401k Plan data: IBEW LU2221 HEALTH & WELFARE PLAN plan

IBEW LU2221 HEALTH & WELFARE PLAN 401k Plan overview

Plan Name	IBEW LU2221 HEALTH & WELFARE PLAN
Plan identification number	502

IBEW LU2221 HEALTH & WELFARE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Temporary disability (accident and sickness)

401k Sponsoring company profile

IBEW LU2221 HEALTH & WELFARE BOARD OF TRUSTEES has sponsored the creation of one or more 401k plans.

Company Name: IBEW LU2221 HEALTH & WELFARE BOARD OF TRUSTEES

Employer identification number (EIN): 382346242

NAIC Classification: 332900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan IBEW LU2221 HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
502 2016-01-01 DAN LIEBERGEN DAN LIEBERGEN 2017-07-27
502 2015-01-01 DAN LIEBERGEN DAN LIEBERGEN 2016-07-27
502 2014-01-01 DAN LIEBERGEN DAN LIEBERGEN 2015-07-27

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
502	2016-01-01	DAN LIEBERGEN	DAN LIEBERGEN	2017-07-27
502	2015-01-01	DAN LIEBERGEN	DAN LIEBERGEN	2016-07-27
502	2014-01-01	DAN LIEBERGEN	DAN LIEBERGEN	2015-07-27

Plan Statistics for IBEW LU2221 HEALTH & WELFARE PLAN

401k plan membership statisitcs for IBEW LU2221 HEALTH & WELFARE PLAN

Measure Date Value
2016: IBEW LU2221 HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 228
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 236
Number of retired or separated participants receiving benefits 2016-01-01 3
Total of all active and inactive participants 2016-01-01 239
Total participants 2016-01-01 239
2015: IBEW LU2221 HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 342
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 226
Number of retired or separated participants receiving benefits 2015-01-01 2
Total of all active and inactive participants 2015-01-01 228
Total participants 2015-01-01 228
2014: IBEW LU2221 HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 302
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 341
Number of retired or separated participants receiving benefits 2014-01-01 1
Total of all active and inactive participants 2014-01-01 342
Total participants 2014-01-01 342

Measure	Date	Value
2016: IBEW LU2221 HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	228
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	236
Number of retired or separated participants receiving benefits	2016-01-01	3
Total of all active and inactive participants	2016-01-01	239
Total participants	2016-01-01	239
2015: IBEW LU2221 HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	342
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	226
Number of retired or separated participants receiving benefits	2015-01-01	2
Total of all active and inactive participants	2015-01-01	228
Total participants	2015-01-01	228
2014: IBEW LU2221 HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	302
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	341
Number of retired or separated participants receiving benefits	2014-01-01	1
Total of all active and inactive participants	2014-01-01	342
Total participants	2014-01-01	342

