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HEALTH PLAN FOR HOURLY EMPLOYEES 401k Plan overview

Plan NameHEALTH PLAN FOR HOURLY EMPLOYEES
Plan identification number 513

HEALTH PLAN FOR HOURLY EMPLOYEES Benefits

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

401k Sponsoring company profile

NUCLEAR FUEL SERVICES, INC. C/O COMPENSATION & BENEFITS DEPT. has sponsored the creation of one or more 401k plans.

Company Name:NUCLEAR FUEL SERVICES, INC. C/O COMPENSATION & BENEFITS DEPT.
Employer identification number (EIN):520788632
NAIC Classification:325900
NAIC Description:Other Chemical Product and Preparation Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan HEALTH PLAN FOR HOURLY EMPLOYEES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5132016-01-01ROSS WILTZIUS
5132016-01-01ROSS WILTZIUS
5132015-01-01ROSS WILTZIUS
5132014-01-01ROCHELLE WALD
5132013-01-01ROCHELLE WALD
5132012-01-01ROBERT BIRMINGHAM ROBERT BIRMINGHAM2013-10-15
5132011-01-01R. C. BIRMINGHAM, III R. C. BIRMINGHAM, III2012-10-16
5132010-01-01R. C. BIRMINGHAM, III R. C. BIRMINGHAM, III2011-10-18
5132009-01-01R. C. BIRMINGHAM, III R. C. BIRMINGHAM, III2010-10-15

Plan Statistics for HEALTH PLAN FOR HOURLY EMPLOYEES

401k plan membership statisitcs for HEALTH PLAN FOR HOURLY EMPLOYEES

Measure Date Value
2016: HEALTH PLAN FOR HOURLY EMPLOYEES 2016 401k membership
Total participants, beginning-of-year2016-01-01432
Total number of active participants reported on line 7a of the Form 55002016-01-0151
Number of retired or separated participants receiving benefits2016-01-01149
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01200
2015: HEALTH PLAN FOR HOURLY EMPLOYEES 2015 401k membership
Total participants, beginning-of-year2015-01-01438
Total number of active participants reported on line 7a of the Form 55002015-01-01295
Number of retired or separated participants receiving benefits2015-01-01137
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01432
2014: HEALTH PLAN FOR HOURLY EMPLOYEES 2014 401k membership
Total participants, beginning-of-year2014-01-01570
Total number of active participants reported on line 7a of the Form 55002014-01-01311
Number of retired or separated participants receiving benefits2014-01-01251
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01562
2013: HEALTH PLAN FOR HOURLY EMPLOYEES 2013 401k membership
Total participants, beginning-of-year2013-01-01572
Total number of active participants reported on line 7a of the Form 55002013-01-01237
Number of retired or separated participants receiving benefits2013-01-01291
Total of all active and inactive participants2013-01-01528
2012: HEALTH PLAN FOR HOURLY EMPLOYEES 2012 401k membership
Total participants, beginning-of-year2012-01-01580
Total number of active participants reported on line 7a of the Form 55002012-01-01307
Number of retired or separated participants receiving benefits2012-01-01265
Total of all active and inactive participants2012-01-01572
2011: HEALTH PLAN FOR HOURLY EMPLOYEES 2011 401k membership
Total participants, beginning-of-year2011-01-01579
Total number of active participants reported on line 7a of the Form 55002011-01-01310
Number of retired or separated participants receiving benefits2011-01-01270
Total of all active and inactive participants2011-01-01580
2010: HEALTH PLAN FOR HOURLY EMPLOYEES 2010 401k membership
Total participants, beginning-of-year2010-01-01583
Total number of active participants reported on line 7a of the Form 55002010-01-01314
Number of retired or separated participants receiving benefits2010-01-01265
Total of all active and inactive participants2010-01-01579
2009: HEALTH PLAN FOR HOURLY EMPLOYEES 2009 401k membership
Total participants, beginning-of-year2009-01-01586
Total number of active participants reported on line 7a of the Form 55002009-01-01319
Number of retired or separated participants receiving benefits2009-01-01264
Total of all active and inactive participants2009-01-01583
Total participants2009-01-010

