401k Plan data: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN plan

SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 401k Plan overview

Plan Name	SCHROER GROUP EMPLOYEES HEALTH CARE PLAN
Plan identification number	501

SCHROER GROUP EMPLOYEES HEALTH CARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Dental Vision

401k Sponsoring company profile

ALTERCARE EMPLOYEE BENEFITS TRUST has sponsored the creation of one or more 401k plans.

Company Name: ALTERCARE EMPLOYEE BENEFITS TRUST

Employer identification number (EIN): 346949811

NAIC Classification: 623000
NAIC Description: Nursing and Residential Care Facilities

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SCHROER GROUP EMPLOYEES HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01 DIANE GEIS
501 2014-01-01 DIANE GEIS
501 2013-01-01 DIANE GEIS
501 2012-01-01 DIANE GEIS
501 2011-01-01 DIANE GEIS
501 2009-01-01 DIANE GEIS

Plan id#	Filing Submission Date	Name of Administrator
501	2015-01-01	DIANE GEIS
501	2014-01-01	DIANE GEIS
501	2013-01-01	DIANE GEIS
501	2012-01-01	DIANE GEIS
501	2011-01-01	DIANE GEIS
501	2009-01-01	DIANE GEIS

Plan Statistics for SCHROER GROUP EMPLOYEES HEALTH CARE PLAN

401k plan membership statisitcs for SCHROER GROUP EMPLOYEES HEALTH CARE PLAN

Measure Date Value
2015: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 1,273
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 1,243
Number of retired or separated participants receiving benefits 2015-01-01 10
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 1,253
2014: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 1,335
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 1,297
Number of retired or separated participants receiving benefits 2014-01-01 11
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 1,308
2013: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-01-01 1,257
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 1,237
Number of retired or separated participants receiving benefits 2013-01-01 10
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 1,247
2012: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-01-01 1,195
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 1,164
Number of retired or separated participants receiving benefits 2012-01-01 10
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 1,174
2011: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,150
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 1,163
Number of retired or separated participants receiving benefits 2011-01-01 22
Total of all active and inactive participants 2011-01-01 1,185
Total participants 2011-01-01 1,185
2009: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-01-01 976
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,105
Number of retired or separated participants receiving benefits 2009-01-01 0
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 1,105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2009-01-01 0
Total participants 2009-01-01 1,105
Number of participants with account balances 2009-01-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2009-01-01 0

Measure	Date	Value
2015: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	1,273
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	1,243
Number of retired or separated participants receiving benefits	2015-01-01	10
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	1,253
2014: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	1,335
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	1,297
Number of retired or separated participants receiving benefits	2014-01-01	11
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	1,308
2013: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-01-01	1,257
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	1,237
Number of retired or separated participants receiving benefits	2013-01-01	10
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	1,247
2012: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-01-01	1,195
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	1,164
Number of retired or separated participants receiving benefits	2012-01-01	10
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	1,174
2011: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,150
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	1,163
Number of retired or separated participants receiving benefits	2011-01-01	22
Total of all active and inactive participants	2011-01-01	1,185
Total participants	2011-01-01	1,185
2009: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-01-01	976
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,105
Number of retired or separated participants receiving benefits	2009-01-01	0
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	1,105
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2009-01-01	0
Total participants	2009-01-01	1,105
Number of participants with account balances	2009-01-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2009-01-01	0

