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ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 401k Plan overview

Plan NameONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN
Plan identification number 503

ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

ONETA COMPANY has sponsored the creation of one or more 401k plans.

Company Name:ONETA COMPANY
Employer identification number (EIN):741929308
NAIC Classification:424990
NAIC Description:Other Miscellaneous Nondurable Goods Merchant Wholesalers

Additional information about ONETA COMPANY

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1977-05-27
Company Identification Number: 0040662000
Legal Registered Office Address: 1401 S PADRE ISLAND DR

CORPUS CHRISTI
United States of America (USA)
78416

More information about ONETA COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032021-12-01
5032020-12-01
5032019-12-01
5032019-12-01
5032018-12-01
5032017-12-01
5032016-12-01OMAR O. VERA
5032015-12-01OMAR O. VERA
5032014-12-01OMAR O. VERA
5032013-12-01OMAR O. VERA

Plan Statistics for ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN

401k plan membership statisitcs for ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN

Measure Date Value
2021: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01272
Total number of active participants reported on line 7a of the Form 55002021-12-01308
Total of all active and inactive participants2021-12-01308
2020: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-01181
Total number of active participants reported on line 7a of the Form 55002020-12-01272
Total of all active and inactive participants2020-12-01272
2019: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01178
Total number of active participants reported on line 7a of the Form 55002019-12-01181
Total of all active and inactive participants2019-12-01181
2018: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01166
Total number of active participants reported on line 7a of the Form 55002018-12-01181
Total of all active and inactive participants2018-12-01181
2017: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-01169
Total number of active participants reported on line 7a of the Form 55002017-12-01163
Total of all active and inactive participants2017-12-01163
2016: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01167
Total number of active participants reported on line 7a of the Form 55002016-12-01172
Total of all active and inactive participants2016-12-01172
2015: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-01156
Total number of active participants reported on line 7a of the Form 55002015-12-01146
Total of all active and inactive participants2015-12-01146
2014: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-01153
Total number of active participants reported on line 7a of the Form 55002014-12-01142
Total of all active and inactive participants2014-12-01142
2013: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-01153
Total number of active participants reported on line 7a of the Form 55002013-12-01142
Total of all active and inactive participants2013-12-01142

