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WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 401k Plan overview

Plan NameWISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN
Plan identification number 501

WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Other welfare benefit cover

401k Sponsoring company profile

BOARD OF TRUSTEES WI UFCW UNIONS AND EMPLOYERS HEALTH PLAN has sponsored the creation of one or more 401k plans.

Company Name:BOARD OF TRUSTEES WI UFCW UNIONS AND EMPLOYERS HEALTH PLAN
Employer identification number (EIN):390979166
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-12-01JAKE BAILEY2023-11-06
5012020-12-01JAKE BAILEY2022-09-14
5012019-12-01JAKE BAILEY2021-09-13
5012018-12-01JOHN EIDEN2020-09-15
5012017-12-01JOHN EIDEN2019-09-03 DARREN HORNDASCH2019-09-03
5012016-12-01
5012015-12-01
5012014-12-01
5012013-12-01JOHN EIDEN DARREN HORNDASCH2015-09-08
5012012-12-01JOHN EIDEN DARREN HORNDASCH2014-09-09
5012011-12-01JOHN EIDEN DARREN HORNDASCH2013-07-16
5012009-12-01JOHN R. EIDEN MICHAEL T. MORTENSEN2011-06-20
5012008-12-01

Plan Statistics for WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN

401k plan membership statisitcs for WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN

Measure Date Value
2021: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01215
Total number of active participants reported on line 7a of the Form 55002021-12-01223
Number of retired or separated participants receiving benefits2021-12-010
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-01223
Number of employers contributing to the scheme2021-12-016
2020: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-01229
Total number of active participants reported on line 7a of the Form 55002020-12-01215
Number of retired or separated participants receiving benefits2020-12-010
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-01215
Number of employers contributing to the scheme2020-12-017
2019: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01197
Total number of active participants reported on line 7a of the Form 55002019-12-01229
Number of retired or separated participants receiving benefits2019-12-010
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-01229
Number of employers contributing to the scheme2019-12-017
2018: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01142
Total number of active participants reported on line 7a of the Form 55002018-12-01197
Number of retired or separated participants receiving benefits2018-12-010
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-01197
Number of employers contributing to the scheme2018-12-017
2017: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-01183
Total number of active participants reported on line 7a of the Form 55002017-12-01142
Total of all active and inactive participants2017-12-01142
Number of employers contributing to the scheme2017-12-016
2016: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01197
Total number of active participants reported on line 7a of the Form 55002016-12-01183
Total of all active and inactive participants2016-12-01183
Number of employers contributing to the scheme2016-12-017
2015: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-01226
Total number of active participants reported on line 7a of the Form 55002015-12-01197
Total of all active and inactive participants2015-12-01197
Number of employers contributing to the scheme2015-12-017
2014: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-01238
Total number of active participants reported on line 7a of the Form 55002014-12-01226
Total of all active and inactive participants2014-12-01226
Number of employers contributing to the scheme2014-12-018
2013: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-01336
Total number of active participants reported on line 7a of the Form 55002013-12-01238
Total of all active and inactive participants2013-12-01238
Number of employers contributing to the scheme2013-12-0112
2012: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-01418
Total number of active participants reported on line 7a of the Form 55002012-12-01336
Total of all active and inactive participants2012-12-01336
Number of employers contributing to the scheme2012-12-0116
2011: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-01557
Total number of active participants reported on line 7a of the Form 55002011-12-01418
Total of all active and inactive participants2011-12-01418
Number of employers contributing to the scheme2011-12-0117
2009: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-01956
Total number of active participants reported on line 7a of the Form 55002009-12-01753
Total of all active and inactive participants2009-12-01753
Number of employers contributing to the scheme2009-12-0123

Financial Data on WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN

Measure Date Value
2022 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-11-30$447,666
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-11-30$233,941
Total income from all sources (including contributions)2022-11-30$2,533,034
Total loss/gain on sale of assets2022-11-30$0
Total of all expenses incurred2022-11-30$2,499,973
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-11-30$2,246,120
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-11-30$2,766,595
Value of total assets at end of year2022-11-30$3,611,775
Value of total assets at beginning of year2022-11-30$3,364,989
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-11-30$253,853
Total interest from all sources2022-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2022-11-30$56,409
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-11-30No
Total dividends received from registered investment company shares (eg mutual funds)2022-11-30$56,409
Administrative expenses professional fees incurred2022-11-30$121,803
Was this plan covered by a fidelity bond2022-11-30Yes
Value of fidelity bond cover2022-11-30$1,000,000
If this is an individual account plan, was there a blackout period2022-11-30No
Were there any nonexempt tranactions with any party-in-interest2022-11-30No
Contributions received from participants2022-11-30$9,284
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-11-30$105,448
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-11-30$276,988
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-11-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-11-30$175,466
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-11-30$84,083
Administrative expenses (other) incurred2022-11-30$42,050
Liabilities. Value of operating payables at end of year2022-11-30$139,200
Liabilities. Value of operating payables at beginning of year2022-11-30$16,689
Total non interest bearing cash at end of year2022-11-30$1,254,976
Total non interest bearing cash at beginning of year2022-11-30$1,056,199
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-11-30No
Value of net income/loss2022-11-30$33,061
Value of net assets at end of year (total assets less liabilities)2022-11-30$3,164,109
Value of net assets at beginning of year (total assets less liabilities)2022-11-30$3,131,048
