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TOP NOTCH DISTRIBUTORS, INC. 401k Plan overview

Plan NameTOP NOTCH DISTRIBUTORS, INC.
Plan identification number 501

TOP NOTCH DISTRIBUTORS, INC. Benefits

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

401k Sponsoring company profile

TOP NOTCH DISTRIBUTORS INC has sponsored the creation of one or more 401k plans.

Company Name:TOP NOTCH DISTRIBUTORS INC
Employer identification number (EIN):930940340
NAIC Classification:423700

Additional information about TOP NOTCH DISTRIBUTORS INC

Jurisdiction of Incorporation: Nevada Department of State
Incorporation Date: 1986-12-16
Company Identification Number: 19861023808
Legal Registered Office Address: 402 NORTH DIVISION STREET

CARSON CITY
United States of America (USA)
89703

More information about TOP NOTCH DISTRIBUTORS INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TOP NOTCH DISTRIBUTORS, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01
5012020-08-01
5012020-08-01
5012019-08-01
5012018-08-01
5012017-08-01PAMELA POWELL PAMELA POWELL2019-03-20
5012016-08-01PAMELA POWELL
5012015-08-01PAMELA POWELL
5012014-08-01PAMELA POWELL
5012013-08-01PAMELA POWELL
5012012-08-01PAMELA POWELL
5012011-08-01PAMELA POWELL
5012010-08-01PAMELA POWELL
5012009-08-01PAMELA POWELL

Plan Statistics for TOP NOTCH DISTRIBUTORS, INC.

401k plan membership statisitcs for TOP NOTCH DISTRIBUTORS, INC.

Measure Date Value
2021: TOP NOTCH DISTRIBUTORS, INC. 2021 401k membership
Total participants, beginning-of-year2021-07-01176
Total number of active participants reported on line 7a of the Form 55002021-07-01164
Number of retired or separated participants receiving benefits2021-07-010
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01164
2020: TOP NOTCH DISTRIBUTORS, INC. 2020 401k membership
Total participants, beginning-of-year2020-08-01185
Total number of active participants reported on line 7a of the Form 55002020-08-01175
Number of retired or separated participants receiving benefits2020-08-011
Number of other retired or separated participants entitled to future benefits2020-08-010
Total of all active and inactive participants2020-08-01176
2019: TOP NOTCH DISTRIBUTORS, INC. 2019 401k membership
Total participants, beginning-of-year2019-08-01597
Total number of active participants reported on line 7a of the Form 55002019-08-01184
Number of retired or separated participants receiving benefits2019-08-011
Number of other retired or separated participants entitled to future benefits2019-08-010
Total of all active and inactive participants2019-08-01185
2018: TOP NOTCH DISTRIBUTORS, INC. 2018 401k membership
Total participants, beginning-of-year2018-08-01597
Total number of active participants reported on line 7a of the Form 55002018-08-01597
Total of all active and inactive participants2018-08-01597
Total participants2018-08-01597
Number of employers contributing to the scheme2018-08-010
2017: TOP NOTCH DISTRIBUTORS, INC. 2017 401k membership
Total participants, beginning-of-year2017-08-01295
Total number of active participants reported on line 7a of the Form 55002017-08-01295
Total of all active and inactive participants2017-08-01295
Total participants2017-08-01295
Number of employers contributing to the scheme2017-08-010
2016: TOP NOTCH DISTRIBUTORS, INC. 2016 401k membership
Total participants, beginning-of-year2016-08-01253
Total number of active participants reported on line 7a of the Form 55002016-08-01253
Number of retired or separated participants receiving benefits2016-08-010
Number of other retired or separated participants entitled to future benefits2016-08-010
Total of all active and inactive participants2016-08-01253
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-08-010
Total participants2016-08-01253
Number of participants with account balances2016-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-08-010
Number of employers contributing to the scheme2016-08-010
2015: TOP NOTCH DISTRIBUTORS, INC. 2015 401k membership
Total participants, beginning-of-year2015-08-01199
Total number of active participants reported on line 7a of the Form 55002015-08-01199
Number of retired or separated participants receiving benefits2015-08-010
Number of other retired or separated participants entitled to future benefits2015-08-010
Total of all active and inactive participants2015-08-01199
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-08-010
Total participants2015-08-01199
Number of participants with account balances2015-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-08-010
Number of employers contributing to the scheme2015-08-010
2014: TOP NOTCH DISTRIBUTORS, INC. 2014 401k membership
Total participants, beginning-of-year2014-08-01126
Total number of active participants reported on line 7a of the Form 55002014-08-01128
Number of retired or separated participants receiving benefits2014-08-010
Total of all active and inactive participants2014-08-01128
Total participants2014-08-01128
Number of participants with account balances2014-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-08-010
2013: TOP NOTCH DISTRIBUTORS, INC. 2013 401k membership
Total participants, beginning-of-year2013-08-01110
Total number of active participants reported on line 7a of the Form 55002013-08-01120
Number of retired or separated participants receiving benefits2013-08-011
Number of other retired or separated participants entitled to future benefits2013-08-010
Total of all active and inactive participants2013-08-01121
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-08-010
Total participants2013-08-01121
Number of participants with account balances2013-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-08-010
2012: TOP NOTCH DISTRIBUTORS, INC. 2012 401k membership
Total participants, beginning-of-year2012-08-01102
Total number of active participants reported on line 7a of the Form 55002012-08-01101
Number of retired or separated participants receiving benefits2012-08-016
Number of other retired or separated participants entitled to future benefits2012-08-010
Total of all active and inactive participants2012-08-01107
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-08-010
Total participants2012-08-01107
Number of participants with account balances2012-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-08-010
2011: TOP NOTCH DISTRIBUTORS, INC. 2011 401k membership
Total participants, beginning-of-year2011-08-01102
Total number of active participants reported on line 7a of the Form 55002011-08-01101
Number of retired or separated participants receiving benefits2011-08-011
Number of other retired or separated participants entitled to future benefits2011-08-010
Total of all active and inactive participants2011-08-01102
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-08-010
Total participants2011-08-01102
Number of participants with account balances2011-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-08-010
2010: TOP NOTCH DISTRIBUTORS, INC. 2010 401k membership
Total participants, beginning-of-year2010-08-01108
Total number of active participants reported on line 7a of the Form 55002010-08-0197
Number of retired or separated participants receiving benefits2010-08-015
Number of other retired or separated participants entitled to future benefits2010-08-010
Total of all active and inactive participants2010-08-01102
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-08-010
Total participants2010-08-01102
Number of participants with account balances2010-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-08-010
2009: TOP NOTCH DISTRIBUTORS, INC. 2009 401k membership
Total participants, beginning-of-year2009-08-01131
Total number of active participants reported on line 7a of the Form 55002009-08-01102
Number of retired or separated participants receiving benefits2009-08-016
Number of other retired or separated participants entitled to future benefits2009-08-010
Total of all active and inactive participants2009-08-01108
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-08-010
Total participants2009-08-01108
Number of participants with account balances2009-08-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-08-010

