ALLEGHENY CONTRACTING, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN
| Measure | Date | Value |
|---|
| 2023 : ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN 2023 401k financial data |
|---|
| Total plan liabilities at end of year | 2023-12-31 | $135,913 |
| Total plan liabilities at beginning of year | 2023-12-31 | $114,916 |
| Total income from all sources | 2023-12-31 | $1,188,787 |
| Expenses. Total of all expenses incurred | 2023-12-31 | $1,092,875 |
| Benefits paid (including direct rollovers) | 2023-12-31 | $641,784 |
| Total plan assets at end of year | 2023-12-31 | $138,500 |
| Total plan assets at beginning of year | 2023-12-31 | $21,591 |
| Value of fidelity bond covering the plan | 2023-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2023-12-31 | $238,190 |
| Expenses. Other expenses not covered elsewhere | 2023-12-31 | $416,203 |
| Contributions received from other sources (not participants or employers) | 2023-12-31 | $0 |
| Other income received | 2023-12-31 | $2,530 |
| Net income (gross income less expenses) | 2023-12-31 | $95,912 |
| Net plan assets at end of year (total assets less liabilities) | 2023-12-31 | $2,587 |
| Net plan assets at beginning of year (total assets less liabilities) | 2023-12-31 | $-93,325 |
| Total contributions received or receivable from employer(s) | 2023-12-31 | $948,067 |
| Value of corrective distributions | 2023-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2023-12-31 | $34,888 |
| 2022 : ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $114,916 |
| Total plan liabilities at beginning of year | 2022-12-31 | $94,992 |
| Total income from all sources | 2022-12-31 | $967,724 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $1,018,091 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $639,065 |
| Total plan assets at end of year | 2022-12-31 | $21,591 |
| Total plan assets at beginning of year | 2022-12-31 | $52,034 |
| Value of fidelity bond covering the plan | 2022-12-31 | $46,185 |
| Total contributions received or receivable from participants | 2022-12-31 | $258,919 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $346,271 |
| Contributions received from other sources (not participants or employers) | 2022-12-31 | $1,619 |
| Other income received | 2022-12-31 | $128 |
| Net income (gross income less expenses) | 2022-12-31 | $-50,367 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $-93,325 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $-42,958 |
| Total contributions received or receivable from employer(s) | 2022-12-31 | $707,058 |
| Value of corrective distributions | 2022-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $32,755 |
| 2021 : ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $94,992 |
| Total plan liabilities at beginning of year | 2021-12-31 | $51,579 |
| Total income from all sources | 2021-12-31 | $1,008,053 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $1,060,428 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $658,601 |
| Total plan assets at end of year | 2021-12-31 | $52,034 |
| Total plan assets at beginning of year | 2021-12-31 | $60,996 |
| Value of fidelity bond covering the plan | 2021-12-31 | $46,185 |
| Total contributions received or receivable from participants | 2021-12-31 | $284,264 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $352,209 |
| Contributions received from other sources (not participants or employers) | 2021-12-31 | $5,111 |
| Other income received | 2021-12-31 | $146 |
| Net income (gross income less expenses) | 2021-12-31 | $-52,375 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $-42,958 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $9,417 |
| Total contributions received or receivable from employer(s) | 2021-12-31 | $718,532 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $49,618 |
| 2020 : ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $51,579 |
| Total plan liabilities at beginning of year | 2020-12-31 | $54,506 |
| Total income from all sources | 2020-12-31 | $72,962 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $60,221 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $32,380 |
| Total plan assets at end of year | 2020-12-31 | $60,996 |
| Total plan assets at beginning of year | 2020-12-31 | $51,182 |
| Value of fidelity bond covering the plan | 2020-12-31 | $46,185 |
| Total contributions received or receivable from participants | 2020-12-31 | $23,818 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $24,641 |
| Contributions received from other sources (not participants or employers) | 2020-12-31 | $0 |
| Other income received | 2020-12-31 | $17 |
| Net income (gross income less expenses) | 2020-12-31 | $12,741 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $9,417 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $-3,324 |
| Total contributions received or receivable from employer(s) | 2020-12-31 | $49,127 |
| Value of corrective distributions | 2020-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $3,200 |
| Total plan liabilities at end of year | 2020-11-30 | $54,506 |
| Total plan liabilities at beginning of year | 2020-11-30 | $0 |
| Total income from all sources | 2020-11-30 | $915,071 |
| Expenses. Total of all expenses incurred | 2020-11-30 | $918,395 |
| Benefits paid (including direct rollovers) | 2020-11-30 | $570,522 |
| Total plan assets at end of year | 2020-11-30 | $51,182 |
| Total plan assets at beginning of year | 2020-11-30 | $0 |
| Value of fidelity bond covering the plan | 2020-11-30 | $46,185 |
| Total contributions received or receivable from participants | 2020-11-30 | $273,348 |
| Expenses. Other expenses not covered elsewhere | 2020-11-30 | $311,773 |
| Contributions received from other sources (not participants or employers) | 2020-11-30 | $0 |
| Other income received | 2020-11-30 | $147 |
