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SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 401k Plan overview

Plan NameSILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN
Plan identification number 505

SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN Benefits

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

401k Sponsoring company profile

SILBERLINE MANUFACTURING CO., INC has sponsored the creation of one or more 401k plans.

Company Name:SILBERLINE MANUFACTURING CO., INC
Employer identification number (EIN):351273539
NAIC Classification:339900

Additional information about SILBERLINE MANUFACTURING CO., INC

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 2016-01-28
Company Identification Number: 0802378452
Legal Registered Office Address: 130 LINCOLN DR

TAMAQUA
United States of America (USA)
18252

More information about SILBERLINE MANUFACTURING CO., INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052022-01-01
5052021-01-01
5052020-01-01
5052019-01-01
5052018-01-01
5052017-01-01THOMAS SCHWARZ
5052016-01-01THOMAS SCHWARZ

Plan Statistics for SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN

401k plan membership statisitcs for SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN

Measure Date Value
2022: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0150
Total number of active participants reported on line 7a of the Form 55002022-01-0148
Number of retired or separated participants receiving benefits2022-01-011
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-0149
2021: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0152
Total number of active participants reported on line 7a of the Form 55002021-01-0147
Number of retired or separated participants receiving benefits2021-01-010
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-0147
2020: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0178
Total number of active participants reported on line 7a of the Form 55002020-01-0147
Number of retired or separated participants receiving benefits2020-01-015
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-0152
2019: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0199
Total number of active participants reported on line 7a of the Form 55002019-01-0174
Number of retired or separated participants receiving benefits2019-01-014
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-0178
2018: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0184
Total number of active participants reported on line 7a of the Form 55002018-01-0191
Number of retired or separated participants receiving benefits2018-01-018
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-0199
2017: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0194
Total number of active participants reported on line 7a of the Form 55002017-01-0180
Number of retired or separated participants receiving benefits2017-01-014
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-0184
2016: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0185
Total number of active participants reported on line 7a of the Form 55002016-01-0192
Number of retired or separated participants receiving benefits2016-01-012
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-0194

