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PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 401k Plan overview

Plan NamePRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN
Plan identification number 503

PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

PRUDENTIAL OVERALL SUPPLY has sponsored the creation of one or more 401k plans.

Company Name:PRUDENTIAL OVERALL SUPPLY
Employer identification number (EIN):956542231
NAIC Classification:812330
NAIC Description: Linen and Uniform Supply

Additional information about PRUDENTIAL OVERALL SUPPLY

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1993-03-15
Company Identification Number: 0009477106
Legal Registered Office Address: PO BOX 11210

SANTA ANA
United States of America (USA)
92711

More information about PRUDENTIAL OVERALL SUPPLY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5032021-10-01JANA COMER2023-07-14
5032020-10-01OMAR HURTADO2022-07-15
5032019-10-01JOHN THOMPSON2021-07-15
5032019-10-01OMAR HURTADO2023-08-11
5032018-10-01JOHN THOMPSON2020-07-14
5032017-10-01JOHN THOMPSON2019-07-15
5032016-10-01
5032015-10-01JOHN THOMPSON
5032014-10-01JOHN THOMPSON
5032014-10-01JOHN THOMPSON
5032013-10-01JOHN THOMPSON JOHN THOMPSON2015-07-15
5032012-10-01JOHN THOMPSON JOHN THOMPSON2014-07-14
5032011-10-01JOHN THOMPSON JOHN THOMPSON2013-07-12
5032010-10-01JOHN THOMPSON
5032009-10-01JOHN THOMPSON
5032008-10-01 JOHN THOMPSON2010-07-14

Plan Statistics for PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN

401k plan membership statisitcs for PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2021: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-011,290
Total number of active participants reported on line 7a of the Form 55002021-10-011,226
Number of retired or separated participants receiving benefits2021-10-016
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-011,232
2020: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-011,255
Total number of active participants reported on line 7a of the Form 55002020-10-011,299
Number of retired or separated participants receiving benefits2020-10-015
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-011,304
2019: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-011,330
Total number of active participants reported on line 7a of the Form 55002019-10-011,228
Number of retired or separated participants receiving benefits2019-10-017
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-011,235
2018: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-011,248
Total number of active participants reported on line 7a of the Form 55002018-10-011,335
Number of retired or separated participants receiving benefits2018-10-0110
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-011,345
2017: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-011,191
Total number of active participants reported on line 7a of the Form 55002017-10-011,218
Number of retired or separated participants receiving benefits2017-10-0110
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-011,228
2016: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-011,049
Total number of active participants reported on line 7a of the Form 55002016-10-011,191
Number of retired or separated participants receiving benefits2016-10-018
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-011,199
2015: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01864
Total number of active participants reported on line 7a of the Form 55002015-10-011,019
Number of retired or separated participants receiving benefits2015-10-0110
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-011,029
2014: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01813
Total number of active participants reported on line 7a of the Form 55002014-10-01858
Number of retired or separated participants receiving benefits2014-10-017
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01865
2013: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01841
Total number of active participants reported on line 7a of the Form 55002013-10-01836
Total of all active and inactive participants2013-10-01836
Total participants2013-10-01836
2012: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01885
Total number of active participants reported on line 7a of the Form 55002012-10-01863
Total of all active and inactive participants2012-10-01863
Total participants2012-10-01863
2011: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01925
Total number of active participants reported on line 7a of the Form 55002011-10-01885
Total of all active and inactive participants2011-10-01885
Total participants2011-10-01885
2010: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2010 401k membership
Total participants, beginning-of-year2010-10-011,067
Total number of active participants reported on line 7a of the Form 55002010-10-01925
Total of all active and inactive participants2010-10-01925
Total participants2010-10-01925
2009: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01939
Total number of active participants reported on line 7a of the Form 55002009-10-011,067
Total of all active and inactive participants2009-10-011,067
Total participants2009-10-011,067
2008: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2008 401k membership
Total participants, beginning-of-year2008-10-01794
Total number of active participants reported on line 7a of the Form 55002008-10-01939
Total of all active and inactive participants2008-10-01939
Total participants2008-10-01939
Number of employers contributing to the scheme2008-10-01939

Financial Data on PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN

Measure Date Value
2022 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$0
Total income from all sources (including contributions)2022-09-30$10,863,797
Total loss/gain on sale of assets2022-09-30$0
Total of all expenses incurred2022-09-30$11,346,503
