BOARD OF TRUSTEES - ATLANTIC COAST HEALTH PLAN has sponsored the creation of one or more 401k plans.
| Measure | Date | Value |
|---|
| 2021: ATLANTIC COAST HEALTH PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-07-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-07-01 | 38 |
| Number of retired or separated participants receiving benefits | 2021-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2021-07-01 | 0 |
| Total of all active and inactive participants | 2021-07-01 | 38 |
| Number of employers contributing to the scheme | 2021-07-01 | 2 |
| 2020: ATLANTIC COAST HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-07-01 | 57 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-07-01 | 45 |
| Number of retired or separated participants receiving benefits | 2020-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-07-01 | 0 |
| Total of all active and inactive participants | 2020-07-01 | 45 |
| Number of employers contributing to the scheme | 2020-07-01 | 4 |
| 2019: ATLANTIC COAST HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-07-01 | 55 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-07-01 | 57 |
| Number of retired or separated participants receiving benefits | 2019-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-07-01 | 0 |
| Total of all active and inactive participants | 2019-07-01 | 57 |
| Number of employers contributing to the scheme | 2019-07-01 | 4 |
| 2018: ATLANTIC COAST HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-07-01 | 55 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-07-01 | 55 |
| Number of retired or separated participants receiving benefits | 2018-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2018-07-01 | 0 |
| Total of all active and inactive participants | 2018-07-01 | 55 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2018-07-01 | 0 |
| Total participants | 2018-07-01 | 55 |
| Number of employers contributing to the scheme | 2018-07-01 | 3 |
| 2017: ATLANTIC COAST HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-07-01 | 54 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-07-01 | 55 |
| Number of retired or separated participants receiving benefits | 2017-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-07-01 | 0 |
| Total of all active and inactive participants | 2017-07-01 | 55 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2017-07-01 | 0 |
| Total participants | 2017-07-01 | 55 |
| Number of employers contributing to the scheme | 2017-07-01 | 3 |
| 2016: ATLANTIC COAST HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-07-01 | 56 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-07-01 | 54 |
| Number of retired or separated participants receiving benefits | 2016-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2016-07-01 | 0 |
| Total of all active and inactive participants | 2016-07-01 | 54 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2016-07-01 | 0 |
| Total participants | 2016-07-01 | 54 |
| Number of employers contributing to the scheme | 2016-07-01 | 3 |
| 2015: ATLANTIC COAST HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-07-01 | 57 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-07-01 | 56 |
| Number of retired or separated participants receiving benefits | 2015-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-07-01 | 0 |
| Total of all active and inactive participants | 2015-07-01 | 56 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2015-07-01 | 0 |
| Total participants | 2015-07-01 | 56 |
| Number of employers contributing to the scheme | 2015-07-01 | 3 |
| 2014: ATLANTIC COAST HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-07-01 | 59 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-07-01 | 57 |
| Number of retired or separated participants receiving benefits | 2014-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-07-01 | 0 |
| Total of all active and inactive participants | 2014-07-01 | 57 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2014-07-01 | 0 |
| Total participants | 2014-07-01 | 57 |
| Number of employers contributing to the scheme | 2014-07-01 | 4 |
| 2013: ATLANTIC COAST HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-07-01 | 81 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-07-01 | 59 |
| Number of retired or separated participants receiving benefits | 2013-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-07-01 | 0 |
| Total of all active and inactive participants | 2013-07-01 | 59 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2013-07-01 | 0 |
| Total participants | 2013-07-01 | 59 |
| Number of employers contributing to the scheme | 2013-07-01 | 3 |
| 2012: ATLANTIC COAST HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-07-01 | 91 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-07-01 | 81 |
| Number of retired or separated participants receiving benefits | 2012-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2012-07-01 | 0 |
| Total of all active and inactive participants | 2012-07-01 | 81 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2012-07-01 | 0 |
| Total participants | 2012-07-01 | 81 |
| Number of employers contributing to the scheme | 2012-07-01 | 2 |
| 2011: ATLANTIC COAST HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-07-01 | 83 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-07-01 | 91 |