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-11-30No
Were any leases to which the plan was party in default or uncollectible2022-11-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-11-30$2,060,434
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-11-30$2,293,995
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-11-30$2,922
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-11-30$2,922
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-11-30$2,922
Expenses. Payments to insurance carriers foe the provision of benefits2022-11-30$103,616
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-11-30$-289,970
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-11-30No
Was there a failure to transmit to the plan any participant contributions2022-11-30No
Has the plan failed to provide any benefit when due under the plan2022-11-30No
Contributions received in cash from employer2022-11-30$2,757,311
Employer contributions (assets) at end of year2022-11-30$1,869
Employer contributions (assets) at beginning of year2022-11-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-11-30$2,037,056
Contract administrator fees2022-11-30$90,000
Liabilities. Value of benefit claims payable at end of year2022-11-30$133,000
Liabilities. Value of benefit claims payable at beginning of year2022-11-30$133,169
Assets. Value of buildings and other operty used in plan operation at end of year2022-11-30$14,586
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-11-30$11,873
Did the plan have assets held for investment2022-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-11-30No
Opinion of an independent qualified public accountant for this plan2022-11-30Unqualified
Accountancy firm name2022-11-30SIKICH LLP
Accountancy firm EIN2022-11-30363168081
2021 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-11-30$233,941
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-11-30$242,047
Total income from all sources (including contributions)2021-11-30$2,827,904
Total loss/gain on sale of assets2021-11-30$0
Total of all expenses incurred2021-11-30$2,429,018
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-11-30$2,209,418
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-11-30$2,762,343
Value of total assets at end of year2021-11-30$3,364,989
Value of total assets at beginning of year2021-11-30$2,974,209
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-11-30$219,600
Total interest from all sources2021-11-30$1
Total dividends received (eg from common stock, registered investment company shares)2021-11-30$71,316
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-11-30No
Administrative expenses professional fees incurred2021-11-30$88,594
Was this plan covered by a fidelity bond2021-11-30Yes
Value of fidelity bond cover2021-11-30$1,000,000
If this is an individual account plan, was there a blackout period2021-11-30No
Were there any nonexempt tranactions with any party-in-interest2021-11-30No
Contributions received from participants2021-11-30$5,533
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-11-30$197,600
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-11-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-11-30$2,358
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-11-30$84,083
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-11-30$87,144
Administrative expenses (other) incurred2021-11-30$35,036
Liabilities. Value of operating payables at end of year2021-11-30$16,689
Liabilities. Value of operating payables at beginning of year2021-11-30$39,803
Total non interest bearing cash at end of year2021-11-30$1,056,199
Total non interest bearing cash at beginning of year2021-11-30$736,332
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-11-30No
Value of net income/loss2021-11-30$398,886
Value of net assets at end of year (total assets less liabilities)2021-11-30$3,131,048
Value of net assets at beginning of year (total assets less liabilities)2021-11-30$2,732,162
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-11-30No
Were any leases to which the plan was party in default or uncollectible2021-11-30No
Investment advisory and management fees2021-11-30$5,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-11-30$2,293,995
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-11-30$2,228,434
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-11-30$2,922
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-11-30$2,922
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-11-30$2,922
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-11-30$1
Expenses. Payments to insurance carriers foe the provision of benefits2021-11-30$20,309
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-11-30$-5,756
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-11-30No
Was there a failure to transmit to the plan any participant contributions2021-11-30No
Has the plan failed to provide any benefit when due under the plan2021-11-30No
Contributions received in cash from employer2021-11-30$2,756,810
Employer contributions (assets) at end of year2021-11-30$0
Employer contributions (assets) at beginning of year2021-11-30$0
Income. Dividends from common stock2021-11-30$71,316
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-11-30$1,991,509
Contract administrator fees2021-11-30$90,970
Liabilities. Value of benefit claims payable at end of year2021-11-30$133,169
Liabilities. Value of benefit claims payable at beginning of year2021-11-30$115,100
Assets. Value of buildings and other operty used in plan operation at end of year2021-11-30$11,873
Assets. Value of buildings and other operty used in plan operation at beginning of year2021-11-30$4,163
Did the plan have assets held for investment2021-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-11-30No
Opinion of an independent qualified public accountant for this plan2021-11-30Unqualified
Accountancy firm name2021-11-30SIKICH LLP
Accountancy firm EIN2021-11-30363168081
2020 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-11-30$242,047
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-11-30$387,781
Total income from all sources (including contributions)2020-11-30$2,838,099
Total loss/gain on sale of assets2020-11-30$0
Total of all expenses incurred2020-11-30$2,682,098
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-11-30$2,420,413
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-11-30$2,634,437
Value of total assets at end of year2020-11-30$2,974,209
Value of total assets at beginning of year2020-11-30$2,963,942
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-11-30$261,685
Total interest from all sources2020-11-30$1
Total dividends received (eg from common stock, registered investment company shares)2020-11-30$45,244
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-11-30No
Total dividends received from registered investment company shares (eg mutual funds)2020-11-30$45,244
Administrative expenses professional fees incurred2020-11-30$126,378
Was this plan covered by a fidelity bond2020-11-30Yes
Value of fidelity bond cover2020-11-30$1,000,000
If this is an individual account plan, was there a blackout period2020-11-30No