Financial Data on ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN

Measure Date Value
2022 : ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-11-30$229,559
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-11-30$639,878
Total income from all sources (including contributions)2022-11-30$1,595,477
Total loss/gain on sale of assets2022-11-30$0
Total of all expenses incurred2022-11-30$1,646,254
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-11-30$1,470,317
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-11-30$1,595,477
Value of total assets at end of year2022-11-30$628,071
Value of total assets at beginning of year2022-11-30$1,089,167
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-11-30$175,937
Total interest from all sources2022-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2022-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-11-30No
Administrative expenses professional fees incurred2022-11-30$10,750
Was this plan covered by a fidelity bond2022-11-30Yes
Value of fidelity bond cover2022-11-30$500,000
Were there any nonexempt tranactions with any party-in-interest2022-11-30No
Contributions received from participants2022-11-30$402,990
Administrative expenses (other) incurred2022-11-30$684
Total non interest bearing cash at end of year2022-11-30$397,612
Total non interest bearing cash at beginning of year2022-11-30$445,008
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-11-30No
Value of net income/loss2022-11-30$-50,777
Value of net assets at end of year (total assets less liabilities)2022-11-30$398,512
Value of net assets at beginning of year (total assets less liabilities)2022-11-30$449,289
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-11-30No
Were any leases to which the plan was party in default or uncollectible2022-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2022-11-30$285,779
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-11-30No
Was there a failure to transmit to the plan any participant contributions2022-11-30No
Has the plan failed to provide any benefit when due under the plan2022-11-30No
Contributions received in cash from employer2022-11-30$1,192,487
Employer contributions (assets) at end of year2022-11-30$230,459
Employer contributions (assets) at beginning of year2022-11-30$644,159
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-11-30$1,184,538
Contract administrator fees2022-11-30$164,503
Liabilities. Value of benefit claims payable at end of year2022-11-30$229,559
Liabilities. Value of benefit claims payable at beginning of year2022-11-30$639,878
Did the plan have assets held for investment2022-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-11-30No
Opinion of an independent qualified public accountant for this plan2022-11-30Unqualified
Accountancy firm name2022-11-30COLLIER, JOHNSON & WOODS P.C.
Accountancy firm EIN2022-11-30742520265
2021 : ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-11-30$639,878
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-11-30$157,940
Total income from all sources (including contributions)2021-11-30$1,451,492
Total loss/gain on sale of assets2021-11-30$0
Total of all expenses incurred2021-11-30$1,119,952
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-11-30$962,281
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-11-30$1,451,492
Value of total assets at end of year2021-11-30$1,089,167
Value of total assets at beginning of year2021-11-30$275,689
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-11-30$157,671
Total interest from all sources2021-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2021-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-11-30No
Administrative expenses professional fees incurred2021-11-30$10,500
Was this plan covered by a fidelity bond2021-11-30Yes
Value of fidelity bond cover2021-11-30$250,000
Were there any nonexempt tranactions with any party-in-interest2021-11-30No
Contributions received from participants2021-11-30$425,079
Administrative expenses (other) incurred2021-11-30$644
Total non interest bearing cash at end of year2021-11-30$445,008
Total non interest bearing cash at beginning of year2021-11-30$117,749
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-11-30No
Value of net income/loss2021-11-30$331,540
Value of net assets at end of year (total assets less liabilities)2021-11-30$449,289
Value of net assets at beginning of year (total assets less liabilities)2021-11-30$117,749
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-11-30No
Were any leases to which the plan was party in default or uncollectible2021-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2021-11-30$239,459
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-11-30No
Was there a failure to transmit to the plan any participant contributions2021-11-30No
Has the plan failed to provide any benefit when due under the plan2021-11-30No
Contributions received in cash from employer2021-11-30$1,026,413
Employer contributions (assets) at end of year2021-11-30$644,159
Employer contributions (assets) at beginning of year2021-11-30$157,940
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-11-30$722,822
Contract administrator fees2021-11-30$146,527
Liabilities. Value of benefit claims payable at end of year2021-11-30$639,878
Liabilities. Value of benefit claims payable at beginning of year2021-11-30$157,940
Did the plan have assets held for investment2021-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-11-30No
Opinion of an independent qualified public accountant for this plan2021-11-30Unqualified
Accountancy firm name2021-11-30COLLIER, JOHNSON & WIIDS P.C.
Accountancy firm EIN2021-11-30742520265
2020 : ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-11-30$157,940
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-11-30$276,909
Total income from all sources (including contributions)2020-11-30$1,238,004
Total loss/gain on sale of assets2020-11-30$0
Total of all expenses incurred2020-11-30$1,343,791
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-11-30$1,175,216
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-11-30$1,238,004
Value of total assets at end of year2020-11-30$275,689