| Number of retired or separated participants receiving benefits | 2011-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-07-01 | 0 |
| Total of all active and inactive participants | 2011-07-01 | 91 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2011-07-01 | 0 |
| Total participants | 2011-07-01 | 91 |
| Number of employers contributing to the scheme | 2011-07-01 | 2 |
| 2010: ATLANTIC COAST HEALTH PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-07-01 | 230 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-07-01 | 83 |
| Number of retired or separated participants receiving benefits | 2010-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-07-01 | 0 |
| Total of all active and inactive participants | 2010-07-01 | 83 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-07-01 | 0 |
| Total participants | 2010-07-01 | 83 |
| Number of employers contributing to the scheme | 2010-07-01 | 3 |
| 2009: ATLANTIC COAST HEALTH PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-07-01 | 290 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-07-01 | 230 |
| Number of retired or separated participants receiving benefits | 2009-07-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-07-01 | 0 |
| Total of all active and inactive participants | 2009-07-01 | 230 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2009-07-01 | 0 |
| Total participants | 2009-07-01 | 230 |
| Number of employers contributing to the scheme | 2009-07-01 | 3 |
| Measure | Date | Value |
|---|
| 2022 : ATLANTIC COAST HEALTH PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-06-30 | $82,225 |
| Total plan liabilities at beginning of year | 2022-06-30 | $88,371 |
| Total income from all sources | 2022-06-30 | $955,066 |
| Expenses. Total of all expenses incurred | 2022-06-30 | $970,252 |
| Benefits paid (including direct rollovers) | 2022-06-30 | $759,454 |
| Total plan assets at end of year | 2022-06-30 | $3,099,612 |
| Total plan assets at beginning of year | 2022-06-30 | $3,120,944 |
| Value of fidelity bond covering the plan | 2022-06-30 | $350,000 |
| Total contributions received or receivable from participants | 2022-06-30 | $10,400 |
| Expenses. Other expenses not covered elsewhere | 2022-06-30 | $80,858 |
| Other income received | 2022-06-30 | $80,952 |
| Net income (gross income less expenses) | 2022-06-30 | $-15,186 |
| Net plan assets at end of year (total assets less liabilities) | 2022-06-30 | $3,017,387 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-06-30 | $3,032,573 |
| Total contributions received or receivable from employer(s) | 2022-06-30 | $863,714 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-06-30 | $129,940 |
| 2021 : ATLANTIC COAST HEALTH PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-06-30 | $88,371 |
| Total plan liabilities at beginning of year | 2021-06-30 | $93,142 |
| Total income from all sources | 2021-06-30 | $1,141,567 |
| Expenses. Total of all expenses incurred | 2021-06-30 | $947,077 |
| Benefits paid (including direct rollovers) | 2021-06-30 | $727,296 |
| Total plan assets at end of year | 2021-06-30 | $3,120,944 |
| Total plan assets at beginning of year | 2021-06-30 | $2,931,225 |
| Value of fidelity bond covering the plan | 2021-06-30 | $350,000 |
| Expenses. Other expenses not covered elsewhere | 2021-06-30 | $96,014 |
| Other income received | 2021-06-30 | $69,176 |
| Net income (gross income less expenses) | 2021-06-30 | $194,490 |
| Net plan assets at end of year (total assets less liabilities) | 2021-06-30 | $3,032,573 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-06-30 | $2,838,083 |
| Total contributions received or receivable from employer(s) | 2021-06-30 | $1,072,391 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-06-30 | $123,767 |
| 2020 : ATLANTIC COAST HEALTH PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-06-30 | $93,142 |
| Total plan liabilities at beginning of year | 2020-06-30 | $154,700 |
| Total income from all sources | 2020-06-30 | $1,137,777 |
| Expenses. Total of all expenses incurred | 2020-06-30 | $979,466 |
| Benefits paid (including direct rollovers) | 2020-06-30 | $757,641 |
| Total plan assets at end of year | 2020-06-30 | $2,931,225 |
| Total plan assets at beginning of year | 2020-06-30 | $2,834,472 |
| Value of fidelity bond covering the plan | 2020-06-30 | $350,000 |
| Expenses. Other expenses not covered elsewhere | 2020-06-30 | $14,974 |
| Other income received | 2020-06-30 | $109,755 |
| Net income (gross income less expenses) | 2020-06-30 | $158,311 |
| Net plan assets at end of year (total assets less liabilities) | 2020-06-30 | $2,838,083 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-06-30 | $2,679,772 |
| Total contributions received or receivable from employer(s) | 2020-06-30 | $1,028,022 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-06-30 | $206,851 |
| 2019 : ATLANTIC COAST HEALTH PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-06-30 | $154,700 |
| Total plan liabilities at beginning of year | 2019-06-30 | $119,980 |
| Total income from all sources | 2019-06-30 | $1,035,616 |
| Expenses. Total of all expenses incurred | 2019-06-30 | $1,180,108 |
| Benefits paid (including direct rollovers) | 2019-06-30 | $959,200 |