Were there any nonexempt tranactions with any party-in-interest2020-11-30No
Contributions received from participants2020-11-30$16,774
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-11-30$197,216
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-11-30$2,358
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-11-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-11-30$87,144
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-11-30$61,541
Administrative expenses (other) incurred2020-11-30$40,307
Liabilities. Value of operating payables at end of year2020-11-30$39,803
Liabilities. Value of operating payables at beginning of year2020-11-30$136,240
Total non interest bearing cash at end of year2020-11-30$736,332
Total non interest bearing cash at beginning of year2020-11-30$918,954
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Value of net income/loss2020-11-30$156,001
Value of net assets at end of year (total assets less liabilities)2020-11-30$2,732,162
Value of net assets at beginning of year (total assets less liabilities)2020-11-30$2,576,161
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-11-30No
Were any leases to which the plan was party in default or uncollectible2020-11-30No
Investment advisory and management fees2020-11-30$5,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-11-30$2,228,434
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-11-30$2,024,772
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-11-30$2,922
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-11-30$2,922
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-11-30$2,922
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-11-30$1
Expenses. Payments to insurance carriers foe the provision of benefits2020-11-30$15,723
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-11-30$158,417
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-11-30No
Was there a failure to transmit to the plan any participant contributions2020-11-30No
Has the plan failed to provide any benefit when due under the plan2020-11-30No
Contributions received in cash from employer2020-11-30$2,617,663
Employer contributions (assets) at end of year2020-11-30$0
Employer contributions (assets) at beginning of year2020-11-30$11,220
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-11-30$2,207,474
Contract administrator fees2020-11-30$90,000
Liabilities. Value of benefit claims payable at end of year2020-11-30$115,100
Liabilities. Value of benefit claims payable at beginning of year2020-11-30$190,000
Assets. Value of buildings and other operty used in plan operation at end of year2020-11-30$4,163
Assets. Value of buildings and other operty used in plan operation at beginning of year2020-11-30$6,074
Did the plan have assets held for investment2020-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-11-30No
Opinion of an independent qualified public accountant for this plan2020-11-30Unqualified
Accountancy firm name2020-11-30SIKICH LLP
Accountancy firm EIN2020-11-30363168081
2019 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-11-30$387,781
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-11-30$367,911
Total income from all sources (including contributions)2019-11-30$2,181,517
Total loss/gain on sale of assets2019-11-30$0
Total of all expenses incurred2019-11-30$2,356,883
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-11-30$2,086,211
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-11-30$2,153,823
Value of total assets at end of year2019-11-30$2,963,942
Value of total assets at beginning of year2019-11-30$3,119,438
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-11-30$270,672
Total interest from all sources2019-11-30$422
Total dividends received (eg from common stock, registered investment company shares)2019-11-30$7,157
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-11-30No
Total dividends received from registered investment company shares (eg mutual funds)2019-11-30$7,157
Administrative expenses professional fees incurred2019-11-30$125,239
Was this plan covered by a fidelity bond2019-11-30Yes
Value of fidelity bond cover2019-11-30$1,000,000
If this is an individual account plan, was there a blackout period2019-11-30No
Were there any nonexempt tranactions with any party-in-interest2019-11-30No
Contributions received from participants2019-11-30$18,760
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-11-30$156,207
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-11-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-11-30$156
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-11-30$61,541
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-11-30$63,671
Other income not declared elsewhere2019-11-30$2,500
Administrative expenses (other) incurred2019-11-30$39,183
Liabilities. Value of operating payables at end of year2019-11-30$136,240
Liabilities. Value of operating payables at beginning of year2019-11-30$97,240
Total non interest bearing cash at end of year2019-11-30$918,954
Total non interest bearing cash at beginning of year2019-11-30$3,100,095
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Value of net income/loss2019-11-30$-175,366
Value of net assets at end of year (total assets less liabilities)2019-11-30$2,576,161
Value of net assets at beginning of year (total assets less liabilities)2019-11-30$2,751,527
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-11-30No
Were any leases to which the plan was party in default or uncollectible2019-11-30No
Investment advisory and management fees2019-11-30$6,250
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-11-30$2,024,772
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-11-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-11-30$2,922
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-11-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-11-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-11-30$422
Expenses. Payments to insurance carriers foe the provision of benefits2019-11-30$12,478
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-11-30$17,615
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-11-30Yes
Was there a failure to transmit to the plan any participant contributions2019-11-30No
Has the plan failed to provide any benefit when due under the plan2019-11-30No
Contributions received in cash from employer2019-11-30$2,135,063
Employer contributions (assets) at end of year2019-11-30$11,220
Employer contributions (assets) at beginning of year2019-11-30$11,220
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-11-30$1,917,526
Contract administrator fees2019-11-30$100,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-11-30No
Liabilities. Value of benefit claims payable at end of year2019-11-30$190,000
Liabilities. Value of benefit claims payable at beginning of year2019-11-30$207,000
Assets. Value of buildings and other operty used in plan operation at end of year2019-11-30$6,074
Assets. Value of buildings and other operty used in plan operation at beginning of year2019-11-30$7,967
Did the plan have assets held for investment2019-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-11-30No
Opinion of an independent qualified public accountant for this plan2019-11-30Unqualified