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-09-30$10,648,442
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-09-30$10,863,797
Value of total assets at end of year2022-09-30$535,339
Value of total assets at beginning of year2022-09-30$1,018,045
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-09-30$698,061
Total interest from all sources2022-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2022-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-09-30No
Administrative expenses professional fees incurred2022-09-30$698,061
Was this plan covered by a fidelity bond2022-09-30Yes
Value of fidelity bond cover2022-09-30$5,000,000
Were there any nonexempt tranactions with any party-in-interest2022-09-30No
Contributions received from participants2022-09-30$2,172,759
Income. Received or receivable in cash from other sources (including rollovers)2022-09-30$79,869
Total non interest bearing cash at end of year2022-09-30$535,339
Total non interest bearing cash at beginning of year2022-09-30$1,018,045
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Value of net income/loss2022-09-30$-482,706
Value of net assets at end of year (total assets less liabilities)2022-09-30$535,339
Value of net assets at beginning of year (total assets less liabilities)2022-09-30$1,018,045
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-09-30No
Were any leases to which the plan was party in default or uncollectible2022-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2022-09-30$1,137,619
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-09-30No
Was there a failure to transmit to the plan any participant contributions2022-09-30No
Has the plan failed to provide any benefit when due under the plan2022-09-30No
Contributions received in cash from employer2022-09-30$8,611,169
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-09-30$9,510,823
Did the plan have assets held for investment2022-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-09-30No
Opinion of an independent qualified public accountant for this plan2022-09-30Unqualified
Accountancy firm name2022-09-30BAKER TILLY, US LLP
Accountancy firm EIN2022-09-30390859910
2021 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$0
Total income from all sources (including contributions)2021-09-30$9,666,397
Total loss/gain on sale of assets2021-09-30$0
Total of all expenses incurred2021-09-30$10,595,696
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-09-30$9,893,647
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-09-30$9,666,397
Value of total assets at end of year2021-09-30$1,018,045
Value of total assets at beginning of year2021-09-30$1,947,344
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-09-30$702,049
Total interest from all sources2021-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2021-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-09-30No
Administrative expenses professional fees incurred2021-09-30$702,049
Was this plan covered by a fidelity bond2021-09-30Yes
Value of fidelity bond cover2021-09-30$5,000,000
Were there any nonexempt tranactions with any party-in-interest2021-09-30No
Contributions received from participants2021-09-30$1,945,716
Income. Received or receivable in cash from other sources (including rollovers)2021-09-30$102,482
Total non interest bearing cash at end of year2021-09-30$1,018,045
Total non interest bearing cash at beginning of year2021-09-30$1,947,344
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Value of net income/loss2021-09-30$-929,299
Value of net assets at end of year (total assets less liabilities)2021-09-30$1,018,045
Value of net assets at beginning of year (total assets less liabilities)2021-09-30$1,947,344
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-09-30No
Were any leases to which the plan was party in default or uncollectible2021-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2021-09-30$881,699
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-09-30No
Was there a failure to transmit to the plan any participant contributions2021-09-30No
Has the plan failed to provide any benefit when due under the plan2021-09-30No
Contributions received in cash from employer2021-09-30$7,618,199
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-09-30$9,011,948
Did the plan have assets held for investment2021-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-09-30No
Opinion of an independent qualified public accountant for this plan2021-09-30Unqualified
Accountancy firm name2021-09-30BAKER TILLY, US LLP
Accountancy firm EIN2021-09-30390859910
2020 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$0
Total income from all sources (including contributions)2020-09-30$9,816,209
Total loss/gain on sale of assets2020-09-30$0
Total of all expenses incurred2020-09-30$9,925,700
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-09-30$9,143,980
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-09-30$9,816,209
Value of total assets at end of year2020-09-30$1,947,344
Value of total assets at beginning of year2020-09-30$2,056,835
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-09-30$781,720
Total interest from all sources2020-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2020-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-09-30No
Administrative expenses professional fees incurred2020-09-30$781,720
Was this plan covered by a fidelity bond2020-09-30Yes
Value of fidelity bond cover2020-09-30$5,000,000
Were there any nonexempt tranactions with any party-in-interest2020-09-30No
Contributions received from participants2020-09-30$1,974,466
Income. Received or receivable in cash from other sources (including rollovers)2020-09-30$98,632
Total non interest bearing cash at end of year2020-09-30$1,947,344
Total non interest bearing cash at beginning of year2020-09-30$2,056,835