| Total plan assets at end of year | 2019-06-30 | $2,834,472 |
| Total plan assets at beginning of year | 2019-06-30 | $2,944,244 |
| Value of fidelity bond covering the plan | 2019-06-30 | $350,000 |
| Expenses. Other expenses not covered elsewhere | 2019-06-30 | $98,308 |
| Other income received | 2019-06-30 | $64,252 |
| Net income (gross income less expenses) | 2019-06-30 | $-144,492 |
| Net plan assets at end of year (total assets less liabilities) | 2019-06-30 | $2,679,772 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-06-30 | $2,824,264 |
| Total contributions received or receivable from employer(s) | 2019-06-30 | $971,364 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-06-30 | $122,600 |
| 2017 : ATLANTIC COAST HEALTH PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-06-30 | $59,717 |
| Total plan liabilities at beginning of year | 2017-06-30 | $42,376 |
| Total income from all sources | 2017-06-30 | $977,768 |
| Expenses. Total of all expenses incurred | 2017-06-30 | $888,829 |
| Benefits paid (including direct rollovers) | 2017-06-30 | $688,455 |
| Total plan assets at end of year | 2017-06-30 | $3,042,101 |
| Total plan assets at beginning of year | 2017-06-30 | $2,935,821 |
| Value of fidelity bond covering the plan | 2017-06-30 | $350,000 |
| Total contributions received or receivable from participants | 2017-06-30 | $22,813 |
| Expenses. Other expenses not covered elsewhere | 2017-06-30 | $78,474 |
| Other income received | 2017-06-30 | $53,387 |
| Net income (gross income less expenses) | 2017-06-30 | $88,939 |
| Net plan assets at end of year (total assets less liabilities) | 2017-06-30 | $2,982,384 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-06-30 | $2,893,445 |
| Total contributions received or receivable from employer(s) | 2017-06-30 | $901,568 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-06-30 | $121,900 |
| 2016 : ATLANTIC COAST HEALTH PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-06-30 | $42,376 |
| Total plan liabilities at beginning of year | 2016-06-30 | $76,033 |
| Total income from all sources | 2016-06-30 | $950,021 |
| Expenses. Total of all expenses incurred | 2016-06-30 | $686,327 |
| Benefits paid (including direct rollovers) | 2016-06-30 | $490,809 |
| Total plan assets at end of year | 2016-06-30 | $2,935,821 |
| Total plan assets at beginning of year | 2016-06-30 | $2,705,784 |
| Value of fidelity bond covering the plan | 2016-06-30 | $300,000 |
| Total contributions received or receivable from participants | 2016-06-30 | $20,820 |
| Expenses. Other expenses not covered elsewhere | 2016-06-30 | $73,968 |
| Other income received | 2016-06-30 | $52,523 |
| Net income (gross income less expenses) | 2016-06-30 | $263,694 |
| Net plan assets at end of year (total assets less liabilities) | 2016-06-30 | $2,893,445 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-06-30 | $2,629,751 |
| Total contributions received or receivable from employer(s) | 2016-06-30 | $876,678 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-06-30 | $121,550 |
| 2015 : ATLANTIC COAST HEALTH PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-06-30 | $76,033 |
| Total plan liabilities at beginning of year | 2015-06-30 | $113,844 |
| Total income from all sources | 2015-06-30 | $864,987 |
| Expenses. Total of all expenses incurred | 2015-06-30 | $760,516 |
| Benefits paid (including direct rollovers) | 2015-06-30 | $565,916 |
| Total plan assets at end of year | 2015-06-30 | $2,705,784 |
| Total plan assets at beginning of year | 2015-06-30 | $2,639,124 |
| Value of fidelity bond covering the plan | 2015-06-30 | $300,000 |
| Total contributions received or receivable from participants | 2015-06-30 | $134 |
| Expenses. Other expenses not covered elsewhere | 2015-06-30 | $73,125 |
| Other income received | 2015-06-30 | $12,878 |
| Net income (gross income less expenses) | 2015-06-30 | $104,471 |
| Net plan assets at end of year (total assets less liabilities) | 2015-06-30 | $2,629,751 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-06-30 | $2,525,280 |
| Total contributions received or receivable from employer(s) | 2015-06-30 | $851,975 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-06-30 | $121,475 |
| 2014 : ATLANTIC COAST HEALTH PLAN 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-06-30 | $113,844 |
| Total plan liabilities at beginning of year | 2014-06-30 | $110,376 |
| Total income from all sources | 2014-06-30 | $1,030,832 |
| Expenses. Total of all expenses incurred | 2014-06-30 | $974,361 |
| Benefits paid (including direct rollovers) | 2014-06-30 | $822,720 |
| Total plan assets at end of year | 2014-06-30 | $2,639,124 |
| Total plan assets at beginning of year | 2014-06-30 | $2,579,185 |
| Value of fidelity bond covering the plan | 2014-06-30 | $300,000 |
| Total contributions received or receivable from participants | 2014-06-30 | $1,271 |
| Expenses. Other expenses not covered elsewhere | 2014-06-30 | $30,241 |
| Other income received | 2014-06-30 | $24,252 |
| Net income (gross income less expenses) | 2014-06-30 | $56,471 |
| Net plan assets at end of year (total assets less liabilities) | 2014-06-30 | $2,525,280 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-06-30 | $2,468,809 |