Financial Data on SCHROER GROUP EMPLOYEES HEALTH CARE PLAN

Measure	Date	Value
2015 : SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$1,467,521
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$923,544
Total income from all sources (including contributions)	2015-12-31	$10,531,356
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$11,515,818
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$10,684,857
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$10,531,356
Value of total assets at end of year	2015-12-31	$434,131
Value of total assets at beginning of year	2015-12-31	$874,616
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$830,961
Total interest from all sources	2015-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	No
Administrative expenses professional fees incurred	2015-12-31	$173,136
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$1,000,000
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$3,516,440
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2015-12-31	$9,562,378
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$428,825
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$29,733
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$788,278
Administrative expenses (other) incurred	2015-12-31	$92,620
Liabilities. Value of operating payables at end of year	2015-12-31	$139,343
Liabilities. Value of operating payables at beginning of year	2015-12-31	$135,266
Total non interest bearing cash at end of year	2015-12-31	$5,306
Total non interest bearing cash at beginning of year	2015-12-31	$844,883
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-984,462
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$-1,033,390
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$-48,928
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2015-12-31	$1,122,479
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$7,014,916
Contract administrator fees	2015-12-31	$565,205
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$1,328,178
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$0
Did the plan have assets held for investment	2015-12-31	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	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2015-12-31	381357951
2014 : SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$923,544
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$771,558
Total income from all sources (including contributions)	2014-12-31	$11,067,358
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$11,915,577
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$10,982,618
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$11,067,358
Value of total assets at end of year	2014-12-31	$874,616
Value of total assets at beginning of year	2014-12-31	$1,570,849
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$932,959
Total interest from all sources	2014-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$146,773
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$3,000,000
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$3,167,822
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$9,859,946
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$29,733
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$21,651
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$788,278
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$765,961
Administrative expenses (other) incurred	2014-12-31	$136,954
Liabilities. Value of operating payables at end of year	2014-12-31	$135,266
Liabilities. Value of operating payables at beginning of year	2014-12-31	$5,597
Total non interest bearing cash at end of year	2014-12-31	$844,883
Total non interest bearing cash at beginning of year	2014-12-31	$1,549,198
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-848,219
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$-48,928
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$799,291
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$1,122,672
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$7,899,536
Contract administrator fees	2014-12-31	$649,232
Did the plan have assets held for investment	2014-12-31	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	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2014-12-31	381357951
2013 : SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$771,558
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$173,206
Total income from all sources (including contributions)	2013-12-31	$10,301,623
Total loss/gain on sale of assets	2013-12-31	$0
Total of all expenses incurred	2013-12-31	$10,586,009
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$9,830,827
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$10,301,623
Value of total assets at end of year	2013-12-31	$1,570,849
Value of total assets at beginning of year	2013-12-31	$1,256,883
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$755,182
Total interest from all sources	2013-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$112,942
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$3,000,000
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$2,979,103
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2013-12-31	$8,522,360
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-12-31	$21,651
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-12-31	$70,603
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$765,961
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$172,650
Administrative expenses (other) incurred	2013-12-31	$2,246
Liabilities. Value of operating payables at end of year	2013-12-31	$5,597
Liabilities. Value of operating payables at beginning of year	2013-12-31	$556
Total non interest bearing cash at end of year	2013-12-31	$1,549,198
Total non interest bearing cash at beginning of year	2013-12-31	$1,186,280
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-284,386
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$799,291
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$1,083,677
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$1,308,467
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$7,322,520
Contract administrator fees	2013-12-31	$639,994
Did the plan have assets held for investment	2013-12-31	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	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2013-12-31	381357951
