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USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 401k Plan overview

Plan NameUSW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN
Plan identification number 501

USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN Benefits

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

401k Sponsoring company profile

COMMITTEE USW/YOKOHAMA TIRE RETIREES HEALTH AND WELFARE TRUST has sponsored the creation of one or more 401k plans.

Company Name:COMMITTEE USW/YOKOHAMA TIRE RETIREES HEALTH AND WELFARE TRUST
Employer identification number (EIN):456572676
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01

Plan Statistics for USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN

401k plan membership statisitcs for USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN

Measure Date Value
2022: USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01375
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-01392
Number of other retired or separated participants entitled to future benefits2022-01-0117
Total of all active and inactive participants2022-01-01409
2021: USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01365
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-01375
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01375
2020: USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01927
Total number of active participants reported on line 7a of the Form 55002020-01-01547
Number of retired or separated participants receiving benefits2020-01-01401
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01948
2019: USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01977
Total number of active participants reported on line 7a of the Form 55002019-01-01526
Number of retired or separated participants receiving benefits2019-01-01401
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01927

Financial Data on USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN

Measure Date Value
2022 : USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$-572,977
Total unrealized appreciation/depreciation of assets2022-12-31$-572,977
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$1,139
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$24,273
Total income from all sources (including contributions)2022-12-31$4,028,217
Total loss/gain on sale of assets2022-12-31$-7,264
Total of all expenses incurred2022-12-31$3,935,291
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$3,784,462
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$5,400,480
Value of total assets at end of year2022-12-31$12,824,603
Value of total assets at beginning of year2022-12-31$12,754,811
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$150,829
Total interest from all sources2022-12-31$15,356
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$169,123
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$130,140
Administrative expenses professional fees incurred2022-12-31$90,770
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$841,293
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$6,255
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$8,156
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-12-31$1,139
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-12-31$24,273
Administrative expenses (other) incurred2022-12-31$307
Total non interest bearing cash at end of year2022-12-31$227,511
Total non interest bearing cash at beginning of year2022-12-31$162,368
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$92,926
Value of net assets at end of year (total assets less liabilities)2022-12-31$12,823,464
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$12,730,538
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$7,835
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$4,980,450
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$5,750,717
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$3,091,497
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$3,428,650
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$3,428,650
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$15,356
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$3,783,189
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-976,501
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31Yes
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$4,559,187
Employer contributions (assets) at end of year2022-12-31$1,113,492
Employer contributions (assets) at beginning of year2022-12-31$151,585
Income. Dividends from common stock2022-12-31$38,983
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$1,273
Contract administrator fees2022-12-31$51,917
Assets. Corporate common stocks other than exployer securities at end of year2022-12-31$3,405,398
Assets. Corporate common stocks other than exployer securities at beginning of year2022-12-31$3,253,335
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$53,919
Aggregate carrying amount (costs) on sale of assets2022-12-31$61,183
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31SCHNEIDER DOWNS & CO., INC.
Accountancy firm EIN2022-12-31251408703
2021 : USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$595,095
Total unrealized appreciation/depreciation of assets2021-12-31$595,095
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$24,273
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$5,106,806
Total loss/gain on sale of assets2021-12-31$244,998
Total of all expenses incurred2021-12-31$3,589,931
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$3,411,149
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$4,202,721
Value of total assets at end of year2021-12-31$12,754,811
Value of total assets at beginning of year2021-12-31$11,213,663
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$178,782
Total interest from all sources2021-12-31$182
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$133,716
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$96,869
Administrative expenses professional fees incurred2021-12-31$86,946
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$857,460
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$8,156
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$3,245
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-12-31$24,273
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-12-31$0
Administrative expenses (other) incurred2021-12-31$2,076
Total non interest bearing cash at end of year2021-12-31$162,368
Total non interest bearing cash at beginning of year2021-12-31$70,635
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$1,516,875
Value of net assets at end of year (total assets less liabilities)2021-12-31$12,730,538
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$11,213,663
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$39,795
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$5,750,717
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$5,304,768
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$3,428,650
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$2,962,476
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$2,962,476
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$182
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$3,409,748
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-12-31$-69,906
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31Yes
Was there a failure to transmit to the plan any participant contributions2021-12-31Yes
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$3,345,261
Employer contributions (assets) at end of year2021-12-31$151,585
Employer contributions (assets) at beginning of year2021-12-31$142,228
Income. Dividends from common stock2021-12-31$36,847
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$1,401
Contract administrator fees2021-12-31$49,965
Assets. Corporate common stocks other than exployer securities at end of year2021-12-31$3,253,335
Assets. Corporate common stocks other than exployer securities at beginning of year2021-12-31$2,730,311
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Aggregate proceeds on sale of assets2021-12-31$373,913
Aggregate carrying amount (costs) on sale of assets2021-12-31$128,915
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31SCHNEIDER DOWNS & CO., INC.
Accountancy firm EIN2021-12-31251408703
2020 : USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$409,265
Total unrealized appreciation/depreciation of assets2020-12-31$409,265
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$89,173
Total income from all sources (including contributions)2020-12-31$4,836,723
Total of all expenses incurred2020-12-31$3,355,435
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$3,200,975
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$3,741,580
Value of total assets at end of year2020-12-31$11,213,663
Value of total assets at beginning of year2020-12-31$9,821,548
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$154,460
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$149,543
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$143,941
Administrative expenses professional fees incurred2020-12-31$76,639
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$711,943
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$3,245
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$3,245
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-12-31$89,173
Administrative expenses (other) incurred2020-12-31$3,412
Total non interest bearing cash at end of year2020-12-31$70,635
Total non interest bearing cash at beginning of year2020-12-31$37,657
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$1,481,288
Value of net assets at end of year (total assets less liabilities)2020-12-31$11,213,663
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$9,732,375
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$24,714
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$5,304,768
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$5,068,169
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$2,962,476
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$1,688,044
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$1,688,044
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$3,200,680
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$536,335
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31Yes
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$3,029,637
Employer contributions (assets) at end of year2020-12-31$142,228
Employer contributions (assets) at beginning of year2020-12-31$154,001
Income. Dividends from common stock2020-12-31$5,602
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$295
Contract administrator fees2020-12-31$49,695
Assets. Corporate common stocks other than exployer securities at end of year2020-12-31$2,730,311
Assets. Corporate common stocks other than exployer securities at beginning of year2020-12-31$2,870,432
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31SCHNEIDER DOWNS & CO., INC.
Accountancy firm EIN2020-12-31251408703
2019 : USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$502,876
Total unrealized appreciation/depreciation of assets2019-12-31$502,876
Total transfer of assets to this plan2019-12-31$8,271,658
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$89,173
Total income from all sources (including contributions)2019-12-31$4,635,066
Total of all expenses incurred2019-12-31$3,174,349
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$3,030,934
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$3,610,069
Value of total assets at end of year2019-12-31$9,821,548
Value of total assets at beginning of year2019-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$143,415
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$169,058
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$125,892
Administrative expenses professional fees incurred2019-12-31$78,580
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$517,357
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$3,245
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-12-31$89,173
Administrative expenses (other) incurred2019-12-31$1,308
Total non interest bearing cash at end of year2019-12-31$37,657
Total non interest bearing cash at beginning of year2019-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$1,460,717
Value of net assets at end of year (total assets less liabilities)2019-12-31$9,732,375
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$14,542
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$5,068,169
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$1,688,044
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$3,025,286
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$353,063
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$3,092,712
Employer contributions (assets) at end of year2019-12-31$154,001
Employer contributions (assets) at beginning of year2019-12-31$0
Income. Dividends from common stock2019-12-31$43,166
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$5,648
Contract administrator fees2019-12-31$48,985
Assets. Corporate common stocks other than exployer securities at end of year2019-12-31$2,870,432
Assets. Corporate common stocks other than exployer securities at beginning of year2019-12-31$0
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31SCHNEIDER DOWNS & CO., INC
Accountancy firm EIN2019-12-31251408703

