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COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 401k Plan overview

Plan NameCOPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION
Plan identification number 555

COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION
Employer identification number (EIN):347040042
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5552016-01-01
5552015-01-01
5552014-01-01
5552013-01-01
5552012-01-01TERRY DOBSON
5552011-01-01TERRY DOBSON
5552010-01-01TERRY DOBSON
5552009-01-01TERRY DOBSON TERRY DOBSON2010-10-13

Plan Statistics for COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION

401k plan membership statisitcs for COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION

Measure Date Value
2016: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2016 401k membership
Total participants, beginning-of-year2016-01-010
Total number of active participants reported on line 7a of the Form 55002016-01-010
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 participants2016-01-010
2015: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2015 401k membership
Total participants, beginning-of-year2015-01-01732
Total number of active participants reported on line 7a of the Form 55002015-01-010
Total of all active and inactive participants2015-01-010
2014: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2014 401k membership
Total participants, beginning-of-year2014-01-01800
Total number of active participants reported on line 7a of the Form 55002014-01-01732
Total of all active and inactive participants2014-01-01732
2013: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2013 401k membership
Total participants, beginning-of-year2013-01-01866
Total number of active participants reported on line 7a of the Form 55002013-01-01800
Total of all active and inactive participants2013-01-01800
2012: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2012 401k membership
Total participants, beginning-of-year2012-01-01918
Total number of active participants reported on line 7a of the Form 55002012-01-01866
Total of all active and inactive participants2012-01-01866
2011: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2011 401k membership
Total participants, beginning-of-year2011-01-01983
Total number of active participants reported on line 7a of the Form 55002011-01-01918
Total of all active and inactive participants2011-01-01918
2010: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2010 401k membership
Total participants, beginning-of-year2010-01-011,064
Total number of active participants reported on line 7a of the Form 55002010-01-01983
Total of all active and inactive participants2010-01-01983
2009: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2009 401k membership
Total participants, beginning-of-year2009-01-011,127
Total number of active participants reported on line 7a of the Form 55002009-01-011,064
Total of all active and inactive participants2009-01-011,064

