ABHE & SVOBODA, INC. has sponsored the creation of one or more 401k plans.
Additional information about ABHE & SVOBODA, INC.
Submission information for form 5500 for 401k plan ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN
401k plan membership statisitcs for ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2023 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2023 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-04-30 | $543,201 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-04-30 | $419,731 |
| Total income from all sources (including contributions) | 2023-04-30 | $1,849,893 |
| Total of all expenses incurred | 2023-04-30 | $1,938,682 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-04-30 | $1,825,762 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-04-30 | $1,849,893 |
| Value of total assets at end of year | 2023-04-30 | $492,381 |
| Value of total assets at beginning of year | 2023-04-30 | $457,700 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-04-30 | $112,920 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-04-30 | No |
| Administrative expenses professional fees incurred | 2023-04-30 | $23,064 |
| Was this plan covered by a fidelity bond | 2023-04-30 | Yes |
| Value of fidelity bond cover | 2023-04-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2023-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-04-30 | No |
| Contributions received from participants | 2023-04-30 | $553,831 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-04-30 | $2,237 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-04-30 | $483,962 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-04-30 | $348,305 |
| Administrative expenses (other) incurred | 2023-04-30 | $893 |
| Liabilities. Value of operating payables at end of year | 2023-04-30 | $5,260 |
| Liabilities. Value of operating payables at beginning of year | 2023-04-30 | $2,614 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-04-30 | No |
| Value of net income/loss | 2023-04-30 | $-88,789 |
| Value of net assets at end of year (total assets less liabilities) | 2023-04-30 | $-50,820 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-04-30 | $37,969 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-04-30 | $492,381 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-04-30 | $455,463 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-04-30 | $455,463 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-04-30 | $535,521 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-04-30 | No |
| Contributions received in cash from employer | 2023-04-30 | $1,296,062 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-04-30 | $1,290,241 |
| Contract administrator fees | 2023-04-30 | $88,963 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2023-04-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2023-04-30 | $53,979 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-04-30 | $68,812 |
| Did the plan have assets held for investment | 2023-04-30 | 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 | 2023-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-04-30 | Unqualified |
| Accountancy firm name | 2023-04-30 | REDPATH AND COMPANY, LLC |
| Accountancy firm EIN | 2023-04-30 | 920370318 |
| 2022 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-04-30 | $419,731 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-04-30 | $136,333 |
| Total income from all sources (including contributions) | 2022-04-30 | $1,748,869 |
| Total of all expenses incurred | 2022-04-30 | $2,043,605 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-04-30 | $1,930,735 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-04-30 | $1,748,869 |
| Value of total assets at end of year | 2022-04-30 | $457,700 |
| Value of total assets at beginning of year | 2022-04-30 | $469,038 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-04-30 | $112,870 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-04-30 | No |
| Administrative expenses professional fees incurred | 2022-04-30 | $20,000 |
| Was this plan covered by a fidelity bond | 2022-04-30 | Yes |
| Value of fidelity bond cover | 2022-04-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-04-30 | No |
| Contributions received from participants | 2022-04-30 | $489,471 |
| Participant contributions at end of year | 2022-04-30 | $0 |
| Participant contributions at beginning of year | 2022-04-30 | $49,851 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-04-30 | $2,237 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-04-30 | $1,389 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-04-30 | $348,305 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-04-30 | $29,367 |
| Administrative expenses (other) incurred | 2022-04-30 | $384 |
| Liabilities. Value of operating payables at end of year | 2022-04-30 | $2,614 |
| Liabilities. Value of operating payables at beginning of year | 2022-04-30 | $2,560 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-04-30 | No |
| Value of net income/loss | 2022-04-30 | $-294,736 |
| Value of net assets at end of year (total assets less liabilities) | 2022-04-30 | $37,969 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-04-30 | $332,705 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-04-30 | $455,463 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-04-30 | $417,798 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-04-30 | $417,798 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-04-30 | $548,238 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-04-30 | No |
| Contributions received in cash from employer | 2022-04-30 | $1,259,398 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-04-30 | $1,382,497 |
| Contract administrator fees | 2022-04-30 | $92,486 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-04-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2022-04-30 | $68,812 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-04-30 | $104,406 |
| Did the plan have assets held for investment | 2022-04-30 | 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 | 2022-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-04-30 | Unqualified |
| Accountancy firm name | 2022-04-30 | REDPATH & COMPANY, LTD. |
| Accountancy firm EIN | 2022-04-30 | 410975573 |
| 2021 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-04-30 | $136,333 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-04-30 | $53,012 |
| Total income from all sources (including contributions) | 2021-04-30 | $1,964,681 |
| Total loss/gain on sale of assets | 2021-04-30 | $0 |
| Total of all expenses incurred | 2021-04-30 | $1,954,300 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-04-30 | $1,821,710 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-04-30 | $1,964,681 |
| Value of total assets at end of year | 2021-04-30 | $469,038 |
