BOARD OF TRUSTEES OF OPERATIVE PLASTERERS & CEMENT MASONS LOCAL 394 has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN
401k plan membership statisitcs for OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2022 401k membership |
|---|
| Total participants, beginning-of-year | 2022-01-01 | 35 |
| Total number of active participants reported on line 7a of the Form 5500 | 2022-01-01 | 35 |
| Total of all active and inactive participants | 2022-01-01 | 35 |
| Total participants | 2022-01-01 | 35 |
| Number of employers contributing to the scheme | 2022-01-01 | 0 |
| 2021: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2021 401k membership |
|---|
| Total participants, beginning-of-year | 2021-01-01 | 37 |
| Total number of active participants reported on line 7a of the Form 5500 | 2021-01-01 | 35 |
| Total of all active and inactive participants | 2021-01-01 | 35 |
| Total participants | 2021-01-01 | 35 |
| Number of employers contributing to the scheme | 2021-01-01 | 0 |
| 2020: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 20 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 37 |
| Total of all active and inactive participants | 2020-01-01 | 37 |
| Total participants | 2020-01-01 | 37 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 18 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 20 |
| Total of all active and inactive participants | 2019-01-01 | 20 |
| Total participants | 2019-01-01 | 20 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 25 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 18 |
| Total of all active and inactive participants | 2018-01-01 | 18 |
| Total participants | 2018-01-01 | 18 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 36 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 25 |
| Total of all active and inactive participants | 2017-01-01 | 25 |
| Total participants | 2017-01-01 | 25 |
| Number of employers contributing to the scheme | 2017-01-01 | 0 |
| 2016: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 23 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 36 |
| Total of all active and inactive participants | 2016-01-01 | 36 |
| Total participants | 2016-01-01 | 36 |
| Number of employers contributing to the scheme | 2016-01-01 | 0 |
| 2015: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 25 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 23 |
| Total of all active and inactive participants | 2015-01-01 | 23 |
| Total participants | 2015-01-01 | 23 |
| Number of employers contributing to the scheme | 2015-01-01 | 12 |
| 2014: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 27 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 25 |
| Total of all active and inactive participants | 2014-01-01 | 25 |
| Total participants | 2014-01-01 | 25 |
| Number of employers contributing to the scheme | 2014-01-01 | 12 |
| 2013: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 21 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 27 |
| Total of all active and inactive participants | 2013-01-01 | 27 |
| Total participants | 2013-01-01 | 27 |
| 2012: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 57 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 21 |
| Total of all active and inactive participants | 2012-01-01 | 21 |
| Total participants | 2012-01-01 | 21 |
| Number of employers contributing to the scheme | 2012-01-01 | 0 |
| 2011: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 33 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 57 |
| Total of all active and inactive participants | 2011-01-01 | 57 |
| Total participants | 2011-01-01 | 57 |
| 2010: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 35 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 33 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 33 |
| Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits | 2010-01-01 | 0 |
| Total participants | 2010-01-01 | 33 |
| Number of employers contributing to the scheme | 2010-01-01 | 0 |
| 2009: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-01-01 | 45 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-01-01 | 35 |
| Number of retired or separated participants receiving benefits | 2009-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2009-01-01 | 0 |
| Total of all active and inactive participants | 2009-01-01 | 35 |
| Measure | Date | Value |
|---|
| 2022 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2022 401k financial data |
|---|
| Total plan liabilities at end of year | 2022-12-31 | $0 |
| Total plan liabilities at beginning of year | 2022-12-31 | $0 |
| Total income from all sources | 2022-12-31 | $888 |
| Expenses. Total of all expenses incurred | 2022-12-31 | $13,516 |
| Benefits paid (including direct rollovers) | 2022-12-31 | $6,954 |
| Total plan assets at end of year | 2022-12-31 | $155,049 |
| Total plan assets at beginning of year | 2022-12-31 | $167,677 |
| Value of fidelity bond covering the plan | 2022-12-31 | $2,100,000 |
| Expenses. Other expenses not covered elsewhere | 2022-12-31 | $2,962 |
| Other income received | 2022-12-31 | $888 |
| Net income (gross income less expenses) | 2022-12-31 | $-12,628 |