Financial Data on COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION

Measure Date Value
2016 : COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2016 401k financial data
Total income from all sources2016-12-31$27,515
Expenses. Total of all expenses incurred2016-12-31$101,962
Benefits paid (including direct rollovers)2016-12-31$36,759
Total plan assets at end of year2016-12-31$0
Total plan assets at beginning of year2016-12-31$74,447
Value of fidelity bond covering the plan2016-12-31$500,000
Total contributions received or receivable from participants2016-12-31$26,844
Expenses. Other expenses not covered elsewhere2016-12-31$21,217
Other income received2016-12-31$671
Net income (gross income less expenses)2016-12-31$-74,447
Net plan assets at end of year (total assets less liabilities)2016-12-31$0
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$74,447
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$43,986
2015 : COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$-153
Total unrealized appreciation/depreciation of assets2015-12-31$-153
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$18,999
Total income from all sources (including contributions)2015-12-31$1,211,419
Total of all expenses incurred2015-12-31$1,324,765
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$1,241,585
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$1,211,130
Value of total assets at end of year2015-12-31$74,447
Value of total assets at beginning of year2015-12-31$206,792
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$83,180
Total interest from all sources2015-12-31$59
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$383
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-12-31$0
Administrative expenses professional fees incurred2015-12-31$11,885
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$1,211,130
Assets. Other investments not covered elsewhere at end of year2015-12-31$4,167
Assets. Other investments not covered elsewhere at beginning of year2015-12-31$4,167
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$35
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$32
Administrative expenses (other) incurred2015-12-31$6,798
Liabilities. Value of operating payables at end of year2015-12-31$0
Liabilities. Value of operating payables at beginning of year2015-12-31$18,999
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-113,346
Value of net assets at end of year (total assets less liabilities)2015-12-31$74,447
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$187,793
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
Investment advisory and management fees2015-12-31$14,497
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$51,613
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$51,386
Interest earned on other investments2015-12-31$59
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$18,632
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$151,207
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$151,207
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$1,241,585
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Income. Dividends from common stock2015-12-31$383
Contract administrator fees2015-12-31$50,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31HILL, BARTH & KING LLC
Accountancy firm EIN2015-12-31341897225
2014 : COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$2,233
Total unrealized appreciation/depreciation of assets2014-12-31$2,233
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$18,999
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$895
Total income from all sources (including contributions)2014-12-31$1,373,708
Total of all expenses incurred2014-12-31$1,903,588
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,832,813
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$1,368,650
Value of total assets at end of year2014-12-31$206,792
Value of total assets at beginning of year2014-12-31$718,568
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$70,775
Total interest from all sources2014-12-31$60
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$2,765
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$6,333
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$1,368,650
Assets. Other investments not covered elsewhere at end of year2014-12-31$4,167
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$36,266
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$32
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$394
Administrative expenses (other) incurred2014-12-31$12,767
Liabilities. Value of operating payables at end of year2014-12-31$18,999
Liabilities. Value of operating payables at beginning of year2014-12-31$895
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-529,880
Value of net assets at end of year (total assets less liabilities)2014-12-31$187,793
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$717,673
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
Investment advisory and management fees2014-12-31$1,675
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$51,386
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$622,230
Interest earned on other investments2014-12-31$60
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$151,207
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$59,678
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$59,678
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$1,832,813
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Income. Dividends from common stock2014-12-31$2,765
Contract administrator fees2014-12-31$50,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31HILL, BARTH & KING LLC
Accountancy firm EIN2014-12-31341897225
2013 : COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$-1,138
Total unrealized appreciation/depreciation of assets2013-12-31$-1,138
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$895
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$150,443
Total income from all sources (including contributions)2013-12-31$1,125,699
Total of all expenses incurred2013-12-31$1,828,023
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$1,734,302
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$1,121,260
Value of total assets at end of year2013-12-31$718,568
Value of total assets at beginning of year2013-12-31$1,570,440
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$93,721
Total interest from all sources2013-12-31$231
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$5,346
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$13,325
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$1,121,260
Assets. Other investments not covered elsewhere at end of year2013-12-31$36,266
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$162,228
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$394
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$687
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$149,459
Administrative expenses (other) incurred2013-12-31$19,399
Liabilities. Value of operating payables at end of year2013-12-31$895
Liabilities. Value of operating payables at beginning of year2013-12-31$984
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-702,324
Value of net assets at end of year (total assets less liabilities)2013-12-31$717,673
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$1,419,997
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
Investment advisory and management fees2013-12-31$10,997
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$622,230
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$679,633
Interest earned on other investments2013-12-31$231
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$59,678
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$727,892
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$727,892
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$1,734,302