| Value of total assets at beginning of year | 2021-04-30 | $375,336 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-04-30 | $132,590 |
| Total interest from all sources | 2021-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-04-30 | No |
| Administrative expenses professional fees incurred | 2021-04-30 | $24,850 |
| Was this plan covered by a fidelity bond | 2021-04-30 | Yes |
| Value of fidelity bond cover | 2021-04-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2021-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-04-30 | No |
| Contributions received from participants | 2021-04-30 | $645,405 |
| Participant contributions at end of year | 2021-04-30 | $49,851 |
| Participant contributions at beginning of year | 2021-04-30 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-04-30 | $1,389 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-04-30 | $3,576 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-04-30 | $29,367 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-04-30 | $0 |
| Administrative expenses (other) incurred | 2021-04-30 | $683 |
| Liabilities. Value of operating payables at end of year | 2021-04-30 | $2,560 |
| Liabilities. Value of operating payables at beginning of year | 2021-04-30 | $1,153 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-04-30 | No |
| Value of net income/loss | 2021-04-30 | $10,381 |
| Value of net assets at end of year (total assets less liabilities) | 2021-04-30 | $332,705 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-04-30 | $322,324 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-04-30 | $417,798 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-04-30 | $371,760 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-04-30 | $371,760 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-04-30 | $612,092 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-04-30 | No |
| Contributions received in cash from employer | 2021-04-30 | $1,319,276 |
| Employer contributions (assets) at end of year | 2021-04-30 | $0 |
| Employer contributions (assets) at beginning of year | 2021-04-30 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-04-30 | $1,209,618 |
| Contract administrator fees | 2021-04-30 | $107,057 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-04-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2021-04-30 | $104,406 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-04-30 | $51,859 |
| Did the plan have assets held for investment | 2021-04-30 | 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 | 2021-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-04-30 | Unqualified |
| Accountancy firm name | 2021-04-30 | REDPATH & COMPANY, LTD. |
| Accountancy firm EIN | 2021-04-30 | 410975573 |
| 2020 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-04-30 | $53,012 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-04-30 | $195,217 |
| Total income from all sources (including contributions) | 2020-04-30 | $1,880,232 |
| Total loss/gain on sale of assets | 2020-04-30 | $0 |
| Total of all expenses incurred | 2020-04-30 | $2,186,438 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-04-30 | $2,048,296 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-04-30 | $1,880,232 |
| Value of total assets at end of year | 2020-04-30 | $375,336 |
| Value of total assets at beginning of year | 2020-04-30 | $823,747 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-04-30 | $138,142 |
| Total interest from all sources | 2020-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-04-30 | No |
| Administrative expenses professional fees incurred | 2020-04-30 | $15,731 |
| Was this plan covered by a fidelity bond | 2020-04-30 | Yes |
| Value of fidelity bond cover | 2020-04-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-04-30 | No |
| Contributions received from participants | 2020-04-30 | $498,477 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-04-30 | $3,576 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-04-30 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-04-30 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-04-30 | $23,673 |
| Administrative expenses (other) incurred | 2020-04-30 | $1,316 |
| Liabilities. Value of operating payables at end of year | 2020-04-30 | $1,153 |
| Liabilities. Value of operating payables at beginning of year | 2020-04-30 | $14,982 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-04-30 | No |
| Value of net income/loss | 2020-04-30 | $-306,206 |
| Value of net assets at end of year (total assets less liabilities) | 2020-04-30 | $322,324 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-04-30 | $628,530 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-04-30 | $371,760 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-04-30 | $808,038 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-04-30 | $808,038 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-04-30 | $661,937 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-04-30 | No |
| Contributions received in cash from employer | 2020-04-30 | $1,381,755 |
| Employer contributions (assets) at end of year | 2020-04-30 | $0 |
| Employer contributions (assets) at beginning of year | 2020-04-30 | $15,709 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-04-30 | $1,386,359 |
| Contract administrator fees | 2020-04-30 | $121,095 |
| Liabilities. Value of benefit claims payable at end of year | 2020-04-30 | $51,859 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-04-30 | $156,562 |
| Did the plan have assets held for investment | 2020-04-30 | 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 | 2020-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-04-30 | Unqualified |
| Accountancy firm name | 2020-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2020-04-30 | 410746749 |
| 2019 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-04-30 | $195,217 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-04-30 | $359,951 |
| Total income from all sources (including contributions) | 2019-04-30 | $2,126,094 |
| Total loss/gain on sale of assets | 2019-04-30 | $0 |
| Total of all expenses incurred | 2019-04-30 | $2,664,006 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-04-30 | $2,483,428 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-04-30 | $2,126,094 |
| Value of total assets at end of year | 2019-04-30 | $823,747 |
| Value of total assets at beginning of year | 2019-04-30 | $1,526,393 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-04-30 | $180,578 |
| Total interest from all sources | 2019-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-04-30 | No |
| Administrative expenses professional fees incurred | 2019-04-30 | $41,139 |
| Was this plan covered by a fidelity bond | 2019-04-30 | Yes |
| Value of fidelity bond cover | 2019-04-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-04-30 | No |
