401k Plan data: EMPLOYERS HEALTH INSURANCE TRUST plan

EMPLOYERS HEALTH INSURANCE TRUST 401k Plan overview

Plan Name	EMPLOYERS HEALTH INSURANCE TRUST
Plan identification number	501

EMPLOYERS HEALTH INSURANCE TRUST Benefits

401k Plan Type	Welfare 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) Other welfare benefit cover

401k Sponsoring company profile

MANUFACTURERS ASSOCIATION OF SOUTH CENTRAL PENNSYLVANIA has sponsored the creation of one or more 401k plans.

Company Name: MANUFACTURERS ASSOCIATION OF SOUTH CENTRAL PENNSYLVANIA

Employer identification number (EIN): 236277461

NAIC Classification: 541600

Form 5500 Filing Information

Submission information for form 5500 for 401k plan EMPLOYERS HEALTH INSURANCE TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2015-01-01
501 2014-01-01
501 2013-01-01
501 2012-01-01 MICHAEL SMELTZER
501 2011-01-01 MICHAEL SMELTZER
501 2009-01-01 MICHAEL SMELTZER

Plan Statistics for EMPLOYERS HEALTH INSURANCE TRUST

401k plan membership statisitcs for EMPLOYERS HEALTH INSURANCE TRUST

Measure Date Value
2014: EMPLOYERS HEALTH INSURANCE TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 287
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 0
Total of all active and inactive participants 2014-01-01 0
2013: EMPLOYERS HEALTH INSURANCE TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 303
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 287
Total of all active and inactive participants 2013-01-01 287
2012: EMPLOYERS HEALTH INSURANCE TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 311
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 303
Total of all active and inactive participants 2012-01-01 303
2011: EMPLOYERS HEALTH INSURANCE TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 1,420
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 311
Number of retired or separated participants receiving benefits 2011-01-01 0
Total of all active and inactive participants 2011-01-01 311
2009: EMPLOYERS HEALTH INSURANCE TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 1,603
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 1,396
Number of retired or separated participants receiving benefits 2009-01-01 31
Total of all active and inactive participants 2009-01-01 1,427

Measure	Date	Value
2014: EMPLOYERS HEALTH INSURANCE TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	287
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	0
Total of all active and inactive participants	2014-01-01	0
2013: EMPLOYERS HEALTH INSURANCE TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	303
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	287
Total of all active and inactive participants	2013-01-01	287
2012: EMPLOYERS HEALTH INSURANCE TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	311
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	303
Total of all active and inactive participants	2012-01-01	303
2011: EMPLOYERS HEALTH INSURANCE TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	1,420
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	311
Number of retired or separated participants receiving benefits	2011-01-01	0
Total of all active and inactive participants	2011-01-01	311
2009: EMPLOYERS HEALTH INSURANCE TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	1,603
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	1,396
Number of retired or separated participants receiving benefits	2009-01-01	31
Total of all active and inactive participants	2009-01-01	1,427