Value of total assets at beginning of year2020-11-30$500,445
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-11-30$168,575
Total interest from all sources2020-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2020-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-11-30No
Administrative expenses professional fees incurred2020-11-30$10,300
Was this plan covered by a fidelity bond2020-11-30Yes
Value of fidelity bond cover2020-11-30$500,000
Were there any nonexempt tranactions with any party-in-interest2020-11-30No
Contributions received from participants2020-11-30$533,594
Administrative expenses (other) incurred2020-11-30$422
Total non interest bearing cash at end of year2020-11-30$117,749
Total non interest bearing cash at beginning of year2020-11-30$219,147
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Value of net income/loss2020-11-30$-105,787
Value of net assets at end of year (total assets less liabilities)2020-11-30$117,749
Value of net assets at beginning of year (total assets less liabilities)2020-11-30$223,536
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-11-30No
Were any leases to which the plan was party in default or uncollectible2020-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2020-11-30$259,988
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-11-30No
Was there a failure to transmit to the plan any participant contributions2020-11-30No
Has the plan failed to provide any benefit when due under the plan2020-11-30No
Contributions received in cash from employer2020-11-30$704,410
Employer contributions (assets) at end of year2020-11-30$157,940
Employer contributions (assets) at beginning of year2020-11-30$281,298
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-11-30$915,228
Contract administrator fees2020-11-30$157,853
Liabilities. Value of benefit claims payable at end of year2020-11-30$157,940
Liabilities. Value of benefit claims payable at beginning of year2020-11-30$276,909
Did the plan have assets held for investment2020-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-11-30No
Opinion of an independent qualified public accountant for this plan2020-11-30Unqualified
Accountancy firm name2020-11-30COLLIER, JOHNSON & WOODS P.C.
Accountancy firm EIN2020-11-30742520265
2019 : ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-11-30$276,909
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-11-30$115,311
Total income from all sources (including contributions)2019-11-30$1,142,124
Total loss/gain on sale of assets2019-11-30$0
Total of all expenses incurred2019-11-30$986,514
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-11-30$834,728
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-11-30$1,142,124
Value of total assets at end of year2019-11-30$500,445
Value of total assets at beginning of year2019-11-30$183,237
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-11-30$151,786
Total interest from all sources2019-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2019-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-11-30No
Administrative expenses professional fees incurred2019-11-30$10,000
Was this plan covered by a fidelity bond2019-11-30Yes
Value of fidelity bond cover2019-11-30$500,000
Were there any nonexempt tranactions with any party-in-interest2019-11-30No
Contributions received from participants2019-11-30$482,023
Total non interest bearing cash at end of year2019-11-30$219,147
Total non interest bearing cash at beginning of year2019-11-30$50,237
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Value of net income/loss2019-11-30$155,610
Value of net assets at end of year (total assets less liabilities)2019-11-30$223,536
Value of net assets at beginning of year (total assets less liabilities)2019-11-30$67,926
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-11-30No
Were any leases to which the plan was party in default or uncollectible2019-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2019-11-30$255,625
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-11-30No
Was there a failure to transmit to the plan any participant contributions2019-11-30No
Has the plan failed to provide any benefit when due under the plan2019-11-30No
Contributions received in cash from employer2019-11-30$660,101
Employer contributions (assets) at end of year2019-11-30$281,298
Employer contributions (assets) at beginning of year2019-11-30$133,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-11-30$579,103
Contract administrator fees2019-11-30$141,786
Liabilities. Value of benefit claims payable at end of year2019-11-30$276,909
Liabilities. Value of benefit claims payable at beginning of year2019-11-30$115,311
Did the plan have assets held for investment2019-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-11-30No
Opinion of an independent qualified public accountant for this plan2019-11-30Unqualified
Accountancy firm name2019-11-30COLLIER, JOHNSON & WOODS P.C.
Accountancy firm EIN2019-11-30742520265
2018 : ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-11-30$115,311
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-11-30$90,102
Total income from all sources (including contributions)2018-11-30$694,577
Total loss/gain on sale of assets2018-11-30$0
Total of all expenses incurred2018-11-30$1,027,936
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-11-30$882,806
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-11-30$694,577
Value of total assets at end of year2018-11-30$183,237
Value of total assets at beginning of year2018-11-30$491,387
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-11-30$145,130
Total interest from all sources2018-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2018-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-11-30No
Administrative expenses professional fees incurred2018-11-30$10,000
Was this plan covered by a fidelity bond2018-11-30Yes
Value of fidelity bond cover2018-11-30$250,000
Were there any nonexempt tranactions with any party-in-interest2018-11-30No
Contributions received from participants2018-11-30$426,980
Administrative expenses (other) incurred2018-11-30$94
Total non interest bearing cash at end of year2018-11-30$50,237