| Contributions received from participants | 2019-04-30 | $502,858 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-04-30 | $23,673 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-04-30 | $33,840 |
| Administrative expenses (other) incurred | 2019-04-30 | $4,078 |
| Liabilities. Value of operating payables at end of year | 2019-04-30 | $14,982 |
| Liabilities. Value of operating payables at beginning of year | 2019-04-30 | $19,257 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-04-30 | No |
| Value of net income/loss | 2019-04-30 | $-537,912 |
| Value of net assets at end of year (total assets less liabilities) | 2019-04-30 | $628,530 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-04-30 | $1,166,442 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-04-30 | $808,038 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-04-30 | $1,387,483 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-04-30 | $1,387,483 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-04-30 | $727,428 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-04-30 | No |
| Contributions received in cash from employer | 2019-04-30 | $1,623,236 |
| Employer contributions (assets) at end of year | 2019-04-30 | $15,709 |
| Employer contributions (assets) at beginning of year | 2019-04-30 | $138,910 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-04-30 | $1,756,000 |
| Contract administrator fees | 2019-04-30 | $135,361 |
| Liabilities. Value of benefit claims payable at end of year | 2019-04-30 | $156,562 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-04-30 | $306,854 |
| Did the plan have assets held for investment | 2019-04-30 | 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 | 2019-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-04-30 | Unqualified |
| Accountancy firm name | 2019-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2019-04-30 | 410746749 |
| 2018 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-04-30 | $359,951 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-04-30 | $185,755 |
| Total income from all sources (including contributions) | 2018-04-30 | $2,863,333 |
| Total loss/gain on sale of assets | 2018-04-30 | $0 |
| Total of all expenses incurred | 2018-04-30 | $3,076,464 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-04-30 | $2,862,663 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-04-30 | $2,863,333 |
| Value of total assets at end of year | 2018-04-30 | $1,526,393 |
| Value of total assets at beginning of year | 2018-04-30 | $1,565,328 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-04-30 | $213,801 |
| Total interest from all sources | 2018-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-04-30 | No |
| Administrative expenses professional fees incurred | 2018-04-30 | $35,207 |
| Was this plan covered by a fidelity bond | 2018-04-30 | Yes |
| Value of fidelity bond cover | 2018-04-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-04-30 | No |
| Contributions received from participants | 2018-04-30 | $544,796 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-04-30 | $33,840 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-04-30 | $0 |
| Administrative expenses (other) incurred | 2018-04-30 | $1,463 |
| Liabilities. Value of operating payables at end of year | 2018-04-30 | $19,257 |
| Liabilities. Value of operating payables at beginning of year | 2018-04-30 | $386 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-04-30 | No |
| Value of net income/loss | 2018-04-30 | $-213,131 |
| Value of net assets at end of year (total assets less liabilities) | 2018-04-30 | $1,166,442 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-04-30 | $1,379,573 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-04-30 | $1,387,483 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-04-30 | $1,363,317 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-04-30 | $1,363,317 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-04-30 | $729,547 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-04-30 | No |
| Contributions received in cash from employer | 2018-04-30 | $2,318,537 |
| Employer contributions (assets) at end of year | 2018-04-30 | $138,910 |
| Employer contributions (assets) at beginning of year | 2018-04-30 | $202,011 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-04-30 | $2,133,116 |
| Contract administrator fees | 2018-04-30 | $177,131 |
| Liabilities. Value of benefit claims payable at end of year | 2018-04-30 | $306,854 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-04-30 | $185,369 |
| Did the plan have assets held for investment | 2018-04-30 | 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 | 2018-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-04-30 | Unqualified |
| Accountancy firm name | 2018-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2018-04-30 | 410746749 |
| 2017 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-04-30 | $185,755 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-04-30 | $138,846 |
| Total income from all sources (including contributions) | 2017-04-30 | $3,021,712 |
| Total loss/gain on sale of assets | 2017-04-30 | $0 |
| Total of all expenses incurred | 2017-04-30 | $2,749,533 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-04-30 | $2,537,853 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-04-30 | $3,021,712 |
| Value of total assets at end of year | 2017-04-30 | $1,565,328 |
| Value of total assets at beginning of year | 2017-04-30 | $1,246,240 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-04-30 | $211,680 |
| Total interest from all sources | 2017-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-04-30 | No |
| Administrative expenses professional fees incurred | 2017-04-30 | $27,355 |
| Was this plan covered by a fidelity bond | 2017-04-30 | Yes |
| Value of fidelity bond cover | 2017-04-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-04-30 | No |
| Contributions received from participants | 2017-04-30 | $525,945 |
| Administrative expenses (other) incurred | 2017-04-30 | $13,061 |
| Liabilities. Value of operating payables at end of year | 2017-04-30 | $386 |
| Liabilities. Value of operating payables at beginning of year | 2017-04-30 | $3,546 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-04-30 | No |
| Value of net income/loss | 2017-04-30 | $272,179 |
| Value of net assets at end of year (total assets less liabilities) | 2017-04-30 | $1,379,573 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-04-30 | $1,107,394 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-04-30 | $1,363,317 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-04-30 | $1,214,424 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-04-30 | $1,214,424 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-04-30 | $703,512 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-04-30 | No |