Financial Data on TOP NOTCH DISTRIBUTORS, INC.

Measure Date Value
2022 : TOP NOTCH DISTRIBUTORS, INC. 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$220,350
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$217,799
Total income from all sources (including contributions)2022-06-30$1,675,969
Total loss/gain on sale of assets2022-06-30$0
Total of all expenses incurred2022-06-30$1,633,803
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$1,555,190
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$1,675,397
Value of total assets at end of year2022-06-30$240,885
Value of total assets at beginning of year2022-06-30$196,168
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$78,613
Total interest from all sources2022-06-30$572
Total dividends received (eg from common stock, registered investment company shares)2022-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Was this plan covered by a fidelity bond2022-06-30Yes
Value of fidelity bond cover2022-06-30$500,000
If this is an individual account plan, was there a blackout period2022-06-30No
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$606,230
Income. Received or receivable in cash from other sources (including rollovers)2022-06-30$12,597
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-06-30$111,314
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-06-30$103,465
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$42,166
Value of net assets at end of year (total assets less liabilities)2022-06-30$20,535
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$-21,631
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-06-30$240,885
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-06-30$196,168
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-06-30$196,168
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-06-30$572
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$355,037
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30Yes
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$1,056,570
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$1,200,153
Contract administrator fees2022-06-30$78,613
Liabilities. Value of benefit claims payable at end of year2022-06-30$109,036
Liabilities. Value of benefit claims payable at beginning of year2022-06-30$114,334
Did the plan have assets held for investment2022-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Opinion of an independent qualified public accountant for this plan2022-06-30Unqualified
Accountancy firm name2022-06-30MCGRAIL MERKEL QUINN & ASSOCIATES
Accountancy firm EIN2022-06-30232226550
2021 : TOP NOTCH DISTRIBUTORS, INC. 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$217,799
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$0
Total income from all sources (including contributions)2021-06-30$1,438,965
Total loss/gain on sale of assets2021-06-30$0
Total of all expenses incurred2021-06-30$1,460,596
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$1,382,537
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$1,438,722
Value of total assets at end of year2021-06-30$196,168
Value of total assets at beginning of year2021-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$78,059
Total interest from all sources2021-06-30$243
Total dividends received (eg from common stock, registered investment company shares)2021-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Was this plan covered by a fidelity bond2021-06-30Yes
Value of fidelity bond cover2021-06-30$500,000
If this is an individual account plan, was there a blackout period2021-06-30No
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$548,367
Income. Received or receivable in cash from other sources (including rollovers)2021-06-30$7,254
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-06-30$103,465
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-06-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$-21,631
Value of net assets at end of year (total assets less liabilities)2021-06-30$-21,631
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-06-30$196,168
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-06-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-06-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-06-30$243
Expenses. Payments to insurance carriers foe the provision of benefits2021-06-30$304,915
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30Yes
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$883,101
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$1,077,622
Contract administrator fees2021-06-30$78,059
Liabilities. Value of benefit claims payable at end of year2021-06-30$114,334
Liabilities. Value of benefit claims payable at beginning of year2021-06-30$0
Did the plan have assets held for investment2021-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Unqualified
Accountancy firm name2021-06-30MCGRAIL MERKEL QUINN & ASSOCIATES
Accountancy firm EIN2021-06-30232226550