| Net income (gross income less expenses) | 2020-11-30 | $-3,324 |
| Net plan assets at end of year (total assets less liabilities) | 2020-11-30 | $-3,324 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-11-30 | $0 |
| Total contributions received or receivable from employer(s) | 2020-11-30 | $641,576 |
| Value of corrective distributions | 2020-11-30 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-11-30 | $36,100 |
| 2023: ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – Trust | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement - Trust | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN 2020 form 5500 responses |
|---|
| 2020-12-01 | Type of plan entity | Single employer plan |
| 2020-12-01 | Submission has been amended | No |
| 2020-12-01 | This submission is the final filing | No |
| 2020-12-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2020-12-01 | Plan is a collectively bargained plan | No |
| 2020-12-01 | Plan funding arrangement – Insurance | Yes |
| 2020-12-01 | Plan funding arrangement – Trust | Yes |
| 2020-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-12-01 | Plan benefit arrangement - Trust | Yes |
| 2019: ALLEGHENY CONTRACTING, LLC EMPLOYEE BENEFIT PLAN 2019 form 5500 responses |
|---|
| 2019-12-01 | Type of plan entity | Single employer plan |
| 2019-12-01 | First time form 5500 has been submitted | Yes |
| 2019-12-01 | Submission has been amended | No |
| 2019-12-01 | This submission is the final filing | No |
| 2019-12-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-12-01 | Plan is a collectively bargained plan | No |
| 2019-12-01 | Plan funding arrangement – Insurance | Yes |
| 2019-12-01 | Plan funding arrangement – Trust | Yes |
| 2019-12-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-12-01 | Plan benefit arrangement - Trust | Yes |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 7118 |
| Policy instance | 5 |
| Insurance contract or identification number | 7118 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 007869 |
| Policy instance | 4 |
| Insurance contract or identification number | 007869 | | Number of Individuals Covered | 107 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $2,393 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $52,309 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 827946 |
| Policy instance | 3 |
| Insurance contract or identification number | 827946 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT, CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 063137 |
| Policy instance | 2 |
| Insurance contract or identification number | 063137 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $4,554 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $41,926 | | 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 number | 408041-A |
| Policy instance | 1 |
| Insurance contract or identification number | 408041-A | | Number of Individuals Covered | 83 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $364,129 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 827946 |
| Policy instance | 3 |
| Insurance contract or identification number | 827946 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,195 | | Total amount of fees paid to insurance company | USD $326 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $14,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 16610 |
| Policy instance | 4 |
| Insurance contract or identification number | 16610 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $11,949 | | Total amount of fees paid to insurance company | USD $1,994 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D, VOL LIFE & AD&D; CHILD, SPOUSE, EMPLOYEE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $49,788 | | 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 number | 408041 |
| Policy instance | 5 |
| Insurance contract or identification number | 408041 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $300,324 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 802698 |
| Policy instance | 6 |
| Insurance contract or identification number | 802698 | | Number of Individuals Covered | 89 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $2,424 | | Total amount of fees paid to insurance company | USD $315 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | VOLUNTARY CRITICAL ILLNESS | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $16,159 | | 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 number | 0000064488 |
| Policy instance | 2 |
| Insurance contract or identification number | 0000064488 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $4,712 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $52,724 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | SL30500511 |
| Policy instance | 1 |
| Insurance contract or identification number | SL30500511 | | Number of Individuals Covered | 76 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $-2,063 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 16610 |
| Policy instance | 4 |
| RELIANCE STANDARD (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | 16610 |
| Policy instance | 3 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 0000064488 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | SL30500511 |
| Policy instance | 1 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | SL30500511 |
| Policy instance | 1 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 0000064488 |
| Policy instance | 2 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F0222961 |
| Policy instance | 3 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F0222961 |
| Policy instance | 3 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 0000064488 |
| Policy instance | 2 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | SL30500511 |
| Policy instance | 1 |