| Contributions received in cash from employer | 2017-04-30 | $2,495,767 |
| Employer contributions (assets) at end of year | 2017-04-30 | $202,011 |
| Employer contributions (assets) at beginning of year | 2017-04-30 | $31,816 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-04-30 | $1,834,341 |
| Contract administrator fees | 2017-04-30 | $171,264 |
| Liabilities. Value of benefit claims payable at end of year | 2017-04-30 | $185,369 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-04-30 | $135,300 |
| Did the plan have assets held for investment | 2017-04-30 | 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 | 2017-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-04-30 | Unqualified |
| Accountancy firm name | 2017-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2017-04-30 | 410746749 |
| 2016 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-04-30 | $138,846 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-04-30 | $120,519 |
| Total income from all sources (including contributions) | 2016-04-30 | $2,441,346 |
| Total loss/gain on sale of assets | 2016-04-30 | $0 |
| Total of all expenses incurred | 2016-04-30 | $2,014,351 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-04-30 | $1,822,136 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-04-30 | $2,441,346 |
| Value of total assets at end of year | 2016-04-30 | $1,246,240 |
| Value of total assets at beginning of year | 2016-04-30 | $800,918 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-04-30 | $192,215 |
| Total interest from all sources | 2016-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-04-30 | No |
| Administrative expenses professional fees incurred | 2016-04-30 | $22,771 |
| Was this plan covered by a fidelity bond | 2016-04-30 | Yes |
| Value of fidelity bond cover | 2016-04-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-04-30 | No |
| Contributions received from participants | 2016-04-30 | $528,622 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-04-30 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-04-30 | $1,617 |
| Administrative expenses (other) incurred | 2016-04-30 | $14,606 |
| Liabilities. Value of operating payables at end of year | 2016-04-30 | $3,546 |
| Liabilities. Value of operating payables at beginning of year | 2016-04-30 | $4,455 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-04-30 | No |
| Value of net income/loss | 2016-04-30 | $426,995 |
| Value of net assets at end of year (total assets less liabilities) | 2016-04-30 | $1,107,394 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-04-30 | $680,399 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-04-30 | $1,214,424 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-04-30 | $632,891 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-04-30 | $632,891 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-04-30 | $567,192 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-04-30 | No |
| Contributions received in cash from employer | 2016-04-30 | $1,912,724 |
| Employer contributions (assets) at end of year | 2016-04-30 | $31,816 |
| Employer contributions (assets) at beginning of year | 2016-04-30 | $166,410 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-04-30 | $1,254,944 |
| Contract administrator fees | 2016-04-30 | $154,838 |
| Liabilities. Value of benefit claims payable at end of year | 2016-04-30 | $135,300 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-04-30 | $116,064 |
| Did the plan have assets held for investment | 2016-04-30 | 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 | 2016-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-04-30 | Unqualified |
| Accountancy firm name | 2016-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2016-04-30 | 410746749 |
| 2015 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-04-30 | $120,519 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-04-30 | $256,497 |
| Total income from all sources (including contributions) | 2015-04-30 | $2,349,149 |
| Total loss/gain on sale of assets | 2015-04-30 | $0 |
| Total of all expenses incurred | 2015-04-30 | $2,021,319 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-04-30 | $1,841,302 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-04-30 | $2,349,149 |
| Value of total assets at end of year | 2015-04-30 | $800,918 |
| Value of total assets at beginning of year | 2015-04-30 | $609,066 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-04-30 | $180,017 |
| Total interest from all sources | 2015-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-04-30 | No |
| Administrative expenses professional fees incurred | 2015-04-30 | $27,226 |
| Was this plan covered by a fidelity bond | 2015-04-30 | Yes |
| Value of fidelity bond cover | 2015-04-30 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-04-30 | No |
| Contributions received from participants | 2015-04-30 | $484,570 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-04-30 | $1,617 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-04-30 | $1,401 |
| Administrative expenses (other) incurred | 2015-04-30 | $21,976 |
| Liabilities. Value of operating payables at end of year | 2015-04-30 | $4,455 |
| Liabilities. Value of operating payables at beginning of year | 2015-04-30 | $3,250 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-04-30 | No |
| Value of net income/loss | 2015-04-30 | $327,830 |
| Value of net assets at end of year (total assets less liabilities) | 2015-04-30 | $680,399 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-04-30 | $352,569 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-04-30 | $632,891 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-04-30 | $544,605 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-04-30 | $544,605 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-04-30 | $396,439 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-04-30 | No |
| Contributions received in cash from employer | 2015-04-30 | $1,864,579 |
| Employer contributions (assets) at end of year | 2015-04-30 | $166,410 |
| Employer contributions (assets) at beginning of year | 2015-04-30 | $63,060 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-04-30 | $1,444,863 |
| Contract administrator fees | 2015-04-30 | $130,815 |
| Liabilities. Value of benefit claims payable at end of year | 2015-04-30 | $116,064 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-04-30 | $253,247 |
| Did the plan have assets held for investment | 2015-04-30 | 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 | 2015-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-04-30 | Unqualified |
| Accountancy firm name | 2015-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2015-04-30 | 410746749 |
| 2014 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-04-30 | $256,497 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-04-30 | $334,000 |