Accountancy firm name2019-11-30SIKICH LLP
Accountancy firm EIN2019-11-30363168081
2018 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-11-30$367,911
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-11-30$308,810
Total income from all sources (including contributions)2018-11-30$2,299,298
Total of all expenses incurred2018-11-30$2,257,412
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-11-30$2,027,159
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-11-30$2,298,093
Value of total assets at end of year2018-11-30$3,119,438
Value of total assets at beginning of year2018-11-30$3,018,451
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-11-30$230,253
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-11-30No
Administrative expenses professional fees incurred2018-11-30$106,481
Was this plan covered by a fidelity bond2018-11-30Yes
Value of fidelity bond cover2018-11-30$1,000,000
If this is an individual account plan, was there a blackout period2018-11-30No
Were there any nonexempt tranactions with any party-in-interest2018-11-30No
Contributions received from participants2018-11-30$18,160
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-11-30$144,528
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-11-30$156
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-11-30$3,510
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-11-30$63,671
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-11-30$57,162
Other income not declared elsewhere2018-11-30$1,205
Administrative expenses (other) incurred2018-11-30$33,772
Liabilities. Value of operating payables at end of year2018-11-30$97,240
Liabilities. Value of operating payables at beginning of year2018-11-30$115,961
Total non interest bearing cash at end of year2018-11-30$3,100,095
Total non interest bearing cash at beginning of year2018-11-30$3,009,660
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-11-30No
Value of net income/loss2018-11-30$41,886
Value of net assets at end of year (total assets less liabilities)2018-11-30$2,751,527
Value of net assets at beginning of year (total assets less liabilities)2018-11-30$2,709,641
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-11-30No
Were any leases to which the plan was party in default or uncollectible2018-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2018-11-30$13,398
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-11-30No
Was there a failure to transmit to the plan any participant contributions2018-11-30No
Has the plan failed to provide any benefit when due under the plan2018-11-30No
Contributions received in cash from employer2018-11-30$2,279,933
Employer contributions (assets) at end of year2018-11-30$11,220
Employer contributions (assets) at beginning of year2018-11-30$1,129
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-11-30$1,869,233
Contract administrator fees2018-11-30$90,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-11-30No
Liabilities. Value of benefit claims payable at end of year2018-11-30$207,000
Liabilities. Value of benefit claims payable at beginning of year2018-11-30$135,687
Assets. Value of buildings and other operty used in plan operation at end of year2018-11-30$7,967
Assets. Value of buildings and other operty used in plan operation at beginning of year2018-11-30$4,152
Did the plan have assets held for investment2018-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-11-30No
Opinion of an independent qualified public accountant for this plan2018-11-30Unqualified
Accountancy firm name2018-11-30FREYBERG HINKLE ET AL
Accountancy firm EIN2018-11-30391531945
2017 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$308,810
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$317,520
Total income from all sources (including contributions)2017-11-30$2,428,473
Total of all expenses incurred2017-11-30$2,080,642
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-11-30$1,837,617
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-11-30$2,428,473
Value of total assets at end of year2017-11-30$3,018,451
Value of total assets at beginning of year2017-11-30$2,679,330
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-11-30$243,025
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-11-30No
Administrative expenses professional fees incurred2017-11-30$118,336
Was this plan covered by a fidelity bond2017-11-30Yes
Value of fidelity bond cover2017-11-30$1,000,000
If this is an individual account plan, was there a blackout period2017-11-30No
Were there any nonexempt tranactions with any party-in-interest2017-11-30No
Contributions received from participants2017-11-30$9,740
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-11-30$153,913
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-11-30$3,510
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-11-30$34,431
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-11-30$57,162
Administrative expenses (other) incurred2017-11-30$34,689
Liabilities. Value of operating payables at end of year2017-11-30$115,961
Liabilities. Value of operating payables at beginning of year2017-11-30$163,525
Total non interest bearing cash at end of year2017-11-30$3,009,660
Total non interest bearing cash at beginning of year2017-11-30$2,640,822
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Value of net income/loss2017-11-30$347,831
Value of net assets at end of year (total assets less liabilities)2017-11-30$2,709,641
Value of net assets at beginning of year (total assets less liabilities)2017-11-30$2,361,810
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-11-30No
Were any leases to which the plan was party in default or uncollectible2017-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-11-30$15,740
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-11-30No
Was there a failure to transmit to the plan any participant contributions2017-11-30No
Has the plan failed to provide any benefit when due under the plan2017-11-30No
Contributions received in cash from employer2017-11-30$2,418,733
Employer contributions (assets) at end of year2017-11-30$1,129
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-11-30$1,667,964
Contract administrator fees2017-11-30$90,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-11-30No
Liabilities. Value of benefit claims payable at end of year2017-11-30$135,687
Liabilities. Value of benefit claims payable at beginning of year2017-11-30$153,995
Assets. Value of buildings and other operty used in plan operation at end of year2017-11-30$4,152
Assets. Value of buildings and other operty used in plan operation at beginning of year2017-11-30$4,077
Did the plan have assets held for investment2017-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-11-30No
Opinion of an independent qualified public accountant for this plan2017-11-30Unqualified
Accountancy firm name2017-11-30FREYBERG HINKLE ET AL
Accountancy firm EIN2017-11-30391531945
2016 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$317,520
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$416,916
Total income from all sources (including contributions)2016-11-30$2,858,417