| Total contributions received or receivable from employer(s) | 2014-06-30 | $1,005,309 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-06-30 | $121,400 |
| 2013 : ATLANTIC COAST HEALTH PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $110,376 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $106,936 |
| Total income from all sources (including contributions) | 2013-06-30 | $1,169,948 |
| Total of all expenses incurred | 2013-06-30 | $1,126,121 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-06-30 | $971,785 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-06-30 | $1,144,441 |
| Value of total assets at end of year | 2013-06-30 | $2,579,185 |
| Value of total assets at beginning of year | 2013-06-30 | $2,531,918 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-06-30 | $154,336 |
| Total interest from all sources | 2013-06-30 | $12,657 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-06-30 | No |
| Administrative expenses professional fees incurred | 2013-06-30 | $8,750 |
| Was this plan covered by a fidelity bond | 2013-06-30 | Yes |
| Value of fidelity bond cover | 2013-06-30 | $300,000 |
| If this is an individual account plan, was there a blackout period | 2013-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-06-30 | No |
| Contributions received from participants | 2013-06-30 | $8,274 |
| Assets. Other investments not covered elsewhere at end of year | 2013-06-30 | $4,796 |
| Assets. Other investments not covered elsewhere at beginning of year | 2013-06-30 | $8,011 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-06-30 | $7,356 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-06-30 | $12,233 |
| Other income not declared elsewhere | 2013-06-30 | $12,850 |
| Administrative expenses (other) incurred | 2013-06-30 | $31,586 |
| Liabilities. Value of operating payables at end of year | 2013-06-30 | $2,198 |
| Liabilities. Value of operating payables at beginning of year | 2013-06-30 | $455 |
| Total non interest bearing cash at end of year | 2013-06-30 | $396,093 |
| Total non interest bearing cash at beginning of year | 2013-06-30 | $344,907 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Value of net income/loss | 2013-06-30 | $43,827 |
| Value of net assets at end of year (total assets less liabilities) | 2013-06-30 | $2,468,809 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-06-30 | $2,424,982 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-06-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-06-30 | $2,170,940 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-06-30 | $2,166,767 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-06-30 | $2,166,767 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-06-30 | $12,657 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-06-30 | $128,165 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-06-30 | No |
| Contributions received in cash from employer | 2013-06-30 | $1,136,167 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-06-30 | $843,620 |
| Contract administrator fees | 2013-06-30 | $114,000 |
| Liabilities. Value of benefit claims payable at end of year | 2013-06-30 | $108,178 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-06-30 | $106,481 |
| Did the plan have assets held for investment | 2013-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-06-30 | Unqualified |
| Accountancy firm name | 2013-06-30 | DANIELS, IRWIN & AYLOR, CPAS |
| Accountancy firm EIN | 2013-06-30 | 621802605 |
| 2012 : ATLANTIC COAST HEALTH PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $106,936 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $300,313 |
| Total income from all sources (including contributions) | 2012-06-30 | $1,309,208 |
| Total of all expenses incurred | 2012-06-30 | $992,089 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-06-30 | $834,250 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-06-30 | $1,152,891 |
| Value of total assets at end of year | 2012-06-30 | $2,531,918 |
| Value of total assets at beginning of year | 2012-06-30 | $2,408,176 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-06-30 | $157,839 |
| Total interest from all sources | 2012-06-30 | $19,203 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-06-30 | No |
| Administrative expenses professional fees incurred | 2012-06-30 | $9,000 |
| Was this plan covered by a fidelity bond | 2012-06-30 | Yes |
| Value of fidelity bond cover | 2012-06-30 | $300,000 |
| If this is an individual account plan, was there a blackout period | 2012-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-06-30 | No |
| Contributions received from participants | 2012-06-30 | $38,395 |
| Assets. Other investments not covered elsewhere at end of year | 2012-06-30 | $8,011 |
| Assets. Other investments not covered elsewhere at beginning of year | 2012-06-30 | $6,132 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-06-30 | $12,233 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-06-30 | $27,556 |
| Other income not declared elsewhere | 2012-06-30 | $137,114 |
| Administrative expenses (other) incurred | 2012-06-30 | $34,839 |
| Liabilities. Value of operating payables at end of year | 2012-06-30 | $455 |
| Liabilities. Value of operating payables at beginning of year | 2012-06-30 | $1,127 |
| Total non interest bearing cash at end of year | 2012-06-30 | $344,907 |