| Total income from all sources (including contributions) | 2014-04-30 | $1,788,368 |
| Total loss/gain on sale of assets | 2014-04-30 | $0 |
| Total of all expenses incurred | 2014-04-30 | $1,727,986 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-04-30 | $1,563,282 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-04-30 | $1,788,368 |
| Value of total assets at end of year | 2014-04-30 | $609,066 |
| Value of total assets at beginning of year | 2014-04-30 | $626,187 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-04-30 | $164,704 |
| Total interest from all sources | 2014-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-04-30 | No |
| Administrative expenses professional fees incurred | 2014-04-30 | $8,546 |
| Was this plan covered by a fidelity bond | 2014-04-30 | Yes |
| Value of fidelity bond cover | 2014-04-30 | $1,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-04-30 | No |
| Contributions received from participants | 2014-04-30 | $289,088 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-04-30 | $1,401 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-04-30 | $120,837 |
| Administrative expenses (other) incurred | 2014-04-30 | $1,848 |
| Liabilities. Value of operating payables at end of year | 2014-04-30 | $3,250 |
| Liabilities. Value of operating payables at beginning of year | 2014-04-30 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-04-30 | No |
| Value of net income/loss | 2014-04-30 | $60,382 |
| Value of net assets at end of year (total assets less liabilities) | 2014-04-30 | $352,569 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-04-30 | $292,187 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-04-30 | $544,605 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-04-30 | $433,838 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-04-30 | $433,838 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-04-30 | $382,870 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-04-30 | No |
| Contributions received in cash from employer | 2014-04-30 | $1,499,280 |
| Employer contributions (assets) at end of year | 2014-04-30 | $63,060 |
| Employer contributions (assets) at beginning of year | 2014-04-30 | $71,512 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-04-30 | $1,180,412 |
| Contract administrator fees | 2014-04-30 | $154,310 |
| Liabilities. Value of benefit claims payable at end of year | 2014-04-30 | $253,247 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-04-30 | $334,000 |
| Did the plan have assets held for investment | 2014-04-30 | 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 | 2014-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-04-30 | Unqualified |
| Accountancy firm name | 2014-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2014-04-30 | 410746749 |
| 2013 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-04-30 | $334,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-04-30 | $274,000 |
| Total income from all sources (including contributions) | 2013-04-30 | $2,054,197 |
| Total loss/gain on sale of assets | 2013-04-30 | $0 |
| Total of all expenses incurred | 2013-04-30 | $2,103,805 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-04-30 | $1,919,312 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-04-30 | $2,054,197 |
| Value of total assets at end of year | 2013-04-30 | $626,187 |
| Value of total assets at beginning of year | 2013-04-30 | $615,795 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-04-30 | $184,493 |
| Total interest from all sources | 2013-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-04-30 | No |
| Administrative expenses professional fees incurred | 2013-04-30 | $8,112 |
| Was this plan covered by a fidelity bond | 2013-04-30 | Yes |
| Value of fidelity bond cover | 2013-04-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-04-30 | No |
| Contributions received from participants | 2013-04-30 | $276,407 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-04-30 | $120,837 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-04-30 | $8,952 |
| Administrative expenses (other) incurred | 2013-04-30 | $1,998 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-04-30 | No |
| Value of net income/loss | 2013-04-30 | $-49,608 |
| Value of net assets at end of year (total assets less liabilities) | 2013-04-30 | $292,187 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-04-30 | $341,795 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-04-30 | $433,838 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-04-30 | $606,843 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-04-30 | $606,843 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-04-30 | $437,953 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-04-30 | No |
| Contributions received in cash from employer | 2013-04-30 | $1,777,790 |
| Employer contributions (assets) at end of year | 2013-04-30 | $71,512 |
| Employer contributions (assets) at beginning of year | 2013-04-30 | $0 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-04-30 | $1,481,359 |
| Contract administrator fees | 2013-04-30 | $174,383 |
| Liabilities. Value of benefit claims payable at end of year | 2013-04-30 | $334,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-04-30 | $274,000 |
| Did the plan have assets held for investment | 2013-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-04-30 | Unqualified |
| Accountancy firm name | 2013-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2013-04-30 | 410746749 |
| 2012 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2012 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2012-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-04-30 | $274,000 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-04-30 | $177,201 |
| Total income from all sources (including contributions) | 2012-04-30 | $1,682,677 |
| Total loss/gain on sale of assets | 2012-04-30 | $0 |
| Total of all expenses incurred | 2012-04-30 | $1,881,653 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-04-30 | $1,663,252 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-04-30 | $1,682,677 |
| Value of total assets at end of year | 2012-04-30 | $615,795 |
| Value of total assets at beginning of year | 2012-04-30 | $717,972 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-04-30 | $218,401 |
| Total interest from all sources | 2012-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-04-30 | No |
| Administrative expenses professional fees incurred | 2012-04-30 | $42,277 |
| Was this plan covered by a fidelity bond | 2012-04-30 | Yes |
| Value of fidelity bond cover | 2012-04-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-04-30 | No |
| Contributions received from participants | 2012-04-30 | $327,628 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-04-30 | $8,952 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-04-30 | $6,859 |