Form 5500 Responses for TOP NOTCH DISTRIBUTORS, INC.

2021: TOP NOTCH DISTRIBUTORS, INC. 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Submission has been amendedNo
2021-07-01This submission is the final filingNo
2021-07-01This return/report is a short plan year return/report (less than 12 months)No
2021-07-01Plan is a collectively bargained planNo
2021-07-01Plan funding arrangement – InsuranceYes
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan funding arrangement – General assets of the sponsorYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement - TrustYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: TOP NOTCH DISTRIBUTORS, INC. 2020 form 5500 responses
2020-08-01Type of plan entitySingle employer plan
2020-08-01Submission has been amendedNo
2020-08-01This submission is the final filingNo
2020-08-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-08-01Plan is a collectively bargained planNo
2020-08-01Plan funding arrangement – InsuranceYes
2020-08-01Plan funding arrangement – General assets of the sponsorYes
2020-08-01Plan benefit arrangement – InsuranceYes
2020-08-01Plan benefit arrangement – General assets of the sponsorYes
2019: TOP NOTCH DISTRIBUTORS, INC. 2019 form 5500 responses
2019-08-01Type of plan entitySingle employer plan
2019-08-01Submission has been amendedNo
2019-08-01This submission is the final filingNo
2019-08-01This return/report is a short plan year return/report (less than 12 months)No
2019-08-01Plan is a collectively bargained planNo
2019-08-01Plan funding arrangement – InsuranceYes
2019-08-01Plan benefit arrangement – InsuranceYes
2018: TOP NOTCH DISTRIBUTORS, INC. 2018 form 5500 responses
2018-08-01Type of plan entitySingle employer plan
2018-08-01Submission has been amendedNo
2018-08-01This submission is the final filingNo
2018-08-01This return/report is a short plan year return/report (less than 12 months)No
2018-08-01Plan is a collectively bargained planNo
2018-08-01Plan funding arrangement – InsuranceYes
2018-08-01Plan benefit arrangement – InsuranceYes
2017: TOP NOTCH DISTRIBUTORS, INC. 2017 form 5500 responses
2017-08-01Type of plan entitySingle employer plan
2017-08-01Submission has been amendedNo
2017-08-01This submission is the final filingNo
2017-08-01This return/report is a short plan year return/report (less than 12 months)No
2017-08-01Plan is a collectively bargained planNo
2017-08-01Plan funding arrangement – InsuranceYes
2017-08-01Plan benefit arrangement – InsuranceYes
2016: TOP NOTCH DISTRIBUTORS, INC. 2016 form 5500 responses
2016-08-01Type of plan entitySingle employer plan
2016-08-01Submission has been amendedNo
2016-08-01This submission is the final filingNo
2016-08-01This return/report is a short plan year return/report (less than 12 months)No
2016-08-01Plan is a collectively bargained planNo
2016-08-01Plan funding arrangement – InsuranceYes
2016-08-01Plan benefit arrangement – InsuranceYes
2015: TOP NOTCH DISTRIBUTORS, INC. 2015 form 5500 responses
2015-08-01Type of plan entitySingle employer plan
2015-08-01Submission has been amendedNo
2015-08-01This submission is the final filingNo
2015-08-01This return/report is a short plan year return/report (less than 12 months)No
2015-08-01Plan is a collectively bargained planNo
2015-08-01Plan funding arrangement – InsuranceYes
2015-08-01Plan benefit arrangement – InsuranceYes
2014: TOP NOTCH DISTRIBUTORS, INC. 2014 form 5500 responses
2014-08-01Type of plan entitySingle employer plan
2014-08-01Submission has been amendedNo
2014-08-01This submission is the final filingNo
2014-08-01This return/report is a short plan year return/report (less than 12 months)No
2014-08-01Plan is a collectively bargained planNo
2014-08-01Plan funding arrangement – InsuranceYes
2014-08-01Plan benefit arrangement – InsuranceYes
2013: TOP NOTCH DISTRIBUTORS, INC. 2013 form 5500 responses
2013-08-01Type of plan entitySingle employer plan
2013-08-01Submission has been amendedNo
2013-08-01This submission is the final filingNo
2013-08-01This return/report is a short plan year return/report (less than 12 months)No
2013-08-01Plan is a collectively bargained planNo
2013-08-01Plan funding arrangement – InsuranceYes
2013-08-01Plan benefit arrangement – InsuranceYes
2012: TOP NOTCH DISTRIBUTORS, INC. 2012 form 5500 responses
2012-08-01Type of plan entitySingle employer plan
2012-08-01Submission has been amendedNo
2012-08-01This submission is the final filingNo
2012-08-01This return/report is a short plan year return/report (less than 12 months)No
2012-08-01Plan is a collectively bargained planNo
2012-08-01Plan funding arrangement – InsuranceYes
2012-08-01Plan benefit arrangement – InsuranceYes
2011: TOP NOTCH DISTRIBUTORS, INC. 2011 form 5500 responses