Financial Data on HEALTH PLAN FOR HOURLY EMPLOYEES

Measure Date Value
2016 : HEALTH PLAN FOR HOURLY EMPLOYEES 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total transfer of assets from this plan2016-12-31$21,635,948
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$507,297
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$635,211
Total income from all sources (including contributions)2016-12-31$6,444,361
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$5,521,553
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$5,302,014
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$4,556,957
Value of total assets at end of year2016-12-31$22,143,245
Value of total assets at beginning of year2016-12-31$21,348,351
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$219,539
Total interest from all sources2016-12-31$2,492
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$525,924
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$525,924
Administrative expenses professional fees incurred2016-12-31$26,500
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$15,000,000
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$889,656
Participant contributions at end of year2016-12-31$13,463
Participant contributions at beginning of year2016-12-31$8,883
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$66,619
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$183
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Other income not declared elsewhere2016-12-31$12
Administrative expenses (other) incurred2016-12-31$143,707
Liabilities. Value of operating payables at end of year2016-12-31$47,377
Liabilities. Value of operating payables at beginning of year2016-12-31$205,719
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$922,808
Value of net assets at end of year (total assets less liabilities)2016-12-31$21,635,948
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$20,713,140
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$35,679
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$21,182,131
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$20,387,842
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$881,032
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$951,443
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$951,443
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$2,492
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$1,019,702
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$1,358,976
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$3,667,301
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$4,282,312
Contract administrator fees2016-12-31$13,653
Liabilities. Value of benefit claims payable at end of year2016-12-31$459,920
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$429,492
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31L. J.MOSBY, P. C.
Accountancy firm EIN2016-12-31841656069
2015 : HEALTH PLAN FOR HOURLY EMPLOYEES 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$635,211
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$494,028
Total income from all sources (including contributions)2015-12-31$4,279,434
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$5,043,418
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$4,762,184
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$4,114,736
Value of total assets at end of year2015-12-31$21,348,351
Value of total assets at beginning of year2015-12-31$21,971,152
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$281,234
Total interest from all sources2015-12-31$895
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$510,703
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$510,703
Administrative expenses professional fees incurred2015-12-31$27,738
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$15,000,000
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$838,460
Participant contributions at end of year2015-12-31$8,883
Participant contributions at beginning of year2015-12-31$37,239
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$183
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$61,670
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$17,461
Other income not declared elsewhere2015-12-31$9,046
Liabilities. Value of operating payables at end of year2015-12-31$205,719
Liabilities. Value of operating payables at beginning of year2015-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-763,984
Value of net assets at end of year (total assets less liabilities)2015-12-31$20,713,140
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$21,477,124
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$33,600
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$20,387,842
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$21,626,553
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$951,443
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$245,690
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$245,690
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$895
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$968,088
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-355,946
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$3,276,276
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$3,794,096
Contract administrator fees2015-12-31$219,896
Liabilities. Value of benefit claims payable at end of year2015-12-31$429,492
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$476,567
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31L. J.MOSBY, P. C.
Accountancy firm EIN2015-12-31841656069
2014 : HEALTH PLAN FOR HOURLY EMPLOYEES 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$494,028
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$724,891
Total income from all sources (including contributions)2014-12-31$5,953,548
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$5,093,328
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$4,814,419
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$4,164,085
Value of total assets at end of year2014-12-31$21,971,152
Value of total assets at beginning of year2014-12-31$21,341,795
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$278,909
Total interest from all sources2014-12-31$195
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$592,246
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$592,246
Administrative expenses professional fees incurred2014-12-31$44,799
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$15,000,000
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$811,596
Participant contributions at end of year2014-12-31$37,239
Participant contributions at beginning of year2014-12-31$31,466
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$5,010
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$61,670