Total non interest bearing cash at beginning of year2018-11-30$399,784
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-11-30No
Value of net income/loss2018-11-30$-333,359
Value of net assets at end of year (total assets less liabilities)2018-11-30$67,926
Value of net assets at beginning of year (total assets less liabilities)2018-11-30$401,285
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-11-30No
Were any leases to which the plan was party in default or uncollectible2018-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2018-11-30$254,471
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-11-30No
Was there a failure to transmit to the plan any participant contributions2018-11-30No
Has the plan failed to provide any benefit when due under the plan2018-11-30No
Contributions received in cash from employer2018-11-30$267,597
Employer contributions (assets) at end of year2018-11-30$133,000
Employer contributions (assets) at beginning of year2018-11-30$91,603
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-11-30$628,335
Contract administrator fees2018-11-30$135,036
Liabilities. Value of benefit claims payable at end of year2018-11-30$115,311
Liabilities. Value of benefit claims payable at beginning of year2018-11-30$90,102
Did the plan have assets held for investment2018-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-11-30No
Opinion of an independent qualified public accountant for this plan2018-11-30Unqualified
Accountancy firm name2018-11-30COLLIER, JOHNSON & WOODS P.C.
Accountancy firm EIN2018-11-30742520265
2017 : ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$90,102
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$61,689
Total income from all sources (including contributions)2017-11-30$872,632
Total loss/gain on sale of assets2017-11-30$0
Total of all expenses incurred2017-11-30$887,509
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-11-30$737,331
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-11-30$872,632
Value of total assets at end of year2017-11-30$491,387
Value of total assets at beginning of year2017-11-30$477,851
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-11-30$150,178
Total interest from all sources2017-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2017-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-11-30No
Administrative expenses professional fees incurred2017-11-30$9,000
Was this plan covered by a fidelity bond2017-11-30Yes
Value of fidelity bond cover2017-11-30$250,000
Were there any nonexempt tranactions with any party-in-interest2017-11-30No
Contributions received from participants2017-11-30$413,415
Total non interest bearing cash at end of year2017-11-30$399,784
Total non interest bearing cash at beginning of year2017-11-30$416,162
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Value of net income/loss2017-11-30$-14,877
Value of net assets at end of year (total assets less liabilities)2017-11-30$401,285
Value of net assets at beginning of year (total assets less liabilities)2017-11-30$416,162
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-11-30No
Were any leases to which the plan was party in default or uncollectible2017-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-11-30$253,459
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-11-30No
Was there a failure to transmit to the plan any participant contributions2017-11-30No
Has the plan failed to provide any benefit when due under the plan2017-11-30No
Contributions received in cash from employer2017-11-30$459,217
Employer contributions (assets) at end of year2017-11-30$91,603
Employer contributions (assets) at beginning of year2017-11-30$61,689
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-11-30$483,872
Contract administrator fees2017-11-30$141,178
Liabilities. Value of benefit claims payable at end of year2017-11-30$90,102
Liabilities. Value of benefit claims payable at beginning of year2017-11-30$61,689
Did the plan have assets held for investment2017-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-11-30No
Opinion of an independent qualified public accountant for this plan2017-11-30Unqualified
Accountancy firm name2017-11-30COLLIER, JOHNSON & WOODS P.C.
Accountancy firm EIN2017-11-30742520265
2016 : ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$61,689
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$59,814
Total income from all sources (including contributions)2016-11-30$826,002
Total loss/gain on sale of assets2016-11-30$0
Total of all expenses incurred2016-11-30$845,424
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-11-30$709,316
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-11-30$826,002
Value of total assets at end of year2016-11-30$477,851
Value of total assets at beginning of year2016-11-30$495,398
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-11-30$136,108
Total interest from all sources2016-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2016-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-11-30No
Administrative expenses professional fees incurred2016-11-30$3,500
Was this plan covered by a fidelity bond2016-11-30Yes
Value of fidelity bond cover2016-11-30$250,000
If this is an individual account plan, was there a blackout period2016-11-30No
Were there any nonexempt tranactions with any party-in-interest2016-11-30No
Contributions received from participants2016-11-30$316,743
Total non interest bearing cash at end of year2016-11-30$416,162
Total non interest bearing cash at beginning of year2016-11-30$435,584
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Value of net income/loss2016-11-30$-19,422
Value of net assets at end of year (total assets less liabilities)2016-11-30$416,162
Value of net assets at beginning of year (total assets less liabilities)2016-11-30$435,584
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-11-30No
Were any leases to which the plan was party in default or uncollectible2016-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-11-30$302,980
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-11-30No
Was there a failure to transmit to the plan any participant contributions2016-11-30No
