JOINT BOARD OF TRUSTEES, CENTRAL CALIFOR ELECTRICAL WORKERS HEALTH & W has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CENTRAL CALIFORNIA ELECTRICAL WORKERS HEALTH & WELFARE PLAN
401k plan membership statisitcs for CENTRAL CALIFORNIA ELECTRICAL WORKERS HEALTH & WELFARE PLAN
| Measure | Date | Value |
|---|
| 2013 : CENTRAL CALIFORNIA ELECTRICAL WORKERS HEALTH & WELFARE PLAN 2013 401k financial data |
|---|
| Total transfer of assets from this plan | 2013-07-31 | $4,608,322 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-07-31 | $1,021,797 |
| Total income from all sources (including contributions) | 2013-07-31 | $3,332,397 |
| Total loss/gain on sale of assets | 2013-07-31 | $-33,088 |
| Total of all expenses incurred | 2013-07-31 | $2,217,757 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-07-31 | $1,914,768 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-07-31 | $3,334,656 |
| Value of total assets at beginning of year | 2013-07-31 | $4,515,479 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-07-31 | $302,989 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-07-31 | $30,829 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-07-31 | Yes |
| Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan | 2013-07-31 | $0 |
| Administrative expenses professional fees incurred | 2013-07-31 | $136,938 |
| Was this plan covered by a fidelity bond | 2013-07-31 | Yes |
| Value of fidelity bond cover | 2013-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-07-31 | No |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-07-31 | $253,128 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-07-31 | $52,425 |
| Administrative expenses (other) incurred | 2013-07-31 | $23,365 |
| Liabilities. Value of operating payables at beginning of year | 2013-07-31 | $17,355 |
| Total non interest bearing cash at beginning of year | 2013-07-31 | $4,167,229 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-07-31 | No |
| Value of net income/loss | 2013-07-31 | $1,114,640 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-07-31 | $3,493,682 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-07-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-07-31 | $677,087 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-07-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-07-31 | No |
| Contributions received in cash from employer | 2013-07-31 | $3,334,656 |
| Employer contributions (assets) at beginning of year | 2013-07-31 | $289,838 |
| Income. Dividends from common stock | 2013-07-31 | $30,829 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-07-31 | $984,553 |
| Contract administrator fees | 2013-07-31 | $142,686 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-07-31 | No |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-07-31 | $1,004,442 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2013-07-31 | $5,987 |
| Did the plan have assets held for investment | 2013-07-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-07-31 | Yes |
| Aggregate proceeds on sale of assets | 2013-07-31 | $2,797,664 |
| Aggregate carrying amount (costs) on sale of assets | 2013-07-31 | $2,830,752 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-07-31 | Unqualified |
| Accountancy firm name | 2013-07-31 | BERNARD KOTKIN AND COMPANY, LLP |
| Accountancy firm EIN | 2013-07-31 | 952556670 |
| 2012 : CENTRAL CALIFORNIA ELECTRICAL WORKERS HEALTH & WELFARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-07-31 | $1,021,797 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-07-31 | $922,181 |
| Total income from all sources (including contributions) | 2012-07-31 | $4,455,719 |
| Total loss/gain on sale of assets | 2012-07-31 | $1,523 |
| Total of all expenses incurred | 2012-07-31 | $3,214,169 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-07-31 | $3,006,503 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-07-31 | $4,454,073 |
| Value of total assets at end of year | 2012-07-31 | $4,515,479 |
| Value of total assets at beginning of year | 2012-07-31 | $3,174,313 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-07-31 | $207,666 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-07-31 | $123 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-07-31 | No |
| Administrative expenses professional fees incurred | 2012-07-31 | $96,265 |
| Was this plan covered by a fidelity bond | 2012-07-31 | Yes |
| Value of fidelity bond cover | 2012-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-07-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-07-31 | $52,425 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-07-31 | $47,433 |
| Administrative expenses (other) incurred | 2012-07-31 | $19,836 |
| Liabilities. Value of operating payables at end of year | 2012-07-31 | $17,355 |
| Liabilities. Value of operating payables at beginning of year | 2012-07-31 | $11,384 |
| Total non interest bearing cash at end of year | 2012-07-31 | $4,167,229 |
| Total non interest bearing cash at beginning of year | 2012-07-31 | $2,807,802 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-07-31 | No |
| Value of net income/loss | 2012-07-31 | $1,241,550 |
| Value of net assets at end of year (total assets less liabilities) | 2012-07-31 | $3,493,682 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-07-31 | $2,252,132 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-07-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-07-31 | $814,670 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-07-31 | No |
| Contributions received in cash from employer | 2012-07-31 | $4,454,073 |
| Employer contributions (assets) at end of year | 2012-07-31 | $289,838 |
| Employer contributions (assets) at beginning of year | 2012-07-31 | $286,253 |
| Income. Dividends from common stock | 2012-07-31 | $123 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-07-31 | $2,191,833 |
| Contract administrator fees | 2012-07-31 | $91,565 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-07-31 | No |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2012-07-31 | $26,009 |
| Liabilities. Value of benefit claims payable at end of year | 2012-07-31 | $1,004,442 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-07-31 | $910,797 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2012-07-31 | $5,987 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2012-07-31 | $6,816 |
| Did the plan have assets held for investment | 2012-07-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-07-31 | No |
| Aggregate proceeds on sale of assets | 2012-07-31 | $19,602 |
| Aggregate carrying amount (costs) on sale of assets | 2012-07-31 | $18,079 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-07-31 | Unqualified |
| Accountancy firm name | 2012-07-31 | BERNARD KOTKIN AND COMPANY, LLP |
| Accountancy firm EIN | 2012-07-31 | 952556670 |
| 2011 : CENTRAL CALIFORNIA ELECTRICAL WORKERS HEALTH & WELFARE PLAN 2011 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2011-07-31 | $-2,862 |
| Total unrealized appreciation/depreciation of assets | 2011-07-31 | $-2,862 |
| Total transfer of assets to this plan | 2011-07-31 | $131,336 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-07-31 | $922,181 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-07-31 | $319,810 |
| Total income from all sources (including contributions) | 2011-07-31 | $4,688,828 |