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Value of net income/loss2020-09-30$-109,491
Value of net assets at end of year (total assets less liabilities)2020-09-30$1,947,344
Value of net assets at beginning of year (total assets less liabilities)2020-09-30$2,056,835
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-09-30No
Were any leases to which the plan was party in default or uncollectible2020-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2020-09-30$917,580
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-09-30No
Was there a failure to transmit to the plan any participant contributions2020-09-30No
Has the plan failed to provide any benefit when due under the plan2020-09-30No
Contributions received in cash from employer2020-09-30$7,743,111
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-09-30$8,226,400
Did the plan have assets held for investment2020-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-09-30No
Opinion of an independent qualified public accountant for this plan2020-09-30Unqualified
Accountancy firm name2020-09-30SQUAR MILNER LLP
Accountancy firm EIN2020-09-30330835986
2019 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$0
Total income from all sources (including contributions)2019-09-30$9,310,633
Total loss/gain on sale of assets2019-09-30$0
Total of all expenses incurred2019-09-30$9,014,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-09-30$8,324,441
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-09-30$9,310,633
Value of total assets at end of year2019-09-30$2,056,835
Value of total assets at beginning of year2019-09-30$1,760,909
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-09-30$690,266
Total interest from all sources2019-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2019-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-09-30No
Was this plan covered by a fidelity bond2019-09-30Yes
Value of fidelity bond cover2019-09-30$5,000,000
Were there any nonexempt tranactions with any party-in-interest2019-09-30No
Contributions received from participants2019-09-30$1,931,551
Income. Received or receivable in cash from other sources (including rollovers)2019-09-30$84,764
Administrative expenses (other) incurred2019-09-30$690,266
Total non interest bearing cash at end of year2019-09-30$2,056,835
Total non interest bearing cash at beginning of year2019-09-30$1,760,909
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Value of net income/loss2019-09-30$295,926
Value of net assets at end of year (total assets less liabilities)2019-09-30$2,056,835
Value of net assets at beginning of year (total assets less liabilities)2019-09-30$1,760,909
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-09-30No
Were any leases to which the plan was party in default or uncollectible2019-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2019-09-30$1,013,597
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-09-30No
Was there a failure to transmit to the plan any participant contributions2019-09-30No
Has the plan failed to provide any benefit when due under the plan2019-09-30No
Contributions received in cash from employer2019-09-30$7,294,318
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-09-30$7,310,844
Did the plan have assets held for investment2019-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-09-30No
Opinion of an independent qualified public accountant for this plan2019-09-30Unqualified
Accountancy firm name2019-09-30SQUAR MILNER LLP
Accountancy firm EIN2019-09-30330835986
2018 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$0
Total income from all sources (including contributions)2018-09-30$9,496,305
Total loss/gain on sale of assets2018-09-30$0
Total of all expenses incurred2018-09-30$8,586,580
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-09-30$7,979,676
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-09-30$9,496,305
Value of total assets at end of year2018-09-30$1,760,909
Value of total assets at beginning of year2018-09-30$851,184
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-09-30$606,904
Total interest from all sources2018-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2018-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-09-30No
Was this plan covered by a fidelity bond2018-09-30Yes
Value of fidelity bond cover2018-09-30$5,000,000
Were there any nonexempt tranactions with any party-in-interest2018-09-30No
Contributions received from participants2018-09-30$2,556,931
Income. Received or receivable in cash from other sources (including rollovers)2018-09-30$74,061
Administrative expenses (other) incurred2018-09-30$606,904
Total non interest bearing cash at end of year2018-09-30$1,760,909
Total non interest bearing cash at beginning of year2018-09-30$851,184
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Value of net income/loss2018-09-30$909,725
Value of net assets at end of year (total assets less liabilities)2018-09-30$1,760,909
Value of net assets at beginning of year (total assets less liabilities)2018-09-30$851,184
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-09-30No
Were any leases to which the plan was party in default or uncollectible2018-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2018-09-30$969,911
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-09-30No
Was there a failure to transmit to the plan any participant contributions2018-09-30No
Has the plan failed to provide any benefit when due under the plan2018-09-30No
Contributions received in cash from employer2018-09-30$6,865,313
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-09-30$7,009,765
Did the plan have assets held for investment2018-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-09-30No
Opinion of an independent qualified public accountant for this plan2018-09-30Unqualified
Accountancy firm name2018-09-30SQUAR MILNER LLP
Accountancy firm EIN2018-09-30330835986