Has the plan failed to provide any benefit when due under the plan2016-11-30No
Contributions received in cash from employer2016-11-30$509,259
Employer contributions (assets) at end of year2016-11-30$61,689
Employer contributions (assets) at beginning of year2016-11-30$59,814
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-11-30$406,336
Contract administrator fees2016-11-30$132,608
Liabilities. Value of benefit claims payable at end of year2016-11-30$61,689
Liabilities. Value of benefit claims payable at beginning of year2016-11-30$59,814
Did the plan have assets held for investment2016-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-11-30No
Opinion of an independent qualified public accountant for this plan2016-11-30Unqualified
Accountancy firm name2016-11-30COLLIER, JOHNSON & WOODS P.C.
Accountancy firm EIN2016-11-30742520265
2015 : ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$59,814
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$15,119
Total income from all sources (including contributions)2015-11-30$974,368
Total loss/gain on sale of assets2015-11-30$0
Total of all expenses incurred2015-11-30$716,348
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-11-30$587,297
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-11-30$974,368
Value of total assets at end of year2015-11-30$495,398
Value of total assets at beginning of year2015-11-30$192,683
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-11-30$129,051
Total interest from all sources2015-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2015-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-11-30No
Administrative expenses professional fees incurred2015-11-30$3,200
Was this plan covered by a fidelity bond2015-11-30Yes
Value of fidelity bond cover2015-11-30$250,000
Were there any nonexempt tranactions with any party-in-interest2015-11-30No
Contributions received from participants2015-11-30$266,795
Total non interest bearing cash at end of year2015-11-30$435,584
Total non interest bearing cash at beginning of year2015-11-30$177,564
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Value of net income/loss2015-11-30$258,020
Value of net assets at end of year (total assets less liabilities)2015-11-30$435,584
Value of net assets at beginning of year (total assets less liabilities)2015-11-30$177,564
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-11-30No
Were any leases to which the plan was party in default or uncollectible2015-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2015-11-30$267,643
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-11-30No
Was there a failure to transmit to the plan any participant contributions2015-11-30No
Has the plan failed to provide any benefit when due under the plan2015-11-30No
Contributions received in cash from employer2015-11-30$707,573
Employer contributions (assets) at end of year2015-11-30$59,814
Employer contributions (assets) at beginning of year2015-11-30$15,119
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-11-30$319,654
Contract administrator fees2015-11-30$125,851
Liabilities. Value of benefit claims payable at end of year2015-11-30$59,814
Liabilities. Value of benefit claims payable at beginning of year2015-11-30$15,119
Did the plan have assets held for investment2015-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-11-30No
Opinion of an independent qualified public accountant for this plan2015-11-30Unqualified
Accountancy firm name2015-11-30ROMINE CPA'S & ASSOCIATES
Accountancy firm EIN2015-11-30263841391
2014 : ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$15,119
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$0
Total income from all sources (including contributions)2014-11-30$838,518
Total loss/gain on sale of assets2014-11-30$0
Total of all expenses incurred2014-11-30$660,954
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-11-30$547,465
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-11-30$838,518
Value of total assets at end of year2014-11-30$192,683
Value of total assets at beginning of year2014-11-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-11-30$113,489
Total interest from all sources2014-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2014-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-11-30No
Was this plan covered by a fidelity bond2014-11-30No
Were there any nonexempt tranactions with any party-in-interest2014-11-30No
Contributions received from participants2014-11-30$311,770
Administrative expenses (other) incurred2014-11-30$82
Total non interest bearing cash at end of year2014-11-30$177,564
Total non interest bearing cash at beginning of year2014-11-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Value of net income/loss2014-11-30$177,564
Value of net assets at end of year (total assets less liabilities)2014-11-30$177,564
Value of net assets at beginning of year (total assets less liabilities)2014-11-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-11-30No
Were any leases to which the plan was party in default or uncollectible2014-11-30No
Expenses. Payments to insurance carriers foe the provision of benefits2014-11-30$320,759
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-11-30No
Was there a failure to transmit to the plan any participant contributions2014-11-30No
Has the plan failed to provide any benefit when due under the plan2014-11-30No
Contributions received in cash from employer2014-11-30$526,748
Employer contributions (assets) at end of year2014-11-30$15,119
Employer contributions (assets) at beginning of year2014-11-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-11-30$226,706
Contract administrator fees2014-11-30$113,407
Liabilities. Value of benefit claims payable at end of year2014-11-30$15,119
Liabilities. Value of benefit claims payable at beginning of year2014-11-30$0
Did the plan have assets held for investment2014-11-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-11-30No
Opinion of an independent qualified public accountant for this plan2014-11-30Unqualified
Accountancy firm name2014-11-30ROMAINE CPA'S & ASSOCIATES
Accountancy firm EIN2014-11-30263841391