| Administrative expenses (other) incurred | 2012-04-30 | $1,202 |
| Liabilities. Value of operating payables at beginning of year | 2012-04-30 | $60,201 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-04-30 | No |
| Value of net income/loss | 2012-04-30 | $-198,976 |
| Value of net assets at end of year (total assets less liabilities) | 2012-04-30 | $341,795 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-04-30 | $540,771 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-04-30 | $606,843 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-04-30 | $711,113 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-04-30 | $711,113 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-04-30 | $469,779 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-04-30 | No |
| Contributions received in cash from employer | 2012-04-30 | $1,355,049 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-04-30 | $1,193,473 |
| Contract administrator fees | 2012-04-30 | $174,922 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-04-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-04-30 | $274,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-04-30 | $117,000 |
| Did the plan have assets held for investment | 2012-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-04-30 | Unqualified |
| Accountancy firm name | 2012-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2012-04-30 | 410746749 |
| 2011 : ABHE & SVOBODA, INC. HEALTH AND WELFARE PLAN 2011 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2011-04-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-04-30 | $177,201 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-04-30 | $32,310 |
| Total income from all sources (including contributions) | 2011-04-30 | $1,717,853 |
| Total loss/gain on sale of assets | 2011-04-30 | $0 |
| Total of all expenses incurred | 2011-04-30 | $1,535,919 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-04-30 | $1,359,346 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-04-30 | $1,717,853 |
| Value of total assets at end of year | 2011-04-30 | $717,972 |
| Value of total assets at beginning of year | 2011-04-30 | $391,147 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-04-30 | $176,573 |
| Total interest from all sources | 2011-04-30 | $0 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-04-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-04-30 | No |
| Administrative expenses professional fees incurred | 2011-04-30 | $41,490 |
| Was this plan covered by a fidelity bond | 2011-04-30 | Yes |
| Value of fidelity bond cover | 2011-04-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-04-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-04-30 | No |
| Contributions received from participants | 2011-04-30 | $308,138 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-04-30 | $6,859 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-04-30 | $36,095 |
| Administrative expenses (other) incurred | 2011-04-30 | $919 |
| Liabilities. Value of operating payables at end of year | 2011-04-30 | $60,201 |
| Liabilities. Value of operating payables at beginning of year | 2011-04-30 | $6,310 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-04-30 | No |
| Value of net income/loss | 2011-04-30 | $181,934 |
| Value of net assets at end of year (total assets less liabilities) | 2011-04-30 | $540,771 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-04-30 | $358,837 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-04-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-04-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-04-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-04-30 | $711,113 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-04-30 | $355,052 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-04-30 | $355,052 |
| Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year | 2011-04-30 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-04-30 | $467,993 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-04-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-04-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-04-30 | No |
| Contributions received in cash from employer | 2011-04-30 | $1,409,715 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-04-30 | $891,353 |
| Contract administrator fees | 2011-04-30 | $134,164 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-04-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-04-30 | $117,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-04-30 | $26,000 |
| Did the plan have assets held for investment | 2011-04-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-04-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-04-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-04-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-04-30 | Unqualified |
| Accountancy firm name | 2011-04-30 | CLIFTONLARSONALLEN LLP |
| Accountancy firm EIN | 2011-04-30 | 410746749 |
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 3 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $11,018 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $220,366 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,018 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10112571001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10112571001 | | Number of Individuals Covered | 128 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $1,089 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,833 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,089 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 1 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 102 | | Insurance policy start date | 2022-05-01 | | Insurance policy end date | 2023-04-30 | | Total amount of commissions paid to insurance broker | USD $482 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $27,064 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $482 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 1 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 91 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $444 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $27,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $444 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10112571001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10112571001 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $1,417 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,125 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,417 | | Insurance broker organization code? | 3 |
|
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 3 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2021-05-01 | | Insurance policy end date | 2022-04-30 | | Total amount of commissions paid to insurance broker | USD $12,770 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $259,663 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,770 | | Insurance broker organization code? | 3 |