2017 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$0
Total income from all sources (including contributions)2017-09-30$8,610,010
Total loss/gain on sale of assets2017-09-30$0
Total of all expenses incurred2017-09-30$8,686,905
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-09-30$7,905,798
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-09-30$8,610,010
Value of total assets at end of year2017-09-30$851,184
Value of total assets at beginning of year2017-09-30$928,079
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-09-30$781,107
Total interest from all sources2017-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2017-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-09-30No
Was this plan covered by a fidelity bond2017-09-30Yes
Value of fidelity bond cover2017-09-30$5,000,000
Were there any nonexempt tranactions with any party-in-interest2017-09-30No
Contributions received from participants2017-09-30$1,693,607
Income. Received or receivable in cash from other sources (including rollovers)2017-09-30$74,289
Administrative expenses (other) incurred2017-09-30$781,107
Total non interest bearing cash at end of year2017-09-30$851,184
Total non interest bearing cash at beginning of year2017-09-30$928,079
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Value of net income/loss2017-09-30$-76,895
Value of net assets at end of year (total assets less liabilities)2017-09-30$851,184
Value of net assets at beginning of year (total assets less liabilities)2017-09-30$928,079
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-09-30No
Were any leases to which the plan was party in default or uncollectible2017-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2017-09-30$900,189
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-09-30No
Was there a failure to transmit to the plan any participant contributions2017-09-30No
Has the plan failed to provide any benefit when due under the plan2017-09-30No
Contributions received in cash from employer2017-09-30$6,842,114
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-09-30$7,005,609
Did the plan have assets held for investment2017-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-09-30No
Opinion of an independent qualified public accountant for this plan2017-09-30Unqualified
Accountancy firm name2017-09-30SQUAR MILNER
Accountancy firm EIN2017-09-30330835986
2016 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$0
Total income from all sources (including contributions)2016-09-30$6,682,712
Total loss/gain on sale of assets2016-09-30$0
Total of all expenses incurred2016-09-30$6,764,245
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-09-30$6,081,817
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-09-30$6,682,712
Value of total assets at end of year2016-09-30$928,079
Value of total assets at beginning of year2016-09-30$1,009,612
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-09-30$682,428
Total interest from all sources2016-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2016-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-09-30No
Was this plan covered by a fidelity bond2016-09-30Yes
Value of fidelity bond cover2016-09-30$5,000,000
Were there any nonexempt tranactions with any party-in-interest2016-09-30No
Contributions received from participants2016-09-30$1,432,083
Income. Received or receivable in cash from other sources (including rollovers)2016-09-30$54,263
Administrative expenses (other) incurred2016-09-30$682,428
Total non interest bearing cash at end of year2016-09-30$928,079
Total non interest bearing cash at beginning of year2016-09-30$1,009,612
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Value of net income/loss2016-09-30$-81,533
Value of net assets at end of year (total assets less liabilities)2016-09-30$928,079
Value of net assets at beginning of year (total assets less liabilities)2016-09-30$1,009,612
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-09-30No
Were any leases to which the plan was party in default or uncollectible2016-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2016-09-30$712,442
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-09-30No
Was there a failure to transmit to the plan any participant contributions2016-09-30No
Has the plan failed to provide any benefit when due under the plan2016-09-30No
Contributions received in cash from employer2016-09-30$5,196,366
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-09-30$5,369,375
Did the plan have assets held for investment2016-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-09-30No
Opinion of an independent qualified public accountant for this plan2016-09-30Unqualified
Accountancy firm name2016-09-30SQUARMILNER
Accountancy firm EIN2016-09-30330835986
2015 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$223,281
Total income from all sources (including contributions)2015-09-30$6,468,766
Total loss/gain on sale of assets2015-09-30$0
Total of all expenses incurred2015-09-30$5,236,184
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-09-30$4,714,338
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-09-30$6,468,766
Value of total assets at end of year2015-09-30$1,009,612
Value of total assets at beginning of year2015-09-30$311
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-09-30$521,846
Total interest from all sources2015-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2015-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-09-30No
Was this plan covered by a fidelity bond2015-09-30Yes
Value of fidelity bond cover2015-09-30$5,000,000
Were there any nonexempt tranactions with any party-in-interest2015-09-30No
Contributions received from participants2015-09-30$1,303,867
Income. Received or receivable in cash from other sources (including rollovers)2015-09-30$35,399
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-09-30$223,281
Administrative expenses (other) incurred2015-09-30$521,846