| Net plan assets at end of year (total assets less liabilities) | 2022-12-31 | $155,049 |
| Net plan assets at beginning of year (total assets less liabilities) | 2022-12-31 | $167,677 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2022-12-31 | $3,600 |
| 2021 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2021 401k financial data |
|---|
| Total plan liabilities at end of year | 2021-12-31 | $0 |
| Total plan liabilities at beginning of year | 2021-12-31 | $0 |
| Total income from all sources | 2021-12-31 | $162 |
| Expenses. Total of all expenses incurred | 2021-12-31 | $11,895 |
| Benefits paid (including direct rollovers) | 2021-12-31 | $5,644 |
| Total plan assets at end of year | 2021-12-31 | $167,677 |
| Total plan assets at beginning of year | 2021-12-31 | $179,410 |
| Value of fidelity bond covering the plan | 2021-12-31 | $2,100,000 |
| Expenses. Other expenses not covered elsewhere | 2021-12-31 | $2,651 |
| Other income received | 2021-12-31 | $162 |
| Net income (gross income less expenses) | 2021-12-31 | $-11,733 |
| Net plan assets at end of year (total assets less liabilities) | 2021-12-31 | $167,677 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-12-31 | $179,410 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2021-12-31 | $3,600 |
| 2020 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2020 401k financial data |
|---|
| Total plan liabilities at end of year | 2020-12-31 | $0 |
| Total plan liabilities at beginning of year | 2020-12-31 | $687 |
| Total income from all sources | 2020-12-31 | $2,593 |
| Expenses. Total of all expenses incurred | 2020-12-31 | $14,117 |
| Benefits paid (including direct rollovers) | 2020-12-31 | $7,501 |
| Total plan assets at end of year | 2020-12-31 | $179,410 |
| Total plan assets at beginning of year | 2020-12-31 | $191,621 |
| Value of fidelity bond covering the plan | 2020-12-31 | $2,100,000 |
| Expenses. Other expenses not covered elsewhere | 2020-12-31 | $1,571 |
| Other income received | 2020-12-31 | $2,593 |
| Net income (gross income less expenses) | 2020-12-31 | $-11,524 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $179,410 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $190,934 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2020-12-31 | $5,045 |
| 2019 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $687 |
| Total plan liabilities at beginning of year | 2019-12-31 | $687 |
| Total income from all sources | 2019-12-31 | $2,859 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $12,111 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $3,323 |
| Total plan assets at end of year | 2019-12-31 | $191,621 |
| Total plan assets at beginning of year | 2019-12-31 | $200,873 |
| Value of fidelity bond covering the plan | 2019-12-31 | $2,100,000 |
| Expenses. Other expenses not covered elsewhere | 2019-12-31 | $2,288 |
| Other income received | 2019-12-31 | $2,859 |
| Net income (gross income less expenses) | 2019-12-31 | $-9,252 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $190,934 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $200,186 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $6,500 |
| 2018 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $687 |
| Total plan liabilities at beginning of year | 2018-12-31 | $687 |
| Total income from all sources | 2018-12-31 | $2,032 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $12,881 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $3,291 |
| Total plan assets at end of year | 2018-12-31 | $200,873 |
| Total plan assets at beginning of year | 2018-12-31 | $211,722 |
| Value of fidelity bond covering the plan | 2018-12-31 | $2,100,000 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $1,810 |
| Other income received | 2018-12-31 | $2,032 |
| Net income (gross income less expenses) | 2018-12-31 | $-10,849 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $200,186 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $211,035 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $7,780 |
| 2017 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $687 |
| Total plan liabilities at beginning of year | 2017-12-31 | $687 |
| Total income from all sources | 2017-12-31 | $533 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $13,543 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $3,127 |
| Total plan assets at end of year | 2017-12-31 | $211,722 |
| Total plan assets at beginning of year | 2017-12-31 | $224,732 |
| Value of fidelity bond covering the plan | 2017-12-31 | $2,100,000 |
| Expenses. Other expenses not covered elsewhere | 2017-12-31 | $1,996 |
| Other income received | 2017-12-31 | $533 |
| Net income (gross income less expenses) | 2017-12-31 | $-13,010 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $211,035 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $224,045 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $8,420 |
| 2016 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $687 |
| Total income from all sources | 2016-12-31 | $345 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $13,446 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $4,055 |
| Total plan assets at end of year | 2016-12-31 | $224,732 |