2012 : SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets	2012-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$173,206
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$135,583
Total income from all sources (including contributions)	2012-12-31	$9,036,977
Total loss/gain on sale of assets	2012-12-31	$0
Total of all expenses incurred	2012-12-31	$8,986,977
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$8,356,575
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$9,036,977
Value of total assets at end of year	2012-12-31	$1,256,883
Value of total assets at beginning of year	2012-12-31	$1,169,260
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$630,402
Total interest from all sources	2012-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2012-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$20,144
Was this plan covered by a fidelity bond	2012-12-31	Yes
Value of fidelity bond cover	2012-12-31	$3,000,000
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$2,706,906
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-12-31	$70,603
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$172,650
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$128,627
Liabilities. Value of operating payables at end of year	2012-12-31	$556
Liabilities. Value of operating payables at beginning of year	2012-12-31	$6,956
Total non interest bearing cash at end of year	2012-12-31	$1,186,280
Total non interest bearing cash at beginning of year	2012-12-31	$1,169,260
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$50,000
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$1,083,677
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,033,677
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$1,185,390
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$6,330,071
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2012-12-31	$7,171,185
Contract administrator fees	2012-12-31	$610,258
Did the plan have assets held for investment	2012-12-31	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	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	PLANTE & MORAN, PLLC
Accountancy firm EIN	2012-12-31	381357951
2011 : SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$135,583
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$6,846
Total income from all sources (including contributions)	2011-12-31	$7,236,289
Total of all expenses incurred	2011-12-31	$7,499,765
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$6,393,801
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$7,236,289
Value of total assets at end of year	2011-12-31	$1,169,260
Value of total assets at beginning of year	2011-12-31	$1,303,999
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$1,105,964
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-12-31	No
Administrative expenses professional fees incurred	2011-12-31	$20,931
Was this plan covered by a fidelity bond	2011-12-31	Yes
Value of fidelity bond cover	2011-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$2,013,099
Assets. Other investments not covered elsewhere at beginning of year	2011-12-31	$270
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$128,627
Administrative expenses (other) incurred	2011-12-31	$489,138
Liabilities. Value of operating payables at end of year	2011-12-31	$6,956
Liabilities. Value of operating payables at beginning of year	2011-12-31	$6,846
Total non interest bearing cash at end of year	2011-12-31	$1,169,260
Total non interest bearing cash at beginning of year	2011-12-31	$157,315
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-12-31	No
Value of net income/loss	2011-12-31	$-263,476
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$1,033,677
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$1,297,153
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Was there a failure to transmit to the plan any participant contributions	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$5,223,190
Employer contributions (assets) at beginning of year	2011-12-31	$1,146,414
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2011-12-31	$6,393,801
Contract administrator fees	2011-12-31	$595,895
Did the plan have assets held for investment	2011-12-31	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	2011-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	HOWARD WERSHBALE & CO.
Accountancy firm EIN	2011-12-31	341663157
2010 : SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$6,846
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$7,335
Total income from all sources (including contributions)	2010-12-31	$9,687,067
Total of all expenses incurred	2010-12-31	$9,364,160
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$8,394,389
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$9,687,067
Value of total assets at end of year	2010-12-31	$1,303,999
Value of total assets at beginning of year	2010-12-31	$981,581
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$969,771
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$23,165
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$1,669,756
Assets. Other investments not covered elsewhere at end of year	2010-12-31	$270
Assets. Other investments not covered elsewhere at beginning of year	2010-12-31	$452
Administrative expenses (other) incurred	2010-12-31	$390,419
Liabilities. Value of operating payables at end of year	2010-12-31	$6,846
Liabilities. Value of operating payables at beginning of year	2010-12-31	$7,335
Total non interest bearing cash at end of year	2010-12-31	$157,315
Total non interest bearing cash at beginning of year	2010-12-31	$123,055
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$322,907
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$1,297,153
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$974,246
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$8,017,311
Employer contributions (assets) at end of year	2010-12-31	$1,146,414
Employer contributions (assets) at beginning of year	2010-12-31	$858,074
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2010-12-31	$8,394,389
Contract administrator fees	2010-12-31	$556,187
Did the plan have assets held for investment	2010-12-31	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	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	HOWARD WERSHBALE & CO.
Accountancy firm EIN	2010-12-31	341663157