Financial Data on IBEW LU2221 HEALTH & WELFARE PLAN

Measure	Date	Value
2016 : IBEW LU2221 HEALTH & WELFARE PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$1,071
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$1,265
Total income from all sources (including contributions)	2016-12-31	$2,492,389
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$2,108,048
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$2,090,514
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$2,118,656
Value of total assets at end of year	2016-12-31	$2,202,294
Value of total assets at beginning of year	2016-12-31	$1,818,147
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$17,534
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	No
Administrative expenses professional fees incurred	2016-12-31	$5,281
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$98,091
Participant contributions at end of year	2016-12-31	$5,606
Participant contributions at beginning of year	2016-12-31	$5,954
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-12-31	$174,958
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-12-31	$167,122
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-12-31	$1,071
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-12-31	$1,265
Other income not declared elsewhere	2016-12-31	$373,733
Administrative expenses (other) incurred	2016-12-31	$12,253
Total non interest bearing cash at end of year	2016-12-31	$1,862,227
Total non interest bearing cash at beginning of year	2016-12-31	$1,445,475
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$384,341
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$2,201,223
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,816,882
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2016-12-31	$2,090,514
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Contributions received in cash from employer	2016-12-31	$2,020,565
Employer contributions (assets) at end of year	2016-12-31	$159,503
Employer contributions (assets) at beginning of year	2016-12-31	$199,596
Did the plan have assets held for investment	2016-12-31	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	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	FLEURY SINGLER & COMPANY
Accountancy firm EIN	2016-12-31	382180715
2015 : IBEW LU2221 HEALTH & WELFARE 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	$1,265
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$301,656
Total income from all sources (including contributions)	2015-12-31	$2,037,028
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$1,800,859
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$1,783,818
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$2,037,028
Value of total assets at end of year	2015-12-31	$1,818,147
Value of total assets at beginning of year	2015-12-31	$1,882,369
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$17,041
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	$5,525
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$64,866
Participant contributions at end of year	2015-12-31	$5,954
Participant contributions at beginning of year	2015-12-31	$9,194
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-12-31	$167,122
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-12-31	$239,117
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-12-31	$1,265
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-12-31	$301,656
Administrative expenses (other) incurred	2015-12-31	$11,516
Total non interest bearing cash at end of year	2015-12-31	$1,445,475
Total non interest bearing cash at beginning of year	2015-12-31	$1,307,942
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	$236,169
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,816,882
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,580,713
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	$1,783,818
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	$1,972,162
Employer contributions (assets) at end of year	2015-12-31	$199,596
Employer contributions (assets) at beginning of year	2015-12-31	$326,116
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	FLEURY SINGLER & COMPANY
Accountancy firm EIN	2015-12-31	382180715
2014 : IBEW LU2221 HEALTH & WELFARE 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	$301,656
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$9,566
Total income from all sources (including contributions)	2014-12-31	$3,303,506
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$2,763,595
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$2,448,936
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$3,303,506
Value of total assets at end of year	2014-12-31	$1,882,369
Value of total assets at beginning of year	2014-12-31	$1,050,368
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$314,659
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	$4,881
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$91,227
Participant contributions at end of year	2014-12-31	$9,194
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)	2014-12-31	$422
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-12-31	$239,117
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-12-31	$211,161
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-12-31	$301,656
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$6,698
Administrative expenses (other) incurred	2014-12-31	$309,778
Total non interest bearing cash at end of year	2014-12-31	$1,307,942
Total non interest bearing cash at beginning of year	2014-12-31	$609,510
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	$539,911
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,580,713
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$1,040,802
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	$2,448,514
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	$3,212,279
Employer contributions (assets) at end of year	2014-12-31	$326,116
Employer contributions (assets) at beginning of year	2014-12-31	$229,697
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$2,868
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	FLEURY SINGLER & COMPANY
Accountancy firm EIN	2014-12-31	382180715

Form 5500 Responses for IBEW LU2221 HEALTH & WELFARE PLAN

2016: IBEW LU2221 HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: IBEW LU2221 HEALTH & WELFARE 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 – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: IBEW LU2221 HEALTH & WELFARE 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 – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

933605

Policy instance

Insurance contract or identification number	933605
Number of Individuals Covered	253
Insurance policy start date	2015-01-01
Insurance policy end date	2016-01-01
Total amount of commissions paid to insurance broker	USD $4,220
Total amount of fees paid to insurance company	USD $1,806
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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 $90,284
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,220
Amount paid for insurance broker fees	1806
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

68593

Policy instance

Insurance contract or identification number	68593
Number of Individuals Covered	473
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $37,280
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	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $37,280
Insurance broker organization code?	3
Insurance broker name	JAN R STAGE

UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )

Policy contract number

933605

Policy instance

Insurance contract or identification number	933605
Number of Individuals Covered	436
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $4,754
Total amount of fees paid to insurance company	USD $2,411
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	Yes
Temporary Disability Insurance Welfare Benefit	Yes
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 $120,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,754
Amount paid for insurance broker fees	2411
Insurance broker organization code?	3
Insurance broker name	ASSOCIATED FINANCIAL GROUP LLC

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )

Policy contract number

43456

Policy instance

Insurance contract or identification number	43456
Number of Individuals Covered	731
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $31,039
Total amount of fees paid to insurance company	USD $3,711
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	Yes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Amount paid for insurance broker fees	3711
Insurance broker organization code?	3
Commission paid to Insurance Broker	USD $31,039
Insurance broker name	JAN R STAGE

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Company Name:	IBEW LU2221 HEALTH & WELFARE BOARD OF TRUSTEES
Employer identification number (EIN):	382346242
NAIC Classification:	332900