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DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 401k Plan overview

Plan NameDOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN
Plan identification number 572

DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN Benefits

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

401k Sponsoring company profile

DOMINION ENERGY, INC. has sponsored the creation of one or more 401k plans.

Company Name:DOMINION ENERGY, INC.
Employer identification number (EIN):541229715
NAIC Classification:221500

Additional information about DOMINION ENERGY, INC.

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1983-02-18
Company Identification Number: 0238778
Legal Registered Office Address: 100 TREDEGAR STREET

RICHMOND
United States of America (USA)
23219

More information about DOMINION ENERGY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5722022-01-01
5722021-01-01
5722020-01-01
5722019-01-01
5722018-01-01
5722017-01-01JASON HATCHER, ACCOUNTING MANAGER JOSH BLAKENEY, CONTROLLER2018-10-11
5722016-01-01JASON HATCHER, ACCOUNTING MANAGER JOSH BLAKENEY, CONTROLLER2017-10-04
5722015-01-01JASON HATCHER, MANAGER ACCTG JOSH BLAKENEY, CONTROLLER2016-10-13
5722014-01-01JASON HATCHER, MANAGER ACCTG GEORGE FEARNOW, ASST CONTROLLER2015-10-14
5722013-01-01MARK LINDLEY, MANAGER ACCTG JOSH BLAKENEY, ASSISTANT CONTROLLER2014-10-15
5722012-01-01MARK LINDLEY, MANAGER ACCTG JOSH BLAKENEY, DIRECTOR ACCTG2013-10-15
5722011-01-01MARK LINDLEY, MANAGER ACCTG JOSH BLAKENEY, DIRECTOR ACCTG2012-10-15
5722009-01-01MARK LINDLEY, SUPERVISOR ACCTG2010-10-01 JOSH BLAKENEY, DIRECTOR ACCTG2010-10-01

Plan Statistics for DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN

401k plan membership statisitcs for DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN

Measure Date Value
2022: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-0138
Number of retired or separated participants receiving benefits2022-01-0139
Total of all active and inactive participants2022-01-0139
2021: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-0138
Number of retired or separated participants receiving benefits2021-01-0138
Total of all active and inactive participants2021-01-0138
2020: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-0138
Number of retired or separated participants receiving benefits2020-01-0138
Total of all active and inactive participants2020-01-0138
2019: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-0139
Total number of active participants reported on line 7a of the Form 55002019-01-0138
Total of all active and inactive participants2019-01-0138
2018: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0136
Number of retired or separated participants receiving benefits2018-01-0139
Total of all active and inactive participants2018-01-0139
2017: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0136
Number of retired or separated participants receiving benefits2017-01-0136
Total of all active and inactive participants2017-01-0136
2016: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0136
Number of retired or separated participants receiving benefits2016-01-0136
Total of all active and inactive participants2016-01-0136
2015: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0136
Number of retired or separated participants receiving benefits2015-01-0136
Total of all active and inactive participants2015-01-0136
2014: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0135
Number of retired or separated participants receiving benefits2014-01-0136
Total of all active and inactive participants2014-01-0136
2013: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0122
Number of retired or separated participants receiving benefits2013-01-0135
Total of all active and inactive participants2013-01-0135
2012: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0120
Number of retired or separated participants receiving benefits2012-01-0122
Total of all active and inactive participants2012-01-0122
2011: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0118
Number of retired or separated participants receiving benefits2011-01-0120
Total of all active and inactive participants2011-01-0120
2009: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-016
Total number of active participants reported on line 7a of the Form 55002009-01-010
Number of retired or separated participants receiving benefits2009-01-018
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-018