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Income. Dividends from common stock2013-12-31$5,346
Contract administrator fees2013-12-31$50,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31HBK CPAS & CONSULTANTS
Accountancy firm EIN2013-12-31341897225
2012 : COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$29,867
Total unrealized appreciation/depreciation of assets2012-12-31$29,867
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$150,443
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$5,790
Total income from all sources (including contributions)2012-12-31$1,186,885
Total of all expenses incurred2012-12-31$1,929,304
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$1,813,830
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$1,138,927
Value of total assets at end of year2012-12-31$1,570,440
Value of total assets at beginning of year2012-12-31$2,168,206
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$115,474
Total interest from all sources2012-12-31$337
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$17,754
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$2,335
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-interest2012-12-31No
Contributions received from participants2012-12-31$1,138,927
Assets. Other investments not covered elsewhere at end of year2012-12-31$162,228
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$163,201
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$687
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$1,770
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$149,459
Administrative expenses (other) incurred2012-12-31$22,044
Liabilities. Value of operating payables at end of year2012-12-31$984
Liabilities. Value of operating payables at beginning of year2012-12-31$5,790
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-742,419
Value of net assets at end of year (total assets less liabilities)2012-12-31$1,419,997
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$2,162,416
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
Investment advisory and management fees2012-12-31$20,679
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$679,633
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$1,304,386
Interest earned on other investments2012-12-31$337
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$727,892
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$698,849
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$698,849
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$1,813,830
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Income. Dividends from common stock2012-12-31$17,754
Contract administrator fees2012-12-31$70,416
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31HILL, BARTH & KING LLC
Accountancy firm EIN2012-12-31341897225
2011 : COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$29,931
Total unrealized appreciation/depreciation of assets2011-12-31$29,931
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$5,790
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$4,280
Total income from all sources (including contributions)2011-12-31$1,343,548
Total of all expenses incurred2011-12-31$2,120,437
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$1,994,997
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$1,269,436
Value of total assets at end of year2011-12-31$2,168,206
Value of total assets at beginning of year2011-12-31$2,943,585
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$125,440
Total interest from all sources2011-12-31$1,201
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$42,980
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$15,470
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$1,269,436
Assets. Other investments not covered elsewhere at end of year2011-12-31$163,201
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$5,417
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$1,770
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$2,428
Administrative expenses (other) incurred2011-12-31$24,859
Liabilities. Value of operating payables at end of year2011-12-31$5,790
Liabilities. Value of operating payables at beginning of year2011-12-31$4,280
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-776,889
Value of net assets at end of year (total assets less liabilities)2011-12-31$2,162,416
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$2,939,305
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
Investment advisory and management fees2011-12-31$20,111
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$1,304,386
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$1,002,641
Interest earned on other investments2011-12-31$1,201
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$698,849
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$1,933,099
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$1,933,099
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$1,994,997
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Income. Dividends from common stock2011-12-31$42,980
Contract administrator fees2011-12-31$65,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31HILL BARTH & KING, LLC
Accountancy firm EIN2011-12-31341897225
2010 : COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2010 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2010-12-31$59,597
Total unrealized appreciation/depreciation of assets2010-12-31$59,597
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$4,280
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$10,058
Total income from all sources (including contributions)2010-12-31$1,556,066
Total of all expenses incurred2010-12-31$2,394,329
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$2,270,551
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$1,430,470
Value of total assets at end of year2010-12-31$2,943,585
Value of total assets at beginning of year2010-12-31$3,787,626
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$123,778
Total interest from all sources2010-12-31$1,316
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$64,683
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$10,595
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$1,430,470
Assets. Other investments not covered elsewhere at end of year2010-12-31$5,417
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$84,352
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$2,428
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$3,214
Administrative expenses (other) incurred2010-12-31$16,528
Liabilities. Value of operating payables at end of year2010-12-31$4,280
Liabilities. Value of operating payables at beginning of year2010-12-31$10,058
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-838,263
Value of net assets at end of year (total assets less liabilities)2010-12-31$2,939,305
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$3,777,568
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
Investment advisory and management fees2010-12-31$31,655
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$1,002,641
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$1,753,546
Interest earned on other investments2010-12-31$1,316
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$1,933,099
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$1,946,514
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$1,946,514
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$2,270,551
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
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
Income. Dividends from common stock2010-12-31$64,683
Contract administrator fees2010-12-31$65,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
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)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31HILL, BARTH & KING LLC
Accountancy firm EIN2010-12-31341897225