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$24
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$17,461
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$0
Administrative expenses (other) incurred2014-12-31$8,205
Liabilities. Value of operating payables at end of year2014-12-31$0
Liabilities. Value of operating payables at beginning of year2014-12-31$285,462
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$860,220
Value of net assets at end of year (total assets less liabilities)2014-12-31$21,477,124
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$20,616,904
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$21,626,553
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$21,310,305
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$245,690
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$195
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$925,793
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$1,197,022
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$3,347,479
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$3,888,626
Contract administrator fees2014-12-31$225,905
Liabilities. Value of benefit claims payable at end of year2014-12-31$476,567
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$439,429
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31L. J.MOSBY, P. C.
Accountancy firm EIN2014-12-31841656069
2013 : HEALTH PLAN FOR HOURLY EMPLOYEES 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$724,891
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$156,413
Total income from all sources (including contributions)2013-12-31$6,939,906
Total loss/gain on sale of assets2013-12-31$1,407,491
Total of all expenses incurred2013-12-31$5,727,206
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$5,425,681
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$4,576,043
Value of total assets at end of year2013-12-31$21,341,795
Value of total assets at beginning of year2013-12-31$19,560,617
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$301,525
Total interest from all sources2013-12-31$797
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$408,305
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$343,582
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$738,720
Participant contributions at end of year2013-12-31$31,466
Participant contributions at beginning of year2013-12-31$27,927
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$6,890
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$24
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$101,559
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$68,815
Other income not declared elsewhere2013-12-31$-16,529
Liabilities. Value of operating payables at end of year2013-12-31$285,462
Liabilities. Value of operating payables at beginning of year2013-12-31$87,598
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$1,212,700
Value of net assets at end of year (total assets less liabilities)2013-12-31$20,616,904
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$19,404,204
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$21,310,305
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$9,083,515
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$1,786,068
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$1,786,068
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$797
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$862,473
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$563,799
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$3,830,433
Income. Dividends from common stock2013-12-31$64,723
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$4,563,208
Contract administrator fees2013-12-31$301,525
Assets. Corporate common stocks other than exployer securities at beginning of year2013-12-31$8,561,548
Liabilities. Value of benefit claims payable at end of year2013-12-31$439,429
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Aggregate proceeds on sale of assets2013-12-31$15,979,097
Aggregate carrying amount (costs) on sale of assets2013-12-31$14,571,606
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31L. J.MOSBY, P. C.
Accountancy firm EIN2013-12-31841656069
2012 : HEALTH PLAN FOR HOURLY EMPLOYEES 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$1,060,525
Total unrealized appreciation/depreciation of assets2012-12-31$1,060,525
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$156,413
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$182,516
Total income from all sources (including contributions)2012-12-31$6,437,803
Total loss/gain on sale of assets2012-12-31$277,686
Total of all expenses incurred2012-12-31$4,675,927
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$3,529,864
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$4,619,164
Value of total assets at end of year2012-12-31$19,560,617
Value of total assets at beginning of year2012-12-31$17,824,844
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$1,146,063
Total interest from all sources2012-12-31$2,409
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$129,696
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$10,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$661,640
Participant contributions at end of year2012-12-31$27,927
Participant contributions at beginning of year2012-12-31$20,130
Income. Received or receivable in cash from other sources (including rollovers)2012-12-31$15,334
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$101,559
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$34,842
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$68,815
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$53,320
Liabilities. Value of operating payables at end of year2012-12-31$87,598
Liabilities. Value of operating payables at beginning of year2012-12-31$129,196
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$1,761,876
Value of net assets at end of year (total assets less liabilities)2012-12-31$19,404,204
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$17,642,328
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Investment advisory and management fees2012-12-31$25,741
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$9,083,515
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$8,250,462
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$1,786,068
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$1,604,285
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$1,604,285
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$2,409
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$3,529,864
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$348,323
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$3,942,190
Employer contributions (assets) at beginning of year2012-12-31$438,280
Income. Dividends from common stock2012-12-31$129,696
