Policy instance 1
Insurance contract or identification number00171623
Number of Individuals Covered87
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $31,241
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,065,720
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,276
Additional information about fees paid to insurance brokerSALES COMMISSION
Insurance broker organization code?3
Insurance broker nameRM BENEFIT CONSULTING
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00171623
Policy instance 2
Insurance contract or identification number00171623
Number of Individuals Covered46
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $1,215
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $13,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $252
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, ETC
Insurance broker organization code?3
Insurance broker nameRM BENEFIT CONSULTANTS INC
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00171623
Policy instance 1
Insurance contract or identification number00171623
Number of Individuals Covered91
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of fees paid to insurance companyUSD $1,000
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $917,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees1000
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, ETC
Insurance broker organization code?3
Insurance broker nameALPHA BENEFITS INC
KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )
Policy contract number692
Policy instance 1
Insurance contract or identification number692
Number of Individuals Covered107
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $21,966
Total amount of fees paid to insurance companyUSD $6,620
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $948,151
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AC16
Policy instance 2
Insurance contract or identification numberG000AC16
Number of Individuals Covered40
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,221
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $6,105
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AC16
Policy instance 3
Insurance contract or identification numberG000AC16
Number of Individuals Covered40
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $1,508
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,029
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AC16
Policy instance 2
Insurance contract or identification numberG000AC16
Number of Individuals Covered47
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,097
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $7,562
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,097
Insurance broker organization code?3
Insurance broker nameRM BENEFIT CONSULTANTS INC
KAISER FOUNDATION HEALTH PLAN OF OHIO (National Association of Insurance Commissioners NAIC id number: 95204 )
Policy contract number692
Policy instance 1
Insurance contract or identification number692
Number of Individuals Covered107
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $28,546
Total amount of fees paid to insurance companyUSD $1,994
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,078,302
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $28,546
Amount paid for insurance broker fees1994
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameRM BENEFIT CONSULTANTS, INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AC16
Policy instance 3
Insurance contract or identification numberG000AC16
Number of Individuals Covered47
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $2,586
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,347
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,586
Insurance broker organization code?3
Insurance broker nameRM BENEFIT CONSULTANTS INC

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