| Total non interest bearing cash at beginning of year | 2012-06-30 | $236,665 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Value of net income/loss | 2012-06-30 | $317,119 |
| Value of net assets at end of year (total assets less liabilities) | 2012-06-30 | $2,424,982 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-06-30 | $2,107,863 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-06-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-06-30 | $2,166,767 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-06-30 | $2,137,823 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-06-30 | $2,137,823 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-06-30 | $19,203 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-06-30 | $112,640 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-06-30 | No |
| Contributions received in cash from employer | 2012-06-30 | $1,114,496 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-06-30 | $721,610 |
| Contract administrator fees | 2012-06-30 | $114,000 |
| Liabilities. Value of benefit claims payable at end of year | 2012-06-30 | $106,481 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-06-30 | $299,186 |
| Did the plan have assets held for investment | 2012-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-06-30 | Unqualified |
| Accountancy firm name | 2012-06-30 | DANIELS, IRWIN & AYLOR, CPAS |
| Accountancy firm EIN | 2012-06-30 | 621802605 |
| 2011 : ATLANTIC COAST HEALTH PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $300,313 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $255,308 |
| Total income from all sources (including contributions) | 2011-06-30 | $2,344,324 |
| Total of all expenses incurred | 2011-06-30 | $2,373,960 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-06-30 | $2,185,442 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-06-30 | $2,299,246 |
| Value of total assets at end of year | 2011-06-30 | $2,408,176 |
| Value of total assets at beginning of year | 2011-06-30 | $2,392,807 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-06-30 | $188,518 |
| Total interest from all sources | 2011-06-30 | $27,033 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-06-30 | No |
| Administrative expenses professional fees incurred | 2011-06-30 | $8,750 |
| Was this plan covered by a fidelity bond | 2011-06-30 | Yes |
| Value of fidelity bond cover | 2011-06-30 | $250,000 |
| If this is an individual account plan, was there a blackout period | 2011-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-06-30 | No |
| Contributions received from participants | 2011-06-30 | $29,413 |
| Assets. Other investments not covered elsewhere at end of year | 2011-06-30 | $6,132 |
| Assets. Other investments not covered elsewhere at beginning of year | 2011-06-30 | $4,910 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-06-30 | $27,556 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-06-30 | $89,872 |
| Other income not declared elsewhere | 2011-06-30 | $18,045 |
| Administrative expenses (other) incurred | 2011-06-30 | $65,768 |
| Liabilities. Value of operating payables at end of year | 2011-06-30 | $1,127 |
| Liabilities. Value of operating payables at beginning of year | 2011-06-30 | $4,590 |
| Total non interest bearing cash at end of year | 2011-06-30 | $236,665 |
| Total non interest bearing cash at beginning of year | 2011-06-30 | $356,697 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Value of net income/loss | 2011-06-30 | $-29,636 |
| Value of net assets at end of year (total assets less liabilities) | 2011-06-30 | $2,107,863 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-06-30 | $2,137,499 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-06-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-06-30 | $2,137,823 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-06-30 | $1,941,328 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-06-30 | $1,941,328 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-06-30 | $27,033 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-06-30 | $203,586 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-06-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-06-30 | No |
| Contributions received in cash from employer | 2011-06-30 | $2,269,833 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-06-30 | $1,981,856 |
| Contract administrator fees | 2011-06-30 | $114,000 |
| Liabilities. Value of benefit claims payable at end of year | 2011-06-30 | $299,186 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-06-30 | $250,718 |
| Did the plan have assets held for investment | 2011-06-30 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-06-30 | Unqualified |
| Accountancy firm name | 2011-06-30 | DANIELS, IRWIN & AYLOR, CPAS |
| Accountancy firm EIN | 2011-06-30 | 621802605 |
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10123 |
| Policy instance | 4 |
| Insurance contract or identification number | SL10123 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $81,539 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,568 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,071 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 38 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,763 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,669 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,443 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10123 |