| Total plan assets at beginning of year | 2016-12-31 | $237,146 |
| Value of fidelity bond covering the plan | 2016-12-31 | $1,000,000 |
| Expenses. Other expenses not covered elsewhere | 2016-12-31 | $1,111 |
| Other income received | 2016-12-31 | $345 |
| Net income (gross income less expenses) | 2016-12-31 | $-13,101 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $224,045 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $237,146 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $8,280 |
| 2015 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2015 401k financial data |
|---|
| Total income from all sources | 2015-12-31 | $364 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $13,213 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $3,427 |
| Total plan assets at end of year | 2015-12-31 | $237,146 |
| Total plan assets at beginning of year | 2015-12-31 | $249,995 |
| Value of fidelity bond covering the plan | 2015-12-31 | $1,000,000 |
| Expenses. Other expenses not covered elsewhere | 2015-12-31 | $2,226 |
| Other income received | 2015-12-31 | $364 |
| Net income (gross income less expenses) | 2015-12-31 | $-12,849 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $237,146 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $249,995 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $7,560 |
| 2014 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2014 401k financial data |
|---|
| Total income from all sources | 2014-12-31 | $729 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $14,325 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $4,751 |
| Total plan assets at end of year | 2014-12-31 | $249,995 |
| Total plan assets at beginning of year | 2014-12-31 | $263,591 |
| Value of fidelity bond covering the plan | 2014-12-31 | $1,000,000 |
| Expenses. Other expenses not covered elsewhere | 2014-12-31 | $2,014 |
| Other income received | 2014-12-31 | $729 |
| Net income (gross income less expenses) | 2014-12-31 | $-13,596 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $249,995 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $263,591 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $7,560 |
| 2013 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2013 401k financial data |
|---|
| Total income from all sources | 2013-12-31 | $244 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $14,732 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $4,299 |
| Total plan assets at end of year | 2013-12-31 | $263,591 |
| Total plan assets at beginning of year | 2013-12-31 | $278,079 |
| Value of fidelity bond covering the plan | 2013-12-31 | $1,000,000 |
| Expenses. Other expenses not covered elsewhere | 2013-12-31 | $10,433 |
| Other income received | 2013-12-31 | $244 |
| Net income (gross income less expenses) | 2013-12-31 | $-14,488 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $263,591 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $278,079 |
| 2012 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-12-31 | $0 |
| Total plan liabilities at beginning of year | 2012-12-31 | $19 |
| Total income from all sources | 2012-12-31 | $746 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $13,783 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $5,166 |
| Total plan assets at end of year | 2012-12-31 | $278,079 |
| Total plan assets at beginning of year | 2012-12-31 | $291,135 |
| Value of fidelity bond covering the plan | 2012-12-31 | $100,000 |
| Expenses. Other expenses not covered elsewhere | 2012-12-31 | $8,617 |
| Other income received | 2012-12-31 | $746 |
| Net income (gross income less expenses) | 2012-12-31 | $-13,037 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $278,079 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $291,116 |
| 2011 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-12-31 | $19 |
| Total plan liabilities at beginning of year | 2011-12-31 | $1,369 |
| Total income from all sources | 2011-12-31 | $1,991 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $17,040 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $5,372 |
| Total plan assets at end of year | 2011-12-31 | $291,135 |
| Total plan assets at beginning of year | 2011-12-31 | $307,534 |
| Value of fidelity bond covering the plan | 2011-12-31 | $100,000 |
| Expenses. Other expenses not covered elsewhere | 2011-12-31 | $11,668 |
| Other income received | 2011-12-31 | $1,991 |
| Net income (gross income less expenses) | 2011-12-31 | $-15,049 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $291,116 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $306,165 |
| 2010 : OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2010 401k financial data |
|---|
| Total plan liabilities at end of year | 2010-12-31 | $1,350 |
| Total plan liabilities at beginning of year | 2010-12-31 | $337 |
| Total income from all sources | 2010-12-31 | $3,887 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $19,618 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $7,958 |
| Total plan assets at end of year | 2010-12-31 | $306,806 |
| Total plan assets at beginning of year | 2010-12-31 | $321,524 |