Form 5500 Responses for SCHROER GROUP EMPLOYEES HEALTH CARE PLAN

2015: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Submission has been amended	No
2013-01-01	This submission is the final filing	No
2013-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Submission has been amended	No
2012-01-01	This submission is the final filing	No
2012-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2011-01-01	Plan benefit arrangement – General assets of the sponsor	Yes
2009: SCHROER GROUP EMPLOYEES HEALTH CARE PLAN 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Submission has been amended	No
2009-01-01	This submission is the final filing	No
2009-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-01-01	Plan is a collectively bargained plan	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan funding arrangement – General assets of the sponsor	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2009-01-01	Plan benefit arrangement – General assets of the sponsor	Yes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )

Policy contract number

HCL31617

Policy instance

Insurance contract or identification number	HCL31617
Number of Individuals Covered	1231
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $13,956
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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
Life 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
Welfare Benefit Premiums Paid to Carrier	USD $348,893
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,956
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES, LLC

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00480210

Policy instance

Insurance contract or identification number	00480210
Number of Individuals Covered	2025
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $38,679
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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	Yes
Vision Insurance Welfare Benefit	Yes
Life 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
Welfare Benefit Premiums Paid to Carrier	USD $773,586
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,460
Insurance broker organization code?	3
Insurance broker name	LOCKTON COMPANIES LLC

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )

Policy contract number

234584

Policy instance

Insurance contract or identification number	234584
Number of Individuals Covered	771
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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
Life 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
Welfare Benefit Premiums Paid to Carrier	USD $326,540
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00480210

Policy instance

Insurance contract or identification number	00480210
Number of Individuals Covered	1316
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $39,912
Total amount of fees paid to insurance company	USD $49,198
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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	Yes
Vision Insurance Welfare Benefit	Yes
Life 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
Welfare Benefit Premiums Paid to Carrier	USD $796,132
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $39,912
Amount paid for insurance broker fees	49198
Additional information about fees paid to insurance broker	SPECIAL PRODUCER COMPENSATION PROGRAM
Insurance broker organization code?	3
Insurance broker name	CHARLES L. CRANE AGENCY COMPANY

THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )

Policy contract number

00480210

Policy instance

Insurance contract or identification number	00480210
Number of Individuals Covered	1337
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $37,006
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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	Yes
Vision Insurance Welfare Benefit	Yes
Life 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
Welfare Benefit Premiums Paid to Carrier	USD $735,503
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $36,775
Insurance broker organization code?	3
Insurance broker name	DAVID G BOYKIN

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )

Policy contract number

UNI-200737

Policy instance

Insurance contract or identification number	UNI-200737
Number of Individuals Covered	1235
Insurance policy start date	2013-05-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $37,970
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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
Life 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
Welfare Benefit Premiums Paid to Carrier	USD $379,697
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,970
Insurance broker organization code?	3
Insurance broker name	CHARLES L. CRANE AGENCY COMPANY

UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )

Policy contract number

UNI-200737

Policy instance

Insurance contract or identification number	UNI-200737
Number of Individuals Covered	1206
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $55,788
Total amount of fees paid to insurance company	USD $0
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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
Life 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
Welfare Benefit Premiums Paid to Carrier	USD $557,878
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $55,788
Insurance broker organization code?	3
Insurance broker name	CHARLES L. CRANE AGENCY COMPANY

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

709646

Policy instance

Insurance contract or identification number	709646
Number of Individuals Covered	1174
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $28,188
Total amount of fees paid to insurance company	USD $12,502
Are there contracts with allocated funds for individual policies?	No
Are there contracts with allocated funds for group deferred annuity?	No
Are there contracts with allocated funds for types other than group deferred annuity or individual?	No
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
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	Yes
Vision Insurance Welfare Benefit	Yes
Life 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
Welfare Benefit Premiums Paid to Carrier	USD $1,185,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $28,188
Amount paid for insurance broker fees	12502
Additional information about fees paid to insurance broker	BROKER BONUS
Insurance broker organization code?	3
Insurance broker name	CHARLES CRANE AGENCY CO

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

709646

Policy instance

Insurance contract or identification number	709646
Number of Individuals Covered	1184
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $28,480
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $641,248
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

709646

Policy instance

Insurance contract or identification number	709646
Number of Individuals Covered	1150
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $27,090
Total amount of fees paid to insurance company	USD $0
Health Insurance Welfare Benefit	Yes
Dental Insurance Welfare Benefit	Yes
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $416,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	ALTERCARE EMPLOYEE BENEFITS TRUST
Employer identification number (EIN):	346949811
NAIC Classification:	623000
NAIC Description:	Nursing and Residential Care Facilities