| Policy instance | 4 |
| Insurance contract or identification number | SL10123 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $96,046 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $23,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,815 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,292 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10123 |
| Policy instance | 4 |
| Insurance contract or identification number | SL10123 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $90,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,705 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,012 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,944 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10123 |
| Policy instance | 4 |
| Insurance contract or identification number | SL10123 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $86,274 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,467 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10123 |
| Policy instance | 4 |
| Insurance contract or identification number | SL10123 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $84,340 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,319 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,860 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10123 |
| Policy instance | 4 |
| Insurance contract or identification number | SL10123 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $75,066 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,184 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,771 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,649 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10123 |
| Policy instance | 4 |
| Insurance contract or identification number | SL10123 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $65,149 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,199 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,687 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 57 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,465 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 3 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,127 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10123 |
| Policy instance | 4 |
| Insurance contract or identification number | SL10123 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $76,456 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,050 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | SE3E0135 |
| Policy instance | 3 |
| Insurance contract or identification number | SE3E0135 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-01-31 | | Welfare Benefit Premiums Paid to Carrier | USD $45,741 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 4 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,961 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | SL10123 |
| Policy instance | 5 |
| Insurance contract or identification number | SL10123 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2013-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $31,406 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 81 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,007 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,156 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,039 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | SE3E0135 |
| Policy instance | 3 |
| Insurance contract or identification number | SE3E0135 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $64,189 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 4 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 91 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,256 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| AMERICAN UNITED LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60895 ) |
| Policy contract number | 15636 |
| Policy instance | 1 |
| Insurance contract or identification number | 15636 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,873 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 ) |
| Policy contract number | SE3E0135 |
| Policy instance | 3 |
| Insurance contract or identification number | SE3E0135 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Welfare Benefit Premiums Paid to Carrier | USD $116,930 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | |
| Policy instance | 4 |
| Number of Individuals Covered | 83 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-04-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 ) |
| Policy contract number | 000000209495 |
| Policy instance | 5 |
| Insurance contract or identification number | 000000209495 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2011-05-01 | | Insurance policy end date | 2011-06-30 | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,449 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FORT DEARBORN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | L-XS0002 |
| Policy instance | 2 |
| Insurance contract or identification number | L-XS0002 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,612 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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