| Value of fidelity bond covering the plan | 2010-12-31 | $100,000 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $11,660 |
| Other income received | 2010-12-31 | $3,887 |
| Net income (gross income less expenses) | 2010-12-31 | $-15,731 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $305,456 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $321,187 |
| 2022: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Multi-employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Multi-employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Multi-employer plan |
| 2020-01-01 | Submission has been amended | No |
| 2020-01-01 | This submission is the final filing | No |
| 2020-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2020-01-01 | Plan is a collectively bargained plan | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Multi-employer plan |
| 2019-01-01 | Submission has been amended | No |
| 2019-01-01 | This submission is the final filing | No |
| 2019-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-01-01 | Plan is a collectively bargained plan | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Multi-employer plan |
| 2018-01-01 | Submission has been amended | No |
| 2018-01-01 | This submission is the final filing | No |
| 2018-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-01-01 | Plan is a collectively bargained plan | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2017: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Multi-employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Multi-employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Multi-employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Multi-employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Multi-employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Multi-employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Multi-employer plan |
| 2011-01-01 | Plan is a collectively bargained plan | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Multi-employer plan |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | Yes |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| 2009: OPERATIVE PLASTERERS AND CEMENT MASONS LOCAL 394 HEALTH & WELFARE PLAN 2009 form 5500 responses |
|---|
| 2009-01-01 | Type of plan entity | Multi-employer plan |
| 2009-01-01 | Submission has been amended | No |
| 2009-01-01 | This submission is the final filing | No |
| 2009-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-01-01 | Plan is a collectively bargained plan | Yes |
| 2009-01-01 | Plan funding arrangement – Trust | Yes |
| 2009-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-01-01 | Plan benefit arrangement - Trust | Yes |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,954 | | 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 number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 35 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $5,644 | | 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 number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $7,501 | | 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 number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,323 | | 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 number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,291 | | 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 number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,127 | | 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 number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $3,427 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of fees paid to insurance company | USD $4,751 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $4,751 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of fees paid to insurance company | USD $4,299 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $4,299 | | Insurance broker organization code? | 3 | | Insurance broker name | FRINGE BENEFIT PLANS |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 548144 |
| Policy instance | 1 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of fees paid to insurance company | USD $5,166 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,166 | | Insurance broker organization code? | 3 | | Insurance broker name | FRINGE BENEFIT PLANS |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 580078 |
| Policy instance | 1 |
| Insurance contract or identification number | 580078 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2011-09-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $166 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,201 | | 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 number | 548144 |
| Policy instance | 2 |
| Insurance contract or identification number | 548144 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2010-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $674 |
|
| PACIFICARE DENTAL & VISION ADMINISTRATORS (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 102584 |
| Policy instance | 1 |
| Insurance contract or identification number | 102584 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2009-10-01 | | Insurance policy end date | 2010-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $7,830 |
|