Financial Data on EMPLOYERS HEALTH INSURANCE TRUST

Measure	Date	Value
2014 : EMPLOYERS HEALTH INSURANCE TRUST 2014 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$5,810
Total income from all sources (including contributions)	2014-12-31	$63,784
Total of all expenses incurred	2014-12-31	$72,098
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$61,471
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$63,784
Value of total assets at end of year	2014-12-31	$4,076
Value of total assets at beginning of year	2014-12-31	$18,200
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$10,627
Administrative expenses professional fees incurred	2014-12-31	$4,750
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$36,564
Participant contributions at end of year	2014-12-31	$441
Participant contributions at beginning of year	2014-12-31	$1,307
Income. Received or receivable in cash from other sources (including rollovers)	2014-12-31	$501
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-12-31	$5,810
Administrative expenses (other) incurred	2014-12-31	$5,877
Total non interest bearing cash at end of year	2014-12-31	$3,312
Total non interest bearing cash at beginning of year	2014-12-31	$14,466
Value of net income/loss	2014-12-31	$-8,314
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$4,076
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$12,390
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$61,471
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$26,719
Employer contributions (assets) at end of year	2014-12-31	$323
Employer contributions (assets) at beginning of year	2014-12-31	$2,427
Did the plan have assets held for investment	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	STAMBAUGH NESS PC
Accountancy firm EIN	2014-12-31	232846715
2013 : EMPLOYERS HEALTH INSURANCE TRUST 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$5,810
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$16,314
Total income from all sources (including contributions)	2013-12-31	$70,751
Total of all expenses incurred	2013-12-31	$73,486
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$68,736
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$70,751
Value of total assets at end of year	2013-12-31	$18,200
Value of total assets at beginning of year	2013-12-31	$31,439
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$4,750
Administrative expenses professional fees incurred	2013-12-31	$4,750
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$24,673
Participant contributions at end of year	2013-12-31	$1,307
Participant contributions at beginning of year	2013-12-31	$978
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-12-31	$5,810
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-12-31	$16,314
Total non interest bearing cash at end of year	2013-12-31	$14,466
Total non interest bearing cash at beginning of year	2013-12-31	$29,380
Value of net income/loss	2013-12-31	$-2,735
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$12,390
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$15,125
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$68,736
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$46,078
Employer contributions (assets) at end of year	2013-12-31	$2,427
Employer contributions (assets) at beginning of year	2013-12-31	$1,081
Did the plan have assets held for investment	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	STAMBAUGH NESS PC
Accountancy firm EIN	2013-12-31	232846715
2012 : EMPLOYERS HEALTH INSURANCE TRUST 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$16,314
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$5,857
Total income from all sources (including contributions)	2012-12-31	$64,992
Total of all expenses incurred	2012-12-31	$73,627
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$63,043
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$64,992
Value of total assets at end of year	2012-12-31	$31,439
Value of total assets at beginning of year	2012-12-31	$29,617
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$10,584
Administrative expenses professional fees incurred	2012-12-31	$10,584
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$30,878
Participant contributions at end of year	2012-12-31	$1,081
Participant contributions at beginning of year	2012-12-31	$1,415
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-12-31	$5,212
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-12-31	$16,314
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-12-31	$5,857
Total non interest bearing cash at end of year	2012-12-31	$29,380
Total non interest bearing cash at beginning of year	2012-12-31	$21,819
Value of net income/loss	2012-12-31	$-8,635
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$15,125
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$23,760
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$63,043
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$34,114
Employer contributions (assets) at end of year	2012-12-31	$978
Employer contributions (assets) at beginning of year	2012-12-31	$1,171
Did the plan have assets held for investment	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	STAMBAUGH NESS PC
Accountancy firm EIN	2012-12-31	232846715
2011 : EMPLOYERS HEALTH INSURANCE TRUST 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$5,857
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-12-31	$244,896
Total income from all sources (including contributions)	2011-12-31	$71,775
Total of all expenses incurred	2011-12-31	$74,360
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-12-31	$67,045
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-12-31	$69,813
Value of total assets at end of year	2011-12-31	$29,617
Value of total assets at beginning of year	2011-12-31	$271,241
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-12-31	$7,315
Administrative expenses professional fees incurred	2011-12-31	$557
Were there any nonexempt tranactions with any party-in-interest	2011-12-31	No
Contributions received from participants	2011-12-31	$31,615
Participant contributions at end of year	2011-12-31	$1,415
Participant contributions at beginning of year	2011-12-31	$18,490
Income. Received or receivable in cash from other sources (including rollovers)	2011-12-31	$0
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-12-31	$5,212
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-12-31	$200,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-12-31	$5,857
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-12-31	$244,896
Other income not declared elsewhere	2011-12-31	$1,962
Administrative expenses (other) incurred	2011-12-31	$6,758
Total non interest bearing cash at end of year	2011-12-31	$21,819
Total non interest bearing cash at beginning of year	2011-12-31	$0
Value of net income/loss	2011-12-31	$-2,585
Value of net assets at end of year (total assets less liabilities)	2011-12-31	$23,760
Value of net assets at beginning of year (total assets less liabilities)	2011-12-31	$26,345
Were any loans by the plan or fixed income obligations due to the plan in default	2011-12-31	No
Were any leases to which the plan was party in default or uncollectible	2011-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2011-12-31	$67,045
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-12-31	No
Has the plan failed to provide any benefit when due under the plan	2011-12-31	No
Contributions received in cash from employer	2011-12-31	$38,198
Employer contributions (assets) at end of year	2011-12-31	$1,171
Employer contributions (assets) at beginning of year	2011-12-31	$52,751
Did the plan have assets held for investment	2011-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-12-31	No
Opinion of an independent qualified public accountant for this plan	2011-12-31	Unqualified
Accountancy firm name	2011-12-31	STAMBAUGH NESS PC
Accountancy firm EIN	2011-12-31	232846715
2010 : EMPLOYERS HEALTH INSURANCE TRUST 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$244,896
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$531,105
Total income from all sources (including contributions)	2010-12-31	$3,799,967
Total of all expenses incurred	2010-12-31	$3,587,753
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$3,571,926
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$3,799,967
Value of total assets at end of year	2010-12-31	$271,241
Value of total assets at beginning of year	2010-12-31	$345,236
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$15,827
Administrative expenses professional fees incurred	2010-12-31	$7,929
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$781,618
Participant contributions at end of year	2010-12-31	$18,490
Participant contributions at beginning of year	2010-12-31	$82,857
Income. Received or receivable in cash from other sources (including rollovers)	2010-12-31	$200,000
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$200,000
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2010-12-31	$244,896
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$531,105
Administrative expenses (other) incurred	2010-12-31	$7,898
Value of net income/loss	2010-12-31	$212,214
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$26,345
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$-185,869
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$3,571,926
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$2,818,349
Employer contributions (assets) at end of year	2010-12-31	$52,751
Employer contributions (assets) at beginning of year	2010-12-31	$262,379
Did the plan have assets held for investment	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	STAMBAUGH NESS PC
Accountancy firm EIN	2010-12-31	232846715