Total of all expenses incurred2016-11-30$3,359,197
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-11-30$3,019,519
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-11-30$2,858,417
Value of total assets at end of year2016-11-30$2,679,330
Value of total assets at beginning of year2016-11-30$3,279,506
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-11-30$339,678
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-11-30No
Administrative expenses professional fees incurred2016-11-30$109,081
Was this plan covered by a fidelity bond2016-11-30Yes
Value of fidelity bond cover2016-11-30$1,000,000
If this is an individual account plan, was there a blackout period2016-11-30No
Were there any nonexempt tranactions with any party-in-interest2016-11-30No
Contributions received from participants2016-11-30$11,460
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-11-30$187,998
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-11-30$34,431
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-11-30$43,430
Administrative expenses (other) incurred2016-11-30$56,401
Liabilities. Value of operating payables at end of year2016-11-30$163,525
Liabilities. Value of operating payables at beginning of year2016-11-30$155,991
Total non interest bearing cash at end of year2016-11-30$2,640,822
Total non interest bearing cash at beginning of year2016-11-30$3,209,440
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Value of net income/loss2016-11-30$-500,780
Value of net assets at end of year (total assets less liabilities)2016-11-30$2,361,810
Value of net assets at beginning of year (total assets less liabilities)2016-11-30$2,862,590
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-11-30No
Were any leases to which the plan was party in default or uncollectible2016-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-11-30$17,690
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-11-30No
Was there a failure to transmit to the plan any participant contributions2016-11-30No
Has the plan failed to provide any benefit when due under the plan2016-11-30No
Contributions received in cash from employer2016-11-30$2,846,957
Employer contributions (assets) at beginning of year2016-11-30$1,340
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-11-30$2,813,831
Contract administrator fees2016-11-30$174,196
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-11-30No
Liabilities. Value of benefit claims payable at end of year2016-11-30$153,995
Liabilities. Value of benefit claims payable at beginning of year2016-11-30$260,925
Assets. Value of buildings and other operty used in plan operation at end of year2016-11-30$4,077
Assets. Value of buildings and other operty used in plan operation at beginning of year2016-11-30$25,296
Did the plan have assets held for investment2016-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-11-30No
Opinion of an independent qualified public accountant for this plan2016-11-30Unqualified
Accountancy firm name2016-11-30FREYBERG HINKLE ET AL
Accountancy firm EIN2016-11-30391531945
2015 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$416,916
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$752,350
Total income from all sources (including contributions)2015-11-30$3,017,229
Total of all expenses incurred2015-11-30$3,045,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-11-30$2,595,682
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-11-30$3,017,229
Value of total assets at end of year2015-11-30$3,279,506
Value of total assets at beginning of year2015-11-30$3,642,820
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-11-30$449,427
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-11-30No
Administrative expenses professional fees incurred2015-11-30$108,226
Was this plan covered by a fidelity bond2015-11-30Yes
Value of fidelity bond cover2015-11-30$1,000,000
If this is an individual account plan, was there a blackout period2015-11-30No
Were there any nonexempt tranactions with any party-in-interest2015-11-30No
Contributions received from participants2015-11-30$31,709
Income. Received or receivable in cash from other sources (including rollovers)2015-11-30$379
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-11-30$195,203
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-11-30$43,430
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-11-30$205,591
Administrative expenses (other) incurred2015-11-30$96,048
Liabilities. Value of operating payables at end of year2015-11-30$155,991
Liabilities. Value of operating payables at beginning of year2015-11-30$531,424
Total non interest bearing cash at end of year2015-11-30$3,209,440
Total non interest bearing cash at beginning of year2015-11-30$3,430,771
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Value of net income/loss2015-11-30$-27,880
Value of net assets at end of year (total assets less liabilities)2015-11-30$2,862,590
Value of net assets at beginning of year (total assets less liabilities)2015-11-30$2,890,470
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-11-30No
Were any leases to which the plan was party in default or uncollectible2015-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2015-11-30$18,449
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-11-30No
Was there a failure to transmit to the plan any participant contributions2015-11-30No
Has the plan failed to provide any benefit when due under the plan2015-11-30No
Contributions received in cash from employer2015-11-30$2,985,141
Employer contributions (assets) at end of year2015-11-30$1,340
Employer contributions (assets) at beginning of year2015-11-30$1,129
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-11-30$2,382,030
Contract administrator fees2015-11-30$245,153
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-11-30No
Liabilities. Value of benefit claims payable at end of year2015-11-30$260,925
Liabilities. Value of benefit claims payable at beginning of year2015-11-30$220,926
Assets. Value of buildings and other operty used in plan operation at end of year2015-11-30$25,296
Assets. Value of buildings and other operty used in plan operation at beginning of year2015-11-30$5,329
Did the plan have assets held for investment2015-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-11-30No
Opinion of an independent qualified public accountant for this plan2015-11-30Unqualified
Accountancy firm name2015-11-30FREYBERG HINKLE ET AL
Accountancy firm EIN2015-11-30391531945
2014 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$752,350
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$557,078
Total income from all sources (including contributions)2014-11-30$3,534,948
Total of all expenses incurred2014-11-30$4,460,411
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-11-30$4,072,560
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-11-30$3,532,943
Value of total assets at end of year2014-11-30$3,642,820
Value of total assets at beginning of year2014-11-30$4,373,011
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-11-30$387,851
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-11-30No
Administrative expenses professional fees incurred2014-11-30$103,340