Total non interest bearing cash at end of year2015-09-30$1,009,612
Total non interest bearing cash at beginning of year2015-09-30$311
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Value of net income/loss2015-09-30$1,232,582
Value of net assets at end of year (total assets less liabilities)2015-09-30$1,009,612
Value of net assets at beginning of year (total assets less liabilities)2015-09-30$-222,970
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-09-30No
Were any leases to which the plan was party in default or uncollectible2015-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2015-09-30$654,503
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-09-30No
Was there a failure to transmit to the plan any participant contributions2015-09-30No
Has the plan failed to provide any benefit when due under the plan2015-09-30No
Contributions received in cash from employer2015-09-30$5,129,500
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-09-30$4,059,835
Did the plan have assets held for investment2015-09-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-09-30No
Opinion of an independent qualified public accountant for this plan2015-09-30Unqualified
Accountancy firm name2015-09-30SQUARMILNER
Accountancy firm EIN2015-09-30330835986
2014 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$223,281
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$0
Total income from all sources (including contributions)2014-09-30$6,175,951
Total loss/gain on sale of assets2014-09-30$0
Total of all expenses incurred2014-09-30$6,688,723
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-09-30$6,303,309
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-09-30$6,175,951
Value of total assets at end of year2014-09-30$311
Value of total assets at beginning of year2014-09-30$289,802
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-09-30$385,414
Total interest from all sources2014-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2014-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-09-30No
Administrative expenses professional fees incurred2014-09-30$385,414
Was this plan covered by a fidelity bond2014-09-30Yes
Value of fidelity bond cover2014-09-30$5,000,000
If this is an individual account plan, was there a blackout period2014-09-30No
Were there any nonexempt tranactions with any party-in-interest2014-09-30No
Contributions received from participants2014-09-30$1,001,277
Income. Received or receivable in cash from other sources (including rollovers)2014-09-30$27,601
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-09-30$23,630
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-09-30$223,281
Total non interest bearing cash at end of year2014-09-30$311
Total non interest bearing cash at beginning of year2014-09-30$289,802
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Value of net income/loss2014-09-30$-512,772
Value of net assets at end of year (total assets less liabilities)2014-09-30$-222,970
Value of net assets at beginning of year (total assets less liabilities)2014-09-30$289,802
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-09-30No
Were any leases to which the plan was party in default or uncollectible2014-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2014-09-30$533,622
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-09-30No
Was there a failure to transmit to the plan any participant contributions2014-09-30No
Has the plan failed to provide any benefit when due under the plan2014-09-30No
Contributions received in cash from employer2014-09-30$5,147,073
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-09-30$5,746,057
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-09-30No
Did the plan have assets held for investment2014-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-09-30No
Opinion of an independent qualified public accountant for this plan2014-09-30Unqualified
Accountancy firm name2014-09-30SQUARMILNER
Accountancy firm EIN2014-09-30330835986
2013 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$575,903
Total income from all sources (including contributions)2013-09-30$7,385,606
Total loss/gain on sale of assets2013-09-30$0
Total of all expenses incurred2013-09-30$6,520,416
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-09-30$6,376,008
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-09-30$7,385,606
Value of total assets at end of year2013-09-30$289,802
Value of total assets at beginning of year2013-09-30$515
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-09-30$144,408
Total interest from all sources2013-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2013-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-09-30No
Administrative expenses professional fees incurred2013-09-30$12
Was this plan covered by a fidelity bond2013-09-30Yes
Value of fidelity bond cover2013-09-30$5,000,000
If this is an individual account plan, was there a blackout period2013-09-30No
Were there any nonexempt tranactions with any party-in-interest2013-09-30No
Contributions received from participants2013-09-30$615,839
Income. Received or receivable in cash from other sources (including rollovers)2013-09-30$56,871
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-09-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-09-30$575,903
Total non interest bearing cash at end of year2013-09-30$289,802
Total non interest bearing cash at beginning of year2013-09-30$515
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Income. Non cash contributions2013-09-30$0
Value of net income/loss2013-09-30$865,190
Value of net assets at end of year (total assets less liabilities)2013-09-30$289,802
Value of net assets at beginning of year (total assets less liabilities)2013-09-30$-575,388
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-09-30No