Financial Data on DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN

Measure Date Value
2022 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2022 401k financial data
Total income from all sources2022-12-31$-6,436,517
Expenses. Total of all expenses incurred2022-12-31$153,703
Benefits paid (including direct rollovers)2022-12-31$125,185
Total plan assets at end of year2022-12-31$26,382,637
Total plan assets at beginning of year2022-12-31$32,972,857
Value of fidelity bond covering the plan2022-12-31$50,000,000
Total contributions received or receivable from participants2022-12-31$6,420
Other income received2022-12-31$-6,442,937
Net income (gross income less expenses)2022-12-31$-6,590,220
Net plan assets at end of year (total assets less liabilities)2022-12-31$26,382,637
Net plan assets at beginning of year (total assets less liabilities)2022-12-31$32,972,857
Assets. Value of assets in partnership/joint-venture interests2022-12-31$4,473,281
Total contributions received or receivable from employer(s)2022-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2022-12-31$28,518
2021 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2021 401k financial data
Total income from all sources2021-12-31$4,265,654
Expenses. Total of all expenses incurred2021-12-31$426,684
Benefits paid (including direct rollovers)2021-12-31$398,668
Total plan assets at end of year2021-12-31$32,972,857
Total plan assets at beginning of year2021-12-31$29,133,887
Value of fidelity bond covering the plan2021-12-31$50,000,000
Total contributions received or receivable from participants2021-12-31$8,236
Expenses. Other expenses not covered elsewhere2021-12-31$28,016
Other income received2021-12-31$4,257,418
Net income (gross income less expenses)2021-12-31$3,838,970
Net plan assets at end of year (total assets less liabilities)2021-12-31$32,972,857
Net plan assets at beginning of year (total assets less liabilities)2021-12-31$29,133,887
Assets. Value of assets in partnership/joint-venture interests2021-12-31$4,440,650
Total contributions received or receivable from employer(s)2021-12-31$0
2020 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2020 401k financial data
Total income from all sources2020-12-31$3,996,614
Expenses. Total of all expenses incurred2020-12-31$451,286
Benefits paid (including direct rollovers)2020-12-31$408,450
Total plan assets at end of year2020-12-31$29,133,887
Total plan assets at beginning of year2020-12-31$25,588,559
Value of fidelity bond covering the plan2020-12-31$50,000,000
Total contributions received or receivable from participants2020-12-31$11,323
Expenses. Other expenses not covered elsewhere2020-12-31$42,836
Other income received2020-12-31$3,840,441
Net income (gross income less expenses)2020-12-31$3,545,328
Net plan assets at end of year (total assets less liabilities)2020-12-31$29,133,887
Net plan assets at beginning of year (total assets less liabilities)2020-12-31$25,588,559
Total contributions received or receivable from employer(s)2020-12-31$144,850
2019 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2019 401k financial data
Total income from all sources2019-12-31$4,667,853
Expenses. Total of all expenses incurred2019-12-31$347,578
Benefits paid (including direct rollovers)2019-12-31$310,775
Total plan assets at end of year2019-12-31$25,588,559
Total plan assets at beginning of year2019-12-31$21,268,284
Value of fidelity bond covering the plan2019-12-31$50,000,000
Expenses. Other expenses not covered elsewhere2019-12-31$36,803
Other income received2019-12-31$4,667,853
Net income (gross income less expenses)2019-12-31$4,320,275
Net plan assets at end of year (total assets less liabilities)2019-12-31$25,588,559
Net plan assets at beginning of year (total assets less liabilities)2019-12-31$21,268,284
2018 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2018 401k financial data
Total income from all sources2018-12-31$-249,344
Expenses. Total of all expenses incurred2018-12-31$475,358
Benefits paid (including direct rollovers)2018-12-31$447,569
Total plan assets at end of year2018-12-31$21,268,284
Total plan assets at beginning of year2018-12-31$21,992,986
Value of fidelity bond covering the plan2018-12-31$50,000,000
Other income received2018-12-31$-258,548
Net income (gross income less expenses)2018-12-31$-724,702
Net plan assets at end of year (total assets less liabilities)2018-12-31$21,268,284
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$21,992,986
Total contributions received or receivable from employer(s)2018-12-31$9,204
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$27,789
2017 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2017 401k financial data
Total income from all sources2017-12-31$3,098,867
Expenses. Total of all expenses incurred2017-12-31$227,054
Benefits paid (including direct rollovers)2017-12-31$191,303
Total plan assets at end of year2017-12-31$21,992,986
Total plan assets at beginning of year2017-12-31$19,121,173
Value of fidelity bond covering the plan2017-12-31$50,000,000
Other income received2017-12-31$2,871,813
Net income (gross income less expenses)2017-12-31$2,871,813
Net plan assets at end of year (total assets less liabilities)2017-12-31$21,992,986
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$19,121,173
Total contributions received or receivable from employer(s)2017-12-31$227,054
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$35,751
2016 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2016 401k financial data
Total income from all sources2016-12-31$2,256,721
Expenses. Total of all expenses incurred2016-12-31$482,799
Benefits paid (including direct rollovers)2016-12-31$472,967
Total plan assets at end of year2016-12-31$19,121,173
Total plan assets at beginning of year2016-12-31$17,347,251
Value of fidelity bond covering the plan2016-12-31$50,000,000
Other income received2016-12-31$1,773,922
Net income (gross income less expenses)2016-12-31$1,773,922
Net plan assets at end of year (total assets less liabilities)2016-12-31$19,121,173
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$17,347,251
Total contributions received or receivable from employer(s)2016-12-31$482,799
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$9,832
2015 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2015 401k financial data
Total income from all sources2015-12-31$356,258
Expenses. Total of all expenses incurred2015-12-31$284,204
Benefits paid (including direct rollovers)2015-12-31$261,626
Total plan assets at end of year2015-12-31$17,347,251
Total plan assets at beginning of year2015-12-31$17,275,197
Value of fidelity bond covering the plan2015-12-31$50,000,000
Other income received2015-12-31$72,054
Net income (gross income less expenses)2015-12-31$72,054
Net plan assets at end of year (total assets less liabilities)2015-12-31$17,347,251
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$17,275,197
Total contributions received or receivable from employer(s)2015-12-31$284,204
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$22,578
2014 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2014 401k financial data
Total income from all sources2014-12-31$1,302,258
Expenses. Total of all expenses incurred2014-12-31$492,421
Benefits paid (including direct rollovers)2014-12-31$473,701
Total plan assets at end of year2014-12-31$17,275,197
Total plan assets at beginning of year2014-12-31$16,465,360
Value of fidelity bond covering the plan2014-12-31$50,000,000
Other income received2014-12-31$809,838
Net income (gross income less expenses)2014-12-31$809,837
Net plan assets at end of year (total assets less liabilities)2014-12-31$17,275,197
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$16,465,360
Total contributions received or receivable from employer(s)2014-12-31$492,420
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$18,720
2013 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2013 401k financial data
Total income from all sources2013-12-31$2,640,446
Expenses. Total of all expenses incurred2013-12-31$521,325
Benefits paid (including direct rollovers)2013-12-31$505,942
Total plan assets at end of year2013-12-31$16,465,360
Total plan assets at beginning of year2013-12-31$14,346,239
Value of fidelity bond covering the plan2013-12-31$50,000,000
Other income received2013-12-31$2,119,121
Net income (gross income less expenses)2013-12-31$2,119,121
Net plan assets at end of year (total assets less liabilities)2013-12-31$16,465,360
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$14,346,239
Total contributions received or receivable from employer(s)2013-12-31$521,325
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$15,383
2012 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2012 401k financial data
Total income from all sources2012-12-31$1,929,298
Expenses. Total of all expenses incurred2012-12-31$277,937
Benefits paid (including direct rollovers)2012-12-31$261,956
Total plan assets at end of year2012-12-31$14,346,239
Total plan assets at beginning of year2012-12-31$12,694,878
Value of fidelity bond covering the plan2012-12-31$50,000,000
Total contributions received or receivable from participants2012-12-31$30,300
Other income received2012-12-31$1,651,361
Net income (gross income less expenses)2012-12-31$1,651,361
Net plan assets at end of year (total assets less liabilities)2012-12-31$14,346,239
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$12,694,878
Total contributions received or receivable from employer(s)2012-12-31$247,637
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$15,981
2011 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2011 401k financial data
Total income from all sources2011-12-31$248,706
Expenses. Total of all expenses incurred2011-12-31$171,172
Benefits paid (including direct rollovers)2011-12-31$161,793
Total plan assets at end of year2011-12-31$12,694,878
Total plan assets at beginning of year2011-12-31$12,617,344
Value of fidelity bond covering the plan2011-12-31$50,000,000
Total contributions received or receivable from participants2011-12-31$27,823
Other income received2011-12-31$77,533
Net income (gross income less expenses)2011-12-31$77,534
Net plan assets at end of year (total assets less liabilities)2011-12-31$12,694,878
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$12,617,344
Total contributions received or receivable from employer(s)2011-12-31$143,350
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$9,379
2010 : DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2010 401k financial data
Total income from all sources2010-12-31$1,395,657
Expenses. Total of all expenses incurred2010-12-31$117,199
Benefits paid (including direct rollovers)2010-12-31$111,196
Total plan assets at end of year2010-12-31$12,617,344
Total plan assets at beginning of year2010-12-31$11,338,886
Value of fidelity bond covering the plan2010-12-31$50,000,000
Total contributions received or receivable from participants2010-12-31$16,977
Other income received2010-12-31$1,278,457
Net income (gross income less expenses)2010-12-31$1,278,458
Net plan assets at end of year (total assets less liabilities)2010-12-31$12,617,344
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$11,338,886
Total contributions received or receivable from employer(s)2010-12-31$100,223
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$6,003