2011-08-01Type of plan entitySingle employer plan
2011-08-01Submission has been amendedNo
2011-08-01This submission is the final filingNo
2011-08-01This return/report is a short plan year return/report (less than 12 months)No
2011-08-01Plan is a collectively bargained planNo
2011-08-01Plan funding arrangement – InsuranceYes
2011-08-01Plan benefit arrangement – InsuranceYes
2010: TOP NOTCH DISTRIBUTORS, INC. 2010 form 5500 responses
2010-08-01Type of plan entitySingle employer plan
2010-08-01Submission has been amendedNo
2010-08-01This submission is the final filingNo
2010-08-01This return/report is a short plan year return/report (less than 12 months)No
2010-08-01Plan is a collectively bargained planNo
2010-08-01Plan funding arrangement – InsuranceYes
2010-08-01Plan benefit arrangement – InsuranceYes
2009: TOP NOTCH DISTRIBUTORS, INC. 2009 form 5500 responses
2009-08-01Type of plan entitySingle employer plan
2009-08-01Submission has been amendedNo
2009-08-01This submission is the final filingNo
2009-08-01This return/report is a short plan year return/report (less than 12 months)No
2009-08-01Plan is a collectively bargained planNo
2009-08-01Plan funding arrangement – InsuranceYes
2009-08-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number31000151
Policy instance 1
Insurance contract or identification number31000151
Number of Individuals Covered164
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
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
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 $355,037
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 )
Policy contract number31000151
Policy instance 1
Insurance contract or identification number31000151
Number of Individuals Covered175
Insurance policy start date2020-08-01
Insurance policy end date2021-06-30
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
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 $304,915
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number116813
Policy instance 1
Insurance contract or identification number116813
Number of Individuals Covered293
Insurance policy start date2019-08-01
Insurance policy end date2020-07-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
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 $1,653,031
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number116813
Policy instance 1
Insurance contract or identification number116813
Number of Individuals Covered597
Insurance policy start date2018-08-01
Insurance policy end date2019-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number01785069
Policy instance 1
Insurance contract or identification number01785069
Number of Individuals Covered295
Insurance policy start date2017-08-01
Insurance policy end date2018-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 )
Policy contract number052629 500996
Policy instance 1
Insurance contract or identification number052629 500996
Number of Individuals Covered199
Insurance policy start date2015-08-01
Insurance policy end date2016-07-31
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 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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 )
Policy contract number052629 204377
Policy instance 1
Insurance contract or identification number052629 204377
Number of Individuals Covered185
Insurance policy start date2014-08-01
Insurance policy end date2015-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 )
Policy contract number051979 052629
Policy instance 1
Insurance contract or identification number051979 052629
Number of Individuals Covered186
Insurance policy start date2013-08-01
Insurance policy end date2014-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare 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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 )
Policy contract number051979 052629
Policy instance 1
Insurance contract or identification number051979 052629
Number of Individuals Covered154
Insurance policy start date2012-08-01
Insurance policy end date2013-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 )
Policy contract number052629
Policy instance 1
Insurance contract or identification number052629
Number of Individuals Covered145
Insurance policy start date2011-08-01
Insurance policy end date2012-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS OF NORTHEASTERN PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 60147 )
Policy contract number052629
Policy instance 1
Insurance contract or identification number052629
Number of Individuals Covered157
Insurance policy start date2010-08-01
Insurance policy end date2011-07-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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