| Total of all expenses incurred | 2011-07-31 | $3,927,420 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-07-31 | $3,521,500 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-07-31 | $4,596,766 |
| Value of total assets at end of year | 2011-07-31 | $3,174,313 |
| Value of total assets at beginning of year | 2011-07-31 | $1,679,198 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-07-31 | $405,920 |
| Total interest from all sources | 2011-07-31 | $381 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-07-31 | $1,884 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-07-31 | No |
| Administrative expenses professional fees incurred | 2011-07-31 | $294,980 |
| Was this plan covered by a fidelity bond | 2011-07-31 | Yes |
| Value of fidelity bond cover | 2011-07-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-07-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-07-31 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-07-31 | $47,433 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-07-31 | $182,595 |
| Other income not declared elsewhere | 2011-07-31 | $92,659 |
| Administrative expenses (other) incurred | 2011-07-31 | $28,483 |
| Liabilities. Value of operating payables at end of year | 2011-07-31 | $11,384 |
| Liabilities. Value of operating payables at beginning of year | 2011-07-31 | $15,680 |
| Total non interest bearing cash at end of year | 2011-07-31 | $2,807,802 |
| Total non interest bearing cash at beginning of year | 2011-07-31 | $1,438,362 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-07-31 | No |
| Value of net income/loss | 2011-07-31 | $761,408 |
| Value of net assets at end of year (total assets less liabilities) | 2011-07-31 | $2,252,132 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-07-31 | $1,359,388 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-07-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-07-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-07-31 | No |
| Income. Interest from corporate debt instruments | 2011-07-31 | $381 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-07-31 | $1,073,421 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-07-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-07-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-07-31 | No |
| Contributions received in cash from employer | 2011-07-31 | $4,596,766 |
| Employer contributions (assets) at end of year | 2011-07-31 | $286,253 |
| Employer contributions (assets) at beginning of year | 2011-07-31 | $18,952 |
| Income. Dividends from common stock | 2011-07-31 | $1,884 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-07-31 | $2,448,079 |
| Contract administrator fees | 2011-07-31 | $82,457 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-07-31 | No |
| Assets. Corporate common stocks other than exployer securities at end of year | 2011-07-31 | $26,009 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2011-07-31 | $28,871 |
| Liabilities. Value of benefit claims payable at end of year | 2011-07-31 | $910,797 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-07-31 | $304,130 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2011-07-31 | $6,816 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2011-07-31 | $10,418 |
| Did the plan have assets held for investment | 2011-07-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-07-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-07-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-07-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-07-31 | Unqualified |
| Accountancy firm name | 2011-07-31 | BERNARD KOTKIN & COMPANY LLP |
| Accountancy firm EIN | 2011-07-31 | 952556670 |
| STOP LOSS INSURANCE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 21027-004 |
| Policy instance | 1 |
| Insurance contract or identification number | 21027-004 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $322,338 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | K100139001 |
| Policy instance | 2 |
| Insurance contract or identification number | K100139001 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,891 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 10000903-001 |
| Policy instance | 3 |
| Insurance contract or identification number | 10000903-001 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHEMICAL DEPENDENCY | | Welfare Benefit Premiums Paid to Carrier | USD $38,491 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | K100139 |
| Policy instance | 4 |
| Insurance contract or identification number | K100139 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,701 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 10000903-001 |
| Policy instance | 4 |
| Insurance contract or identification number | 10000903-001 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHEMICAL DEPENDENCY | | Welfare Benefit Premiums Paid to Carrier | USD $23,174 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | K100139001 |
| Policy instance | 3 |
| Insurance contract or identification number | K100139001 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| STOP LOSS INSURANCE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 21027-004 |
| Policy instance | 2 |
| Insurance contract or identification number | 21027-004 | | Number of Individuals Covered | 299 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $269,971 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PACIFICARE BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 70785 ) |
| Policy contract number | 10000903-001 |
| Policy instance | 1 |
| Insurance contract or identification number | 10000903-001 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2011-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHEMICAL DEPENDENCY | | Welfare Benefit Premiums Paid to Carrier | USD $17,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM BLUE CROSS LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62825 ) |
| Policy contract number | 275395M001 |
| Policy instance | 5 |
| Insurance contract or identification number | 275395M001 | | Number of Individuals Covered | 280 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $100,641 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ALLIANZ (National Association of Insurance Commissioners NAIC id number: ) |
| Policy contract number | 21027-004 |
| Policy instance | 2 |
| Insurance contract or identification number | 21027-004 | | Number of Individuals Covered | 293 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $254,160 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PACIFICARE BEHAVIORAL HEALTH (National Association of Insurance Commissioners NAIC id number: 70785 ) |
| Policy contract number | 10000903-001 |
| Policy instance | 1 |
| Insurance contract or identification number | 10000903-001 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | CHEMICAL DEPENDENCY | | Welfare Benefit Premiums Paid to Carrier | USD $44,739 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KANAWHA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65110 ) |
| Policy contract number | K100139001 |
| Policy instance | 3 |
| Insurance contract or identification number | K100139001 | | Number of Individuals Covered | 237 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,736 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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