|
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 3 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 65 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $13,030 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $278,831 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,030 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 1 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 92 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $27,678 | | 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 number | 10112571001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10112571001 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2020-05-01 | | Insurance policy end date | 2021-04-30 | | Total amount of commissions paid to insurance broker | USD $1,578 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,666 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,578 | | Insurance broker organization code? | 3 |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 211857 |
| Policy instance | 3 |
| Insurance contract or identification number | 211857 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $315,448 | | 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 number | 10112571001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10112571001 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $1,635 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $21,968 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,635 | | Insurance broker organization code? | 3 |
|
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 237310 |
| Policy instance | 1 |
| Insurance contract or identification number | 237310 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $14,226 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,226 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 4 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 127 | | Insurance policy start date | 2019-05-01 | | Insurance policy end date | 2020-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $90 | | 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 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 $29,281 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 90 | | Additional information about fees paid to insurance broker | BONUS PAID | | Insurance broker organization code? | 3 |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 211857 |
| Policy instance | 3 |
| Insurance contract or identification number | 211857 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $348,407 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 1 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $14,434 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $14,434 | | Insurance broker organization code? | 3 |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10112571001 |
| Policy instance | 2 |
| Insurance contract or identification number | 10112571001 | | Number of Individuals Covered | 216 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | Total amount of commissions paid to insurance broker | USD $1,934 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $21,004 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,934 | | Insurance broker organization code? | 3 |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 4 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 141 | | Insurance policy start date | 2018-05-01 | | Insurance policy end date | 2019-04-30 | | 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 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | 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 $36,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 6 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $12,058 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,058 | | Insurance broker organization code? | 3 | | Insurance broker name | PSH INSURANCE, INC. |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | 211857 |
| Policy instance | 5 |
| Insurance contract or identification number | 211857 | | Number of Individuals Covered | 325 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $3,898 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $139,116 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 3898 | | Additional information about fees paid to insurance broker | AGENT BONUS AND CONTINGENT COMMISSION | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | 10112571001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10112571001 | | Number of Individuals Covered | 254 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $1,821 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $18,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,821 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | SL384 |
| Policy instance | 3 |
| Insurance contract or identification number | SL384 | | Number of Individuals Covered | 325 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $4,067 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $303,399 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 4067 | | Additional information about fees paid to insurance broker | AGENT BONUS AND CONTINGENT COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ |
|
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 2 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-04-30 | | Total amount of commissions paid to insurance broker | USD $10,638 | | Total amount of fees paid to insurance company | USD $0 | | 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 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 | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,638 | | Insurance broker organization code? | 3 | | Insurance broker name | PSH INSURANCE |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 1 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 214 | | Insurance policy start date | 2017-05-01 | | Insurance policy end date | 2018-04-30 | | 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 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD & D | | 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 $41,548 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 1 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 220 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD & D | | 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 $18,959 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 2 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $7,861 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $159,531 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,861 | | Insurance broker organization code? | 3 | | Insurance broker name | PSH INSURANCE |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | SL384 |
| Policy instance | 3 |