Form 5500 Responses for DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN

2022: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement - TrustYes
2021: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement - TrustYes
2020: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement - TrustYes
2019: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement - TrustYes
2018: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement - TrustYes
2017: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement - TrustYes
2016: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: DOMINION KEWAUNEE UNION RETIREE HEALTH AND WELFARE PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0122482
Policy instance 1
Insurance contract or identification number0122482
Number of Individuals Covered38
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $246
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees246
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0122482
Policy instance 1
Insurance contract or identification number0122482
Number of Individuals Covered38
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $237
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedADD
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees237
Additional information about fees paid to insurance brokerSUPPLEMENTAL COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6967-G
Policy instance 1
Insurance contract or identification number6967-G
Number of Individuals Covered38
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $54,871
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6967-G
Policy instance 1
Insurance contract or identification number6967-G
Number of Individuals Covered38
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6967-G
Policy instance 1
Insurance contract or identification number6967-G
Number of Individuals Covered39
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,657
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6967-G
Policy instance 1
Insurance contract or identification number6967-G
Number of Individuals Covered36
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6967-G
Policy instance 1
Insurance contract or identification number6967-G
Number of Individuals Covered36
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $8,155
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6967-G
Policy instance 1
Insurance contract or identification number6967-G
Number of Individuals Covered36
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $7,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number6967-G
Policy instance 1
Insurance contract or identification number6967-G
Number of Individuals Covered35
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $6,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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