Was this plan covered by a fidelity bond2014-11-30Yes
Value of fidelity bond cover2014-11-30$1,000,000
If this is an individual account plan, was there a blackout period2014-11-30No
Were there any nonexempt tranactions with any party-in-interest2014-11-30No
Contributions received from participants2014-11-30$84,693
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-11-30$220,226
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-11-30$205,591
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-11-30$69,436
Other income not declared elsewhere2014-11-30$2,005
Administrative expenses (other) incurred2014-11-30$36,511
Liabilities. Value of operating payables at end of year2014-11-30$531,424
Liabilities. Value of operating payables at beginning of year2014-11-30$221,978
Total non interest bearing cash at end of year2014-11-30$3,430,771
Total non interest bearing cash at beginning of year2014-11-30$4,289,317
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Value of net income/loss2014-11-30$-925,463
Value of net assets at end of year (total assets less liabilities)2014-11-30$2,890,470
Value of net assets at beginning of year (total assets less liabilities)2014-11-30$3,815,933
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-11-30No
Were any leases to which the plan was party in default or uncollectible2014-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2014-11-30$29,429
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-11-30No
Was there a failure to transmit to the plan any participant contributions2014-11-30No
Has the plan failed to provide any benefit when due under the plan2014-11-30No
Contributions received in cash from employer2014-11-30$3,448,250
Employer contributions (assets) at end of year2014-11-30$1,129
Employer contributions (assets) at beginning of year2014-11-30$4,310
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-11-30$3,822,905
Contract administrator fees2014-11-30$248,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-11-30No
Liabilities. Value of benefit claims payable at end of year2014-11-30$220,926
Liabilities. Value of benefit claims payable at beginning of year2014-11-30$335,100
Assets. Value of buildings and other operty used in plan operation at end of year2014-11-30$5,329
Assets. Value of buildings and other operty used in plan operation at beginning of year2014-11-30$9,948
Did the plan have assets held for investment2014-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-11-30No
Opinion of an independent qualified public accountant for this plan2014-11-30Unqualified
Accountancy firm name2014-11-30FREYBERG HINKLE ET AL
Accountancy firm EIN2014-11-30391531945
2013 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-11-30$557,078
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-11-30$584,191
Total income from all sources (including contributions)2013-11-30$4,493,255
Total of all expenses incurred2013-11-30$4,340,064
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-11-30$3,908,434
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-11-30$4,492,255
Value of total assets at end of year2013-11-30$4,373,011
Value of total assets at beginning of year2013-11-30$4,246,933
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-11-30$431,630
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-11-30No
Administrative expenses professional fees incurred2013-11-30$139,616
Was this plan covered by a fidelity bond2013-11-30Yes
Value of fidelity bond cover2013-11-30$1,000,000
If this is an individual account plan, was there a blackout period2013-11-30No
Were there any nonexempt tranactions with any party-in-interest2013-11-30No
Contributions received from participants2013-11-30$54,810
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-11-30$139,457
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-11-30$69,436
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-11-30$72,434
Other income not declared elsewhere2013-11-30$1,000
Administrative expenses (other) incurred2013-11-30$44,014
Liabilities. Value of operating payables at end of year2013-11-30$221,978
Liabilities. Value of operating payables at beginning of year2013-11-30$214,191
Total non interest bearing cash at end of year2013-11-30$4,289,317
Total non interest bearing cash at beginning of year2013-11-30$4,131,421
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-11-30No
Value of net income/loss2013-11-30$153,191
Value of net assets at end of year (total assets less liabilities)2013-11-30$3,815,933
Value of net assets at beginning of year (total assets less liabilities)2013-11-30$3,662,742
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-11-30No
Were any leases to which the plan was party in default or uncollectible2013-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2013-11-30$33,962
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-11-30No
Was there a failure to transmit to the plan any participant contributions2013-11-30No
Has the plan failed to provide any benefit when due under the plan2013-11-30No
Contributions received in cash from employer2013-11-30$4,437,445
Employer contributions (assets) at end of year2013-11-30$4,310
Employer contributions (assets) at beginning of year2013-11-30$5,313
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-11-30$3,735,015
Contract administrator fees2013-11-30$248,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-11-30No
Liabilities. Value of benefit claims payable at end of year2013-11-30$335,100
Liabilities. Value of benefit claims payable at beginning of year2013-11-30$370,000
Assets. Value of buildings and other operty used in plan operation at end of year2013-11-30$9,948
Assets. Value of buildings and other operty used in plan operation at beginning of year2013-11-30$37,765
Did the plan have assets held for investment2013-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-11-30No
Opinion of an independent qualified public accountant for this plan2013-11-30Unqualified
Accountancy firm name2013-11-30FREYBERG HINKLE ET AL
Accountancy firm EIN2013-11-30391531945
2012 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-11-30$584,191
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-11-30$518,581
Total income from all sources (including contributions)2012-11-30$5,722,337
Total loss/gain on sale of assets2012-11-30$0
Total of all expenses incurred2012-11-30$5,779,402
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-11-30$5,140,844
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-11-30$5,702,401
Value of total assets at end of year2012-11-30$4,246,933
Value of total assets at beginning of year2012-11-30$4,238,388
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-11-30$638,558
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-11-30No
Administrative expenses professional fees incurred2012-11-30$132,988
Was this plan covered by a fidelity bond2012-11-30Yes
Value of fidelity bond cover2012-11-30$1,000,000
If this is an individual account plan, was there a blackout period2012-11-30No
Were there any nonexempt tranactions with any party-in-interest2012-11-30No
Contributions received from participants2012-11-30$15,300