Form 5500 Responses for EMPLOYERS HEALTH INSURANCE TRUST

2014: EMPLOYERS HEALTH INSURANCE TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	DFE (Diect Filing Entity)
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: EMPLOYERS HEALTH INSURANCE TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	DFE (Diect Filing Entity)
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: EMPLOYERS HEALTH INSURANCE TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	DFE (Diect Filing Entity)
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: EMPLOYERS HEALTH INSURANCE TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	DFE (Diect Filing Entity)
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2009: EMPLOYERS HEALTH INSURANCE TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	DFE (Diect Filing Entity)
2009-01-01	This submission is the final filing	No
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

G-24200

Policy instance

Insurance contract or identification number	G-24200
Number of Individuals Covered	0
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $6,845
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $68,458
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,134
Insurance broker organization code?	3
Insurance broker name	JOYCE CARDWELL

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

G24200

Policy instance

Insurance contract or identification number	G24200
Number of Individuals Covered	287
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $7,660
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $76,594
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,745
Insurance broker organization code?	3
Amount paid for insurance broker fees	0
Insurance broker name	JOYCE CARDWELL

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

G24200

Policy instance

Insurance contract or identification number	G24200
Number of Individuals Covered	303
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $7,073
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $70,729
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $5,305
Insurance broker organization code?	3
Insurance broker name	JOYCE CARDWELL

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

G24200

Policy instance

Insurance contract or identification number	G24200
Number of Individuals Covered	311
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $7,692
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $76,922
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

BOSTON MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61476 )

Policy contract number

G24200

Policy instance

Insurance contract or identification number	G24200
Number of Individuals Covered	415
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $9,221
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	AD&D
Welfare Benefit Premiums Paid to Carrier	USD $92,217
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $6,916
Insurance broker organization code?	3
Insurance broker name	JOYCE CARDWELL

DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	654
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $4,365
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $349,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,365
Insurance broker organization code?	3
Insurance broker name	MANUFACTURERS ASSOCIATION

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 )

Policy contract number

12208071

Policy instance

Insurance contract or identification number	12208071
Number of Individuals Covered	123
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $1,195
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $896
Insurance broker organization code?	3
Insurance broker name	JOYCE CARDWELL

ICHP (National Association of Insurance Commissioners NAIC id number: 52414 )

Policy contract number

Policy instance

Insurance contract or identification number	50
Number of Individuals Covered	332
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $109,328
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,728,228
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $109,328
Insurance broker organization code?	3
Insurance broker name	MANUFACTURERS ASSOC OF S CENTRAL PA

Potentially related plans

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Company Name:	MANUFACTURERS ASSOCIATION OF SOUTH CENTRAL PENNSYLVANIA
Employer identification number (EIN):	236277461
NAIC Classification:	541600

Plan id#	Filing Submission Date	Name of Administrator
501	2015-01-01
501	2014-01-01
501	2013-01-01
501	2012-01-01	MICHAEL SMELTZER
501	2011-01-01	MICHAEL SMELTZER
501	2009-01-01	MICHAEL SMELTZER