Form 5500 Responses for USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN

2022: USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: USW/YOKOHAMA TIRE RETIREES HEALTH CARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01First time form 5500 has been submittedYes
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number19955
Policy instance 3
Insurance contract or identification number19955
Number of Individuals Covered732
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $26,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number00067106345
Policy instance 2
Insurance contract or identification number00067106345
Number of Individuals Covered106
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $249,764
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number031500
Policy instance 1
Insurance contract or identification number031500
Number of Individuals Covered443
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $966,244
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number19955
Policy instance 3
Insurance contract or identification number19955
Number of Individuals Covered724
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE467297
Policy instance 2
Insurance contract or identification numberAE467297
Number of Individuals Covered111
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $246,550
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number031500
Policy instance 1
Insurance contract or identification number031500
Number of Individuals Covered420
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $946,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number19955
Policy instance 3
Insurance contract or identification number19955
Number of Individuals Covered699
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,846
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE467297
Policy instance 2
Insurance contract or identification numberAE467297
Number of Individuals Covered122
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $268,278
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number031500
Policy instance 1
Insurance contract or identification number031500
Number of Individuals Covered409
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,073,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )
Policy contract number19955
Policy instance 3
Insurance contract or identification number19955
Number of Individuals Covered686
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $24,776
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberAE467297
Policy instance 2
Insurance contract or identification numberAE467297
Number of Individuals Covered146
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $252,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number031500
Policy instance 1
Insurance contract or identification number031500
Number of Individuals Covered387
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $849,457
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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