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-11-30$35,828
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-11-30$72,434
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-11-30$56,995
Other income not declared elsewhere2012-11-30$19,936
Administrative expenses (other) incurred2012-11-30$53,353
Liabilities. Value of operating payables at end of year2012-11-30$214,191
Liabilities. Value of operating payables at beginning of year2012-11-30$196,182
Total non interest bearing cash at end of year2012-11-30$4,131,421
Total non interest bearing cash at beginning of year2012-11-30$42,464
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-11-30No
Value of net income/loss2012-11-30$-57,065
Value of net assets at end of year (total assets less liabilities)2012-11-30$3,662,742
Value of net assets at beginning of year (total assets less liabilities)2012-11-30$3,719,807
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-11-30No
Were any leases to which the plan was party in default or uncollectible2012-11-30No
Investment advisory and management fees2012-11-30$1,500
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-11-30$4,072,930
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-11-30$4,072,930
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-11-30Yes
Was there a failure to transmit to the plan any participant contributions2012-11-30No
Has the plan failed to provide any benefit when due under the plan2012-11-30No
Contributions received in cash from employer2012-11-30$5,687,101
Employer contributions (assets) at end of year2012-11-30$5,313
Employer contributions (assets) at beginning of year2012-11-30$24,252
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-11-30$5,105,016
Contract administrator fees2012-11-30$450,717
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-11-30No
Liabilities. Value of benefit claims payable at end of year2012-11-30$370,000
Liabilities. Value of benefit claims payable at beginning of year2012-11-30$322,399
Assets. Value of buildings and other operty used in plan operation at end of year2012-11-30$37,765
Assets. Value of buildings and other operty used in plan operation at beginning of year2012-11-30$41,747
Did the plan have assets held for investment2012-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-11-30No
Aggregate proceeds on sale of assets2012-11-30$6,317,223
Aggregate carrying amount (costs) on sale of assets2012-11-30$6,317,223
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-11-30No
Opinion of an independent qualified public accountant for this plan2012-11-30Unqualified
Accountancy firm name2012-11-30FREYBERG HINKLE ET AL
Accountancy firm EIN2012-11-30391531945
2011 : WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-11-30$518,581
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-11-30$500,945
Total income from all sources (including contributions)2011-11-30$6,980,660
Total loss/gain on sale of assets2011-11-30$0
Total of all expenses incurred2011-11-30$5,220,057
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-11-30$4,447,864
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-11-30$6,954,096
Value of total assets at end of year2011-11-30$4,238,388
Value of total assets at beginning of year2011-11-30$2,460,149
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-11-30$772,193
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-11-30No
Administrative expenses professional fees incurred2011-11-30$125,358
Was this plan covered by a fidelity bond2011-11-30Yes
Value of fidelity bond cover2011-11-30$1,000,000
If this is an individual account plan, was there a blackout period2011-11-30No
Were there any nonexempt tranactions with any party-in-interest2011-11-30No
Contributions received from participants2011-11-30$50,593
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-11-30$52,106
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-11-30$56,995
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-11-30$100,400
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-11-30$33,943
Other income not declared elsewhere2011-11-30$26,564
Administrative expenses (other) incurred2011-11-30$55,082
Liabilities. Value of operating payables at end of year2011-11-30$196,182
Liabilities. Value of operating payables at beginning of year2011-11-30$76,020
Total non interest bearing cash at end of year2011-11-30$42,464
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-11-30No
Value of net income/loss2011-11-30$1,760,603
Value of net assets at end of year (total assets less liabilities)2011-11-30$3,719,807
Value of net assets at beginning of year (total assets less liabilities)2011-11-30$1,959,204
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-11-30No
Were any leases to which the plan was party in default or uncollectible2011-11-30No
Investment advisory and management fees2011-11-30$6,000
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-11-30$4,072,930
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-11-30$2,344,530
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-11-30$2,344,530
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-11-30Yes
Was there a failure to transmit to the plan any participant contributions2011-11-30No
Has the plan failed to provide any benefit when due under the plan2011-11-30No
Contributions received in cash from employer2011-11-30$6,903,503
Employer contributions (assets) at end of year2011-11-30$24,252
Employer contributions (assets) at beginning of year2011-11-30$6,361
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-11-30$4,395,758
Contract administrator fees2011-11-30$585,753
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-11-30No
Liabilities. Value of benefit claims payable at end of year2011-11-30$322,399
Liabilities. Value of benefit claims payable at beginning of year2011-11-30$390,982
Assets. Value of buildings and other operty used in plan operation at end of year2011-11-30$41,747
Assets. Value of buildings and other operty used in plan operation at beginning of year2011-11-30$8,858
Did the plan have assets held for investment2011-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-11-30No
Aggregate proceeds on sale of assets2011-11-30$3,604,523
Aggregate carrying amount (costs) on sale of assets2011-11-30$3,604,523
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-11-30No
Opinion of an independent qualified public accountant for this plan2011-11-30Unqualified
Accountancy firm name2011-11-30FREYBERG HINKLE ET AL
Accountancy firm EIN2011-11-30391531945

Form 5500 Responses for WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN

2021: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2021 form 5500 responses
2021-12-01Type of plan entityMulti-employer plan
2021-12-01Submission has been amendedYes
2021-12-01This submission is the final filingNo
2021-12-01This return/report is a short plan year return/report (less than 12 months)No
2021-12-01Plan is a collectively bargained planYes
2021-12-01Plan funding arrangement – TrustYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement - TrustYes
2020: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2020 form 5500 responses