Were any leases to which the plan was party in default or uncollectible2013-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2013-09-30$618,037
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-09-30No
Was there a failure to transmit to the plan any participant contributions2013-09-30No
Has the plan failed to provide any benefit when due under the plan2013-09-30No
Contributions received in cash from employer2013-09-30$6,712,896
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-09-30$5,757,971
Contract administrator fees2013-09-30$144,396
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-09-30No
Did the plan have assets held for investment2013-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-09-30No
Opinion of an independent qualified public accountant for this plan2013-09-30Unqualified
Accountancy firm name2013-09-30SQUARMILNER
Accountancy firm EIN2013-09-30330835986
2012 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$575,903
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$725,500
Total income from all sources (including contributions)2012-09-30$6,188,752
Total of all expenses incurred2012-09-30$6,039,350
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-09-30$5,889,173
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-09-30$6,188,752
Value of total assets at end of year2012-09-30$515
Value of total assets at beginning of year2012-09-30$710
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-09-30$150,177
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-09-30No
Administrative expenses professional fees incurred2012-09-30$1,115
Was this plan covered by a fidelity bond2012-09-30Yes
Value of fidelity bond cover2012-09-30$5,000,000
If this is an individual account plan, was there a blackout period2012-09-30No
Were there any nonexempt tranactions with any party-in-interest2012-09-30No
Contributions received from participants2012-09-30$596,516
Income. Received or receivable in cash from other sources (including rollovers)2012-09-30$72,570
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-09-30$575,903
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-09-30$725,500
Administrative expenses (other) incurred2012-09-30$15,616
Total non interest bearing cash at end of year2012-09-30$515
Total non interest bearing cash at beginning of year2012-09-30$710
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Value of net income/loss2012-09-30$149,402
Value of net assets at end of year (total assets less liabilities)2012-09-30$-575,388
Value of net assets at beginning of year (total assets less liabilities)2012-09-30$-724,790
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-09-30No
Were any leases to which the plan was party in default or uncollectible2012-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2012-09-30$593,503
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-09-30No
Was there a failure to transmit to the plan any participant contributions2012-09-30No
Has the plan failed to provide any benefit when due under the plan2012-09-30No
Contributions received in cash from employer2012-09-30$5,519,666
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-09-30$5,295,670
Contract administrator fees2012-09-30$133,446
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-09-30No
Did the plan have assets held for investment2012-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-09-30No
Opinion of an independent qualified public accountant for this plan2012-09-30Unqualified
Accountancy firm name2012-09-30SQUAR MILNER
Accountancy firm EIN2012-09-30330835986
2011 : PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-09-30$725,500
Total income from all sources (including contributions)2011-09-30$4,807,651
Total of all expenses incurred2011-09-30$5,543,349
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-09-30$5,312,831
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-09-30$4,807,651
Value of total assets at end of year2011-09-30$710
Value of total assets at beginning of year2011-09-30$10,908
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-09-30$230,518
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-09-30No
Administrative expenses professional fees incurred2011-09-30$922
Was this plan covered by a fidelity bond2011-09-30Yes
Value of fidelity bond cover2011-09-30$5,000,000
If this is an individual account plan, was there a blackout period2011-09-30No
Were there any nonexempt tranactions with any party-in-interest2011-09-30No
Contributions received from participants2011-09-30$574,677
Income. Received or receivable in cash from other sources (including rollovers)2011-09-30$86,847
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-09-30$725,500
Administrative expenses (other) incurred2011-09-30$99,210
Total non interest bearing cash at end of year2011-09-30$710
Total non interest bearing cash at beginning of year2011-09-30$10,908
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Value of net income/loss2011-09-30$-735,698
Value of net assets at end of year (total assets less liabilities)2011-09-30$-724,790
Value of net assets at beginning of year (total assets less liabilities)2011-09-30$10,908
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-09-30No
Were any leases to which the plan was party in default or uncollectible2011-09-30No
Expenses. Payments to insurance carriers foe the provision of benefits2011-09-30$606,190
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-09-30No
Was there a failure to transmit to the plan any participant contributions2011-09-30No
Has the plan failed to provide any benefit when due under the plan2011-09-30No
Contributions received in cash from employer2011-09-30$4,146,127
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-09-30$4,706,641
Contract administrator fees2011-09-30$130,386
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-09-30No
Did the plan have assets held for investment2011-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-09-30No