Contract administrator fees2012-12-31$1,120,322
Assets. Corporate common stocks other than exployer securities at end of year2012-12-31$8,561,548
Assets. Corporate common stocks other than exployer securities at beginning of year2012-12-31$7,476,845
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$3,121,145
Aggregate carrying amount (costs) on sale of assets2012-12-31$2,843,459
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31LC MOSBY, P. C.
Accountancy firm EIN2012-12-31841656069
2011 : HEALTH PLAN FOR HOURLY EMPLOYEES 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$-192,618
Total unrealized appreciation/depreciation of assets2011-12-31$-192,618
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$182,516
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$338,447
Total income from all sources (including contributions)2011-12-31$4,384,692
Total loss/gain on sale of assets2011-12-31$350,183
Total of all expenses incurred2011-12-31$4,045,448
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$2,975,327
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$3,825,351
Value of total assets at end of year2011-12-31$17,824,844
Value of total assets at beginning of year2011-12-31$17,641,531
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$1,070,121
Total interest from all sources2011-12-31$2,301
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$83,044
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$610,064
Participant contributions at end of year2011-12-31$20,130
Participant contributions at beginning of year2011-12-31$22,643
Income. Received or receivable in cash from other sources (including rollovers)2011-12-31$7,530
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$34,842
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$16,549
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$53,320
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$23,732
Liabilities. Value of operating payables at end of year2011-12-31$129,196
Liabilities. Value of operating payables at beginning of year2011-12-31$314,715
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$339,244
Value of net assets at end of year (total assets less liabilities)2011-12-31$17,642,328
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$17,303,084
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Investment advisory and management fees2011-12-31$47,584
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$8,250,462
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$7,925,801
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$1,604,285
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$1,783,180
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$1,783,180
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$2,301
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$2,975,327
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$316,431
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$3,207,757
Employer contributions (assets) at end of year2011-12-31$438,280
Employer contributions (assets) at beginning of year2011-12-31$219,140
Income. Dividends from common stock2011-12-31$83,044
Contract administrator fees2011-12-31$1,022,537
Assets. Corporate common stocks other than exployer securities at end of year2011-12-31$7,476,845
Assets. Corporate common stocks other than exployer securities at beginning of year2011-12-31$7,674,218
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$6,599,743
Aggregate carrying amount (costs) on sale of assets2011-12-31$6,249,560
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31PUGH & COMPANY, P.C.
Accountancy firm EIN2011-12-31621142155
2010 : HEALTH PLAN FOR HOURLY EMPLOYEES 2010 401k financial data
Unrealized appreciation/depreciation of real estate assets2010-12-31$647,080
Total unrealized appreciation/depreciation of assets2010-12-31$647,080
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$338,447
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$152,490
Total income from all sources (including contributions)2010-12-31$5,170,624
Total loss/gain on sale of assets2010-12-31$510,314
Total of all expenses incurred2010-12-31$3,610,126
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$2,674,694
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$3,670,571
Value of total assets at end of year2010-12-31$17,641,531
Value of total assets at beginning of year2010-12-31$15,895,076
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$935,432
Total interest from all sources2010-12-31$1,638
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$98,575
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$10,000,000
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$584,844
Participant contributions at end of year2010-12-31$22,643
Participant contributions at beginning of year2010-12-31$20,260
Income. Received or receivable in cash from other sources (including rollovers)2010-12-31$8,297
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$16,549
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$3,020
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$23,732
Liabilities. Value of operating payables at end of year2010-12-31$314,715
Liabilities. Value of operating payables at beginning of year2010-12-31$152,490
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$1,560,498
Value of net assets at end of year (total assets less liabilities)2010-12-31$17,303,084
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$15,742,586
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Investment advisory and management fees2010-12-31$23,877
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$7,925,801
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$7,287,605
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$1,783,180
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$1,743,816
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$1,743,816
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$1,638
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$2,674,694
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$242,446
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$3,077,430
Employer contributions (assets) at end of year2010-12-31$219,140
Income. Dividends from common stock2010-12-31$98,575
Contract administrator fees2010-12-31$911,555
Assets. Corporate common stocks other than exployer securities at end of year2010-12-31$7,674,218
Assets. Corporate common stocks other than exployer securities at beginning of year2010-12-31$6,840,375
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Aggregate proceeds on sale of assets2010-12-31$9,757,864
Aggregate carrying amount (costs) on sale of assets2010-12-31$9,247,550
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31PUGH & COMPANY, P.C.
Accountancy firm EIN2010-12-31621142155