2020-12-01Type of plan entityMulti-employer plan
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planYes
2020-12-01Plan funding arrangement – TrustYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement - TrustYes
2019: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2019 form 5500 responses
2019-12-01Type of plan entityMulti-employer plan
2019-12-01Submission has been amendedNo
2019-12-01This submission is the final filingNo
2019-12-01This return/report is a short plan year return/report (less than 12 months)No
2019-12-01Plan is a collectively bargained planYes
2019-12-01Plan funding arrangement – TrustYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement - TrustYes
2018: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2018 form 5500 responses
2018-12-01Type of plan entityMulti-employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planYes
2018-12-01Plan funding arrangement – TrustYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement - TrustYes
2017: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2017 form 5500 responses
2017-12-01Type of plan entityMulti-employer plan
2017-12-01Plan is a collectively bargained planYes
2017-12-01Plan funding arrangement – TrustYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement - TrustYes
2016: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2016 form 5500 responses
2016-12-01Type of plan entityMulti-employer plan
2016-12-01Plan is a collectively bargained planYes
2016-12-01Plan funding arrangement – TrustYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement - TrustYes
2015: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2015 form 5500 responses
2015-12-01Type of plan entityMulti-employer plan
2015-12-01Plan is a collectively bargained planYes
2015-12-01Plan funding arrangement – TrustYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement - TrustYes
2014: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2014 form 5500 responses
2014-12-01Type of plan entityMulti-employer plan
2014-12-01Plan is a collectively bargained planYes
2014-12-01Plan funding arrangement – TrustYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement - TrustYes
2013: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2013 form 5500 responses
2013-12-01Type of plan entityMulti-employer plan
2013-12-01Plan is a collectively bargained planYes
2013-12-01Plan funding arrangement – TrustYes
2013-12-01Plan benefit arrangement – InsuranceYes
2013-12-01Plan benefit arrangement - TrustYes
2012: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2012 form 5500 responses
2012-12-01Type of plan entityMulti-employer plan
2012-12-01Plan is a collectively bargained planYes
2012-12-01Plan funding arrangement – TrustYes
2012-12-01Plan benefit arrangement – InsuranceYes
2012-12-01Plan benefit arrangement - TrustYes
2011: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2011 form 5500 responses
2011-12-01Type of plan entityMulti-employer plan
2011-12-01Plan is a collectively bargained planYes
2011-12-01Plan funding arrangement – TrustYes
2011-12-01Plan benefit arrangement - TrustYes
2009: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2009 form 5500 responses
2009-12-01Type of plan entityMulti-employer plan
2009-12-01This submission is the final filingNo
2009-12-01Plan is a collectively bargained planYes
2009-12-01Plan funding arrangement – TrustYes
2009-12-01Plan benefit arrangement - TrustYes
2008: WISCONSIN UFCW UNIONS AND EMPLOYERS HEALTH PLAN 2008 form 5500 responses
2008-12-01Type of plan entityMulti-employer plan
2008-12-01Submission has been amendedNo
2008-12-01This submission is the final filingNo
2008-12-01This return/report is a short plan year return/report (less than 12 months)No
2008-12-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberSL10417
Policy instance 2
Insurance contract or identification numberSL10417
Number of Individuals Covered216
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 $93,059
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number00226472
Policy instance 1
Insurance contract or identification number00226472
Number of Individuals Covered280
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
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 BenefitYes
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 $12,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberSL10417
Policy instance 3
Insurance contract or identification numberSL10417
Number of Individuals Covered229
Insurance policy start date2020-07-01
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 $42,929
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE4E-50047
Policy instance 2
Insurance contract or identification numberSE4E-50047
Number of Individuals Covered252
Insurance policy start date2020-01-01
Insurance policy end date2020-06-30
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 $46,814
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number00226472
Policy instance 1
Insurance contract or identification number00226472
Number of Individuals Covered361
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
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 BenefitYes
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 $21,026
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE4E50047
Policy instance 2
Insurance contract or identification numberSE4E50047
Number of Individuals Covered195
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 $83,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number00226472
Policy instance 1
Insurance contract or identification number00226472
Number of Individuals Covered308
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
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 BenefitYes
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 $12,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE4E50047
Policy instance 2
Insurance contract or identification numberSE4E50047
Number of Individuals Covered148
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
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 $75,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number00226472
Policy instance 1
Insurance contract or identification number00226472
Number of Individuals Covered302
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
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 BenefitYes
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 $14,028
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract numberSE4E50047
Policy instance 2
Insurance contract or identification numberSE4E50047
Number of Individuals Covered182
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $83,888
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF WISCONSIN (National Association of Insurance Commissioners NAIC id number: 54003 )
Policy contract number00226472
Policy instance 1
Insurance contract or identification number00226472
Number of Individuals Covered344
Insurance policy start date2017-02-01
Insurance policy end date2018-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $15,469
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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