Form 5500 Responses for COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION

2016: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01This submission is the final filingYes
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2015 form 5500 responses
2015-01-01Type of plan entitySingle 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: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
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: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
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: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2012 form 5500 responses
2012-01-01Type of plan entitySingle 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: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2011 form 5500 responses
2011-01-01Type of plan entitySingle 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: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2010 form 5500 responses
2010-01-01Type of plan entitySingle 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: COPPERWELD RETIREE VOLUNTARY EMPLOYEE BENEFICIARY ASSOCIATION 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
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

HEALTHAMERICA OF PENNSYLVANIA, INC. HMO (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number5739598402
Policy instance 5
Insurance contract or identification number5739598402
Number of Individuals Covered1
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,892
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE457646
Policy instance 4
Insurance contract or identification numberAE457646
Number of Individuals Covered7
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $19,850
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE457647
Policy instance 3
Insurance contract or identification numberAE457647
Number of Individuals Covered79
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $204,055
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. HMO (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number5739598401
Policy instance 2
Insurance contract or identification number5739598401
Number of Individuals Covered96
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $206,454
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00081544
Policy instance 1
Insurance contract or identification number00081544
Number of Individuals Covered268
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $809,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 69671 )
Policy contract numberR4431
Policy instance 7
Insurance contract or identification numberR4431
Number of Individuals Covered2
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $150
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $150
Insurance broker nameRIZER GROUP LLC
HUMANA INSURANCE COMPANY OF NE (National Association of Insurance Commissioners NAIC id number: 12634 )
Policy contract numberR2124
Policy instance 6
Insurance contract or identification numberR2124
Number of Individuals Covered1
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $50
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,753
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $50
Insurance broker nameRIZER GROUP LLC
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE457646
Policy instance 5
Insurance contract or identification numberAE457646
Number of Individuals Covered2
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $3,677
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE457647
Policy instance 4
Insurance contract or identification numberAE457647
Number of Individuals Covered101
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $226,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. HMO (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number5739598400
Policy instance 3
Insurance contract or identification number5739598400
Number of Individuals Covered62
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $131,422
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00081544
Policy instance 1
Insurance contract or identification number00081544
Number of Individuals Covered426
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,105,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract numberR9234
Policy instance 2
Insurance contract or identification numberR9234
Number of Individuals Covered120
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $331,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA HEALTH INSURANCE COMPANY OF FLORIDA, INC. (National Association of Insurance Commissioners NAIC id number: 69671 )
Policy contract numberR9235
Policy instance 8
Insurance contract or identification numberR9235
Number of Individuals Covered9
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $25,939
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00081544
Policy instance 1
Insurance contract or identification number00081544
Number of Individuals Covered544
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedANTHEM SENIOR ADVANTAGE
Welfare Benefit Premiums Paid to CarrierUSD $1,167,396
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. HMO (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number5739598400
Policy instance 3
Insurance contract or identification number5739598400
Number of Individuals Covered75
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $179,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberVARIOUS
Policy instance 2
Insurance contract or identification numberVARIOUS
Number of Individuals Covered152
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $387,625
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HEALTHAMERICA OF PENNSYLVANIA, INC. HMO (National Association of Insurance Commissioners NAIC id number: 95060 )
Policy contract number5739598400
Policy instance 3
Insurance contract or identification number5739598400
Number of Individuals Covered2
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $5,642
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberVARIOUS
Policy instance 2
Insurance contract or identification numberVARIOUS
Number of Individuals Covered169
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $506,225
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract number00081544
Policy instance 1
Insurance contract or identification number00081544
Number of Individuals Covered690
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedANTHEM SENIOR ADVANTAGE
Welfare Benefit Premiums Paid to CarrierUSD $1,281,179
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberVARIOUS
Policy instance 2
Insurance contract or identification numberVARIOUS
Number of Individuals Covered179
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $590,885
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberM52483
Policy instance 1
Insurance contract or identification numberM52483
Number of Individuals Covered732
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedANTHEM SENIOR ADVANTAGE
Welfare Benefit Premiums Paid to CarrierUSD $1,393,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract numberVARIOUS
Policy instance 3
Insurance contract or identification numberVARIOUS
Number of Individuals Covered4
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,348
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CONVENTRY HEALTH AND LIFE (National Association of Insurance Commissioners NAIC id number: 81973 )
Policy contract numberVARIOUS
Policy instance 3
Insurance contract or identification numberVARIOUS
Number of Individuals Covered4
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $9,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberVARIOUS
Policy instance 2
Insurance contract or identification numberVARIOUS
Number of Individuals Covered199
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $686,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COMMUNITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 10345 )
Policy contract numberM52483
Policy instance 1
Insurance contract or identification numberM52483
Number of Individuals Covered780
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Other welfare benefits providedANTHEM SENIOR ADVANTAGE
Welfare Benefit Premiums Paid to CarrierUSD $1,571,949
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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