Form 5500 Responses for ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN

2021: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedNo
2021-12-01This submission is the final filingNo
2021-12-01This return/report is a short plan year return/report (less than 12 months)No
2021-12-01Plan is a collectively bargained planNo
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – TrustYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement - TrustYes
2020: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – TrustYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement - TrustYes
2019: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Submission has been amendedYes
2019-12-01This submission is the final filingNo
2019-12-01This return/report is a short plan year return/report (less than 12 months)No
2019-12-01Plan is a collectively bargained planNo
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan funding arrangement – TrustYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement - TrustYes
2018: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan funding arrangement – TrustYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement - TrustYes
2017: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Submission has been amendedNo
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)No
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan funding arrangement – TrustYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement - TrustYes
2016: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)No
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan funding arrangement – TrustYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement - TrustYes
2015: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedNo
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan funding arrangement – TrustYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement - TrustYes
2014: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan funding arrangement – TrustYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement - TrustYes
2013: ONETA COMPANY EMPLOYEE HEALTH & WELFARE PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01First time form 5500 has been submittedYes
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan funding arrangement – TrustYes
2013-12-01Plan benefit arrangement – InsuranceYes
2013-12-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberCLI110409
Policy instance 3
Insurance contract or identification numberCLI110409
Number of Individuals Covered137
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $273,319
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000599
Policy instance 2
Insurance contract or identification number1000599
Number of Individuals Covered137
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $1,217
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedMANAGED TRANSPLANT
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 $12,185
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,217
Insurance broker organization code?5
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1133317
Policy instance 1
Insurance contract or identification number1133317
Number of Individuals Covered308
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Total amount of commissions paid to insurance brokerUSD $12,549
Total amount of fees paid to insurance companyUSD $1,001
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
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 $99,967
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,549
Insurance broker organization code?3
Amount paid for insurance broker fees1001
Additional information about fees paid to insurance brokerBONUS
COMPANION LIFE (National Association of Insurance Commissioners NAIC id number: 77828 )
Policy contract numberCLI110409
Policy instance 3
Insurance contract or identification numberCLI110409
Number of Individuals Covered126
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $228,182
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000599
Policy instance 2
Insurance contract or identification number1000599
Number of Individuals Covered126
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $1,100
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedMANAGED TRANSPLANT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $11,016
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,100
Insurance broker organization code?5
PRINCIPAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61271 )
Policy contract number1133317
Policy instance 1
Insurance contract or identification number1133317
Number of Individuals Covered272
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Total amount of commissions paid to insurance brokerUSD $12,355
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
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 $97,869
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,355
Insurance broker organization code?3
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberGLUG0ARAT
Policy instance 3
Insurance contract or identification numberGLUG0ARAT
Number of Individuals Covered181
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $4,418
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 BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSUPPLEMENTAL LIFE
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 $29,427
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000599
Policy instance 2
Insurance contract or identification number1000599
Number of Individuals Covered130
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Total amount of commissions paid to insurance brokerUSD $1,097
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedMANAGED TRANSPLANT
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 $10,952
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-201809
Policy instance 1
Insurance contract or identification numberUNI-201809
Number of Individuals Covered130
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $219,609
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberGLUG0ARAT
Policy instance 3
Insurance contract or identification numberGLUG0ARAT
Number of Individuals Covered181
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $4,075
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 BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSUPPLEMENTAL LIFE
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 $27,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,716
Insurance broker organization code?3
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-201809
Policy instance 1
Insurance contract or identification numberUNI-201809
Number of Individuals Covered127
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $217,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000599
Policy instance 2
Insurance contract or identification number1000599
Number of Individuals Covered127
Insurance policy start date2018-12-01
Insurance policy end date2019-11-30
Total amount of commissions paid to insurance brokerUSD $1,085
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedMANAGED TRANSPLANT
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 $10,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,085
Insurance broker organization code?5
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number1000599
Policy instance 2
Insurance contract or identification number1000599
Number of Individuals Covered121
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedMANAGED TRANSPLANT
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 $10,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 )
Policy contract numberGOO0ARAT
Policy instance 3
Insurance contract or identification numberGOO0ARAT
Number of Individuals Covered169
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
Total amount of commissions paid to insurance brokerUSD $3,477
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 BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedSUPPLEMENTAL LIFE
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 $23,179
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 )
Policy contract numberUNI-201809
Policy instance 1
Insurance contract or identification numberUNI-201809
Number of Individuals Covered121
Insurance policy start date2017-12-01
Insurance policy end date2018-11-30
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 BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $220,796
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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