Financial Data on SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN

Measure Date Value
2022 : SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2022 401k financial data
Total plan liabilities at end of year2022-12-31$55,647
Total plan liabilities at beginning of year2022-12-31$67,893
Total income from all sources2022-12-31$920,641
Expenses. Total of all expenses incurred2022-12-31$951,953
Benefits paid (including direct rollovers)2022-12-31$355,670
Total plan assets at end of year2022-12-31$194,989
Total plan assets at beginning of year2022-12-31$238,547
Value of fidelity bond covering the plan2022-12-31$1,000,000
Total contributions received or receivable from participants2022-12-31$4,917
Expenses. Other expenses not covered elsewhere2022-12-31$327,651
Contributions received from other sources (not participants or employers)2022-12-31$0
Other income received2022-12-31$833
Net income (gross income less expenses)2022-12-31$-31,312
Net plan assets at end of year (total assets less liabilities)2022-12-31$139,342
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$170,654
Total contributions received or receivable from employer(s)2022-12-31$914,891
Value of corrective distributions2022-12-31$267,077
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$1,555
2021 : SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2021 401k financial data
Total plan liabilities at end of year2021-12-31$67,893
Total plan liabilities at beginning of year2021-12-31$74,321
Total income from all sources2021-12-31$891,298
Expenses. Total of all expenses incurred2021-12-31$918,642
Benefits paid (including direct rollovers)2021-12-31$492,882
Total plan assets at end of year2021-12-31$238,547
Total plan assets at beginning of year2021-12-31$272,319
Value of fidelity bond covering the plan2021-12-31$1,000,000
Total contributions received or receivable from participants2021-12-31$499,033
Expenses. Other expenses not covered elsewhere2021-12-31$297,772
Contributions received from other sources (not participants or employers)2021-12-31$6,137
Other income received2021-12-31$658
Net income (gross income less expenses)2021-12-31$-27,344
Net plan assets at end of year (total assets less liabilities)2021-12-31$170,654
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$197,998
Total contributions received or receivable from employer(s)2021-12-31$385,470
Value of corrective distributions2021-12-31$123,639
Expenses. Administrative service providers (salaries,fees and commissions)2021-12-31$4,349
2020 : SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2020 401k financial data
Total plan liabilities at end of year2020-12-31$74,321
Total plan liabilities at beginning of year2020-12-31$114,088
Total income from all sources2020-12-31$1,132,176
Expenses. Total of all expenses incurred2020-12-31$986,455
Benefits paid (including direct rollovers)2020-12-31$553,703
Total plan assets at end of year2020-12-31$272,319
Total plan assets at beginning of year2020-12-31$166,365
Value of fidelity bond covering the plan2020-12-31$1,000,000
Total contributions received or receivable from participants2020-12-31$200,641
Expenses. Other expenses not covered elsewhere2020-12-31$355,082
Contributions received from other sources (not participants or employers)2020-12-31$101,485
Other income received2020-12-31$686
Net income (gross income less expenses)2020-12-31$145,721
Net plan assets at end of year (total assets less liabilities)2020-12-31$197,998
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$52,277
Total contributions received or receivable from employer(s)2020-12-31$829,364
Value of corrective distributions2020-12-31$70,556
Expenses. Administrative service providers (salaries,fees and commissions)2020-12-31$7,114
2019 : SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2019 401k financial data
Total plan liabilities at end of year2019-12-31$114,088
Total plan liabilities at beginning of year2019-12-31$107,871
Total income from all sources2019-12-31$1,374,554
Expenses. Total of all expenses incurred2019-12-31$1,317,764
Benefits paid (including direct rollovers)2019-12-31$812,639
Total plan assets at end of year2019-12-31$166,365
Total plan assets at beginning of year2019-12-31$103,358
Value of fidelity bond covering the plan2019-12-31$1,000,000
Total contributions received or receivable from participants2019-12-31$269,935
Expenses. Other expenses not covered elsewhere2019-12-31$416,703
Contributions received from other sources (not participants or employers)2019-12-31$62,268
Other income received2019-12-31$470
Net income (gross income less expenses)2019-12-31$56,790
Net plan assets at end of year (total assets less liabilities)2019-12-31$52,277
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$-4,513
Total contributions received or receivable from employer(s)2019-12-31$1,041,881
Value of corrective distributions2019-12-31$70,000
Expenses. Administrative service providers (salaries,fees and commissions)2019-12-31$18,422
2018 : SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2018 401k financial data
Total plan liabilities at end of year2018-12-31$107,871
Total plan liabilities at beginning of year2018-12-31$143,235
Total income from all sources2018-12-31$1,478,828
Expenses. Total of all expenses incurred2018-12-31$1,631,274
Benefits paid (including direct rollovers)2018-12-31$992,389
Total plan assets at end of year2018-12-31$103,358
Total plan assets at beginning of year2018-12-31$291,168
Value of fidelity bond covering the plan2018-12-31$1,000,000
Total contributions received or receivable from participants2018-12-31$260,564
Expenses. Other expenses not covered elsewhere2018-12-31$444,790
Contributions received from other sources (not participants or employers)2018-12-31$61,128
Other income received2018-12-31$717
Net income (gross income less expenses)2018-12-31$-152,446
Net plan assets at end of year (total assets less liabilities)2018-12-31$-4,513
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$147,933
Total contributions received or receivable from employer(s)2018-12-31$1,156,419
Value of corrective distributions2018-12-31$157,646
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$36,449
2017 : SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2017 401k financial data
Total plan liabilities at end of year2017-12-31$143,235
Total plan liabilities at beginning of year2017-12-31$114,703
Total income from all sources2017-12-31$1,510,655
Expenses. Total of all expenses incurred2017-12-31$1,324,923
Benefits paid (including direct rollovers)2017-12-31$838,638
Total plan assets at end of year2017-12-31$291,168
Total plan assets at beginning of year2017-12-31$76,904
Value of fidelity bond covering the plan2017-12-31$1,000,000
Total contributions received or receivable from participants2017-12-31$278,482
Expenses. Other expenses not covered elsewhere2017-12-31$417,266
Contributions received from other sources (not participants or employers)2017-12-31$37,243
Other income received2017-12-31$524
Net income (gross income less expenses)2017-12-31$185,732
Net plan assets at end of year (total assets less liabilities)2017-12-31$147,933
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$-37,799
Total contributions received or receivable from employer(s)2017-12-31$1,194,406
Value of corrective distributions2017-12-31$19,061
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$49,958
2016 : SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2016 401k financial data
Total plan liabilities at end of year2016-12-31$114,703
Total plan liabilities at beginning of year2016-12-31$0
Total income from all sources2016-12-31$1,405,479
Expenses. Total of all expenses incurred2016-12-31$1,443,278
Benefits paid (including direct rollovers)2016-12-31$1,042,973
Total plan assets at end of year2016-12-31$76,904
Total plan assets at beginning of year2016-12-31$0
Value of fidelity bond covering the plan2016-12-31$1,000,000
Total contributions received or receivable from participants2016-12-31$263,209
Expenses. Other expenses not covered elsewhere2016-12-31$354,025
Contributions received from other sources (not participants or employers)2016-12-31$26,777
Other income received2016-12-31$263
Net income (gross income less expenses)2016-12-31$-37,799
Net plan assets at end of year (total assets less liabilities)2016-12-31$-37,799
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$0
Total contributions received or receivable from employer(s)2016-12-31$1,115,230
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$46,280

Form 5500 Responses for SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN

2022: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: SILBERLINE MANUFACTURING CO., INC. GROUP HEALTH PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407382
Policy instance 1
Insurance contract or identification number407382
Number of Individuals Covered47
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $296,086
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407382
Policy instance 1
Insurance contract or identification number407382
Number of Individuals Covered47
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $265,925
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number407382
Policy instance 1
Insurance contract or identification number407382
Number of Individuals Covered52
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $316,810
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered78
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $368,891
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract numberVERIS
Policy instance 1
Insurance contract or identification numberVERIS
Number of Individuals Covered84
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $366,379
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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