Form 5500 Responses for HEALTH PLAN FOR HOURLY EMPLOYEES

2016: HEALTH PLAN FOR HOURLY EMPLOYEES 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: HEALTH PLAN FOR HOURLY EMPLOYEES 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: HEALTH PLAN FOR HOURLY EMPLOYEES 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: HEALTH PLAN FOR HOURLY EMPLOYEES 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: HEALTH PLAN FOR HOURLY EMPLOYEES 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: HEALTH PLAN FOR HOURLY EMPLOYEES 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: HEALTH PLAN FOR HOURLY EMPLOYEES 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedYes
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planYes
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: HEALTH PLAN FOR HOURLY EMPLOYEES 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL31629
Policy instance 2
Insurance contract or identification numberHCL31629
Number of Individuals Covered340
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $43,440
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $225,661
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,849
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FIN SERVICES INC
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract numberH4456-3904
Policy instance 3
Insurance contract or identification numberH4456-3904
Number of Individuals Covered217
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $13,001
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $717,897
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $13,001
Insurance broker organization code?3
Insurance broker namePRICHARD AND JERDEN INC.
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract numberH4456-3903
Policy instance 1
Insurance contract or identification numberH4456-3903
Number of Individuals Covered8
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $413
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $24,530
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $413
Insurance broker organization code?3
Insurance broker namePRITCHARD AND JERDEN INC.
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number404001 0010SSLS
Policy instance 2
Insurance contract or identification number404001 0010SSLS
Number of Individuals Covered352
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $35,262
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $235,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $35,262
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS FNCL
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract numberH4456-3903
Policy instance 1
Insurance contract or identification numberH4456-3903
Number of Individuals Covered6
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $260
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,497
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $260
Insurance broker organization code?3
Insurance broker namePRITCHARD & JERDEN
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract numberH4456-3904
Policy instance 3
Insurance contract or identification numberH4456-3904
Number of Individuals Covered212
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $12,778
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $696,425
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,778
Insurance broker organization code?3
Insurance broker namePRICHARD & JERDEN
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number4041 0010 SLA
Policy instance 2
Insurance contract or identification number4041 0010 SLA
Number of Individuals Covered365
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $16,937
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $202,158
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,937
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS FNCL
UNITED HEALTHCARE SERVICES COMPANY (National Association of Insurance Commissioners NAIC id number: 70254 )
Policy contract numberH4456
Policy instance 1
Insurance contract or identification numberH4456
Number of Individuals Covered751
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $641,868
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract number17019/17020
Policy instance 3
Insurance contract or identification number17019/17020
Number of Individuals Covered211
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $17,297
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number502
Policy instance 1
Insurance contract or identification number502
Number of Individuals Covered322
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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 $12,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract number17019/17020
Policy instance 4
Insurance contract or identification number17019/17020
Number of Individuals Covered212
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
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 $22,770
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE SERVICES COMPANY (National Association of Insurance Commissioners NAIC id number: 70254 )
Policy contract number
Policy instance 3
Number of Individuals Covered839
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $176,325
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number404001 0010 SLA
Policy instance 2
Insurance contract or identification number404001 0010 SLA
Number of Individuals Covered368
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $25,994
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $173,296
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $25,994
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INSURANCE
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberUHIC-102661
Policy instance 3
Insurance contract or identification numberUHIC-102661
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract number
Policy instance 2
Number of Individuals Covered818
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,072,055
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number502
Policy instance 1
Insurance contract or identification number502
Number of Individuals Covered331
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
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 $12,521
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract number17019/17020
Policy instance 4
Insurance contract or identification number17019/17020
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract number17019/17020
Policy instance 5
Insurance contract or identification number17019/17020
Number of Individuals Covered196
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
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 $619,818
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED HEALTHCARE (National Association of Insurance Commissioners NAIC id number: 95378 )
Policy contract number
Policy instance 3
Number of Individuals Covered842
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $2,862,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
NATIONAL GUARDIAN LIFE (National Association of Insurance Commissioners NAIC id number: 66583 )
Policy contract number27343
Policy instance 2
Insurance contract or identification number27343
Number of Individuals Covered244
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $1,628
Total amount of fees paid to insurance companyUSD $0
Vision Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $21,334
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MERITAIN HEALTH (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number502
Policy instance 1
Insurance contract or identification number502
Number of Individuals Covered336
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
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 $12,096
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract numberUHIC-102661
Policy instance 4
Insurance contract or identification numberUHIC-102661
Number of Individuals Covered389
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $36,837
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $184,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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