Opinion of an independent qualified public accountant for this plan2011-09-30Disclaimer
Accountancy firm name2011-09-30SQUAR MILNER
Accountancy firm EIN2011-09-30330835986

Form 5500 Responses for PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN

2021: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Submission has been amendedNo
2021-10-01This submission is the final filingNo
2021-10-01This return/report is a short plan year return/report (less than 12 months)No
2021-10-01Plan is a collectively bargained planNo
2021-10-01Plan funding arrangement – TrustYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement - TrustYes
2020: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Submission has been amendedNo
2020-10-01This submission is the final filingNo
2020-10-01This return/report is a short plan year return/report (less than 12 months)No
2020-10-01Plan is a collectively bargained planNo
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – TrustYes
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement - TrustYes
2020-10-01Plan benefit arrangement – General assets of the sponsorYes
2019: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Submission has been amendedNo
2019-10-01This submission is the final filingNo
2019-10-01This return/report is a short plan year return/report (less than 12 months)No
2019-10-01Plan is a collectively bargained planNo
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – TrustYes
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement - TrustYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2018: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Submission has been amendedNo
2018-10-01This submission is the final filingNo
2018-10-01This return/report is a short plan year return/report (less than 12 months)No
2018-10-01Plan is a collectively bargained planNo
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – TrustYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement - TrustYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Submission has been amendedNo
2017-10-01This submission is the final filingNo
2017-10-01This return/report is a short plan year return/report (less than 12 months)No
2017-10-01Plan is a collectively bargained planNo
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – TrustYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement - TrustYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement - TrustYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – TrustYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement - TrustYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedYes
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – TrustYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement - TrustYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – TrustYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement - TrustYes
2012: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – TrustYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement - TrustYes
2011: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – TrustYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement - TrustYes
2010: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2010 form 5500 responses
2010-10-01Type of plan entitySingle employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planNo
2010-10-01Plan funding arrangement – TrustYes
2010-10-01Plan benefit arrangement – InsuranceYes
2010-10-01Plan benefit arrangement - TrustYes
2009: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – TrustYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan benefit arrangement - TrustYes
2008: PRUDENTIAL OVERALL SUPPLY EMPLOYEE WELFARE BENEFIT PLAN 2008 form 5500 responses
2008-10-01Type of plan entitySingle employer plan
2008-10-01Submission has been amendedNo
2008-10-01This submission is the final filingNo
2008-10-01This return/report is a short plan year return/report (less than 12 months)No
2008-10-01Plan is a collectively bargained planNo
2008-10-01Plan funding arrangement – TrustYes
2008-10-01Plan benefit arrangement – InsuranceYes
2008-10-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract number21996
Policy instance 1
Insurance contract or identification number21996
Number of Individuals Covered1256
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Total amount of commissions paid to insurance brokerUSD $128,640
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $1,111,708
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $128,640
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number682808
Policy instance 6
Insurance contract or identification number682808
Number of Individuals Covered264
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $18,041
Total amount of fees paid to insurance companyUSD $2,973
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedVOLUNTARY SHORT TERM DISABILITY
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 $118,937
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $18,041
Amount paid for insurance broker fees2973
Additional information about fees paid to insurance brokerENHANCED COMMISSION COMPENSATION
Insurance broker organization code?3
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number682807
Policy instance 5
Insurance contract or identification number682807
Number of Individuals Covered755
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $33,178
Total amount of fees paid to insurance companyUSD $5,496
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedLIFESTYLE LIFE AND ACCIDENTAL DEATH AND DISMEMBERMENT
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $219,856
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $33,178
Amount paid for insurance broker fees5496
Additional information about fees paid to insurance brokerENHANCED COMMISSION COMPENSATION