| Insurance contract or identification number | SL384 | | Number of Individuals Covered | 402 | | Insurance policy start date | 2015-05-01 | | Insurance policy end date | 2016-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $1,822 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $328,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 1822 | | Additional information about fees paid to insurance broker | AGENT BONUS AND CONTINGENT COMMISSIONS | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ |
|
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 2 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $9,770 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,770 | | Insurance broker organization code? | 3 | | Insurance broker name | PSH INSURANCE |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 1 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 170 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $273 | | 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 | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD & D | | 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 $17,271 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 273 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS & INS SERVICES |
|
| BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 ) |
| Policy contract number | SL384 |
| Policy instance | 3 |
| Insurance contract or identification number | SL384 | | Number of Individuals Covered | 325 | | Insurance policy start date | 2014-05-01 | | Insurance policy end date | 2015-04-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $228,864 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 1 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 154 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | 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 | | Other welfare benefits provided | AD & D | | 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 $16,166 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 2 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 52 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $7,451 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,451 | | Insurance broker organization code? | 3 | | Insurance broker name | PSH INSURANCE |
|
| BCS INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 38245 ) |
| Policy contract number | 220-0006I |
| Policy instance | 3 |
| Insurance contract or identification number | 220-0006I | | Number of Individuals Covered | 181 | | Insurance policy start date | 2013-05-01 | | Insurance policy end date | 2014-04-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $181,995 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 2 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 177 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $3,155 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD & D | | 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 $20,037 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,884 | | Insurance broker organization code? | 3 | | Insurance broker name | CBIZ BENEFITS & INS SERVICES |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-3344 |
| Policy instance | 3 |
| Insurance contract or identification number | 949-3344 | | Number of Individuals Covered | 98 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Total amount of commissions paid to insurance broker | USD $2,446 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | 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 $24,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,446 | | Insurance broker organization code? | 3 | | Insurance broker name | SHEFFIELD, OLSON & MCQUEEN, INC. |
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| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 4 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $5,769 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,769 | | Insurance broker organization code? | 3 | | Insurance broker name | PSH INSURANCE |
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| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CXL00111 |
| Policy instance | 1 |
| Insurance contract or identification number | CXL00111 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2012-05-01 | | Insurance policy end date | 2013-04-30 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $249,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 4 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $6,586 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 949-0359 |
| Policy instance | 3 |
| Insurance contract or identification number | 949-0359 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $2,532 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | 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 $25,323 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 2 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 195 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $9,375 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD & D | | 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 $59,830 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CXL00111 |
| Policy instance | 1 |
| Insurance contract or identification number | CXL00111 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2012-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $271,992 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 ) |
| Policy contract number | 866326G |
| Policy instance | 1 |
| Insurance contract or identification number | 866326G | | Number of Individuals Covered | 205 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $8,482 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD & D | | 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 $51,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 280-8402 |
| Policy instance | 2 |
| Insurance contract or identification number | 280-8402 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $2,119 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ORGAN TRANSPLANT | | 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 $21,153 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 ) |
| Policy contract number | CXL 00103 |
| Policy instance | 3 |
| Insurance contract or identification number | CXL 00103 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2010-05-01 | | Insurance policy end date | 2011-04-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | 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 | | Welfare Benefit Premiums Paid to Carrier | USD $249,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| UNIVERSITY HEALTH ALLIANCE (National Association of Insurance Commissioners NAIC id number: 47953 ) |
| Policy contract number | 6260 |
| Policy instance | 4 |
| Insurance contract or identification number | 6260 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $6,003 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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