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number21996
Policy instance 4
Insurance contract or identification number21996
Number of Individuals Covered4
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
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 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 $35,250
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number422840
Policy instance 3
Insurance contract or identification number422840
Number of Individuals Covered1839
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $4,121
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $329,658
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees4121
Additional information about fees paid to insurance brokerENHANCED COMMISSION COMPENSATION
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number26835
Policy instance 2
Insurance contract or identification number26835
Number of Individuals Covered38
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
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 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 $252,756
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number107225
Policy instance 1
Insurance contract or identification number107225
Number of Individuals Covered200
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
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 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 $1,148,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberHCL16829
Policy instance 1
Insurance contract or identification numberHCL16829
Number of Individuals Covered1228
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $83,717
Total amount of fees paid to insurance companyUSD $15,843
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 $917,580
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $83,717
Insurance broker organization code?3
Amount paid for insurance broker fees15843
Additional information about fees paid to insurance brokerBONUS
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number21996
Policy instance 4
Insurance contract or identification number21996
Number of Individuals Covered10
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
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 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 $599,120
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number422840
Policy instance 3
Insurance contract or identification number422840
Number of Individuals Covered1686
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $16,519
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $296,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees16519
Additional information about fees paid to insurance brokerENHANCED COMMISSION COMPENSATION
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number26835
Policy instance 2
Insurance contract or identification number26835
Number of Individuals Covered38
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
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 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 $225,992
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number107225
Policy instance 1
Insurance contract or identification number107225
Number of Individuals Covered194
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
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 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 $1,176,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 )
Policy contract number21996
Policy instance 4
Insurance contract or identification number21996
Number of Individuals Covered7
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
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 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 $46,090
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number422840
Policy instance 3
Insurance contract or identification number422840
Number of Individuals Covered1839
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $284,081
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number107225
Policy instance 1
Insurance contract or identification number107225
Number of Individuals Covered212
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
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 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 $1,153,946
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number26835
Policy instance 2
Insurance contract or identification number26835
Number of Individuals Covered33
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
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 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 $185,901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number26835
Policy instance 2
Insurance contract or identification number26835
Number of Individuals Covered21
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
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 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 $114,589
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNUM LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 62235 )
Policy contract number422840
Policy instance 3
Insurance contract or identification number422840
Number of Individuals Covered1717
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
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 BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $300,092
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number107225
Policy instance 1
Insurance contract or identification number107225
Number of Individuals Covered197
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
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 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 $1,094,938
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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