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ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 401k Plan overview

Plan NameROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN
Plan identification number 508

ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Other welfare benefit cover

401k Sponsoring company profile

ROBERT BOSCH FUEL SYSTEMS LLC has sponsored the creation of one or more 401k plans.

Company Name:ROBERT BOSCH FUEL SYSTEMS LLC
Employer identification number (EIN):363818702
NAIC Classification:336990

Additional information about ROBERT BOSCH FUEL SYSTEMS LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 2285837

More information about ROBERT BOSCH FUEL SYSTEMS LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5082020-01-01
5082019-01-01
5082018-01-01
5082017-01-01GARY GRABARCZYK
5082017-01-01GARY GRABARCZYK
5082016-01-01GARY GRABARCZYK
5082015-01-01GARY GRABARCZYK
5082014-01-01GARY D. GRABARCZYK GARY D. GRABARCZYK2015-10-14
5082013-01-01GARY D. GRABARCZYK GARY D. GRABARCZYK2014-10-13
5082012-01-01MARVA J. CASLER JIM HAGENE2013-07-19
5082012-01-01MARVA J. CASLER JIM HAGENE2013-10-15
5082011-01-01MARVA J. CASLER JIM HAGENE2012-10-12
5082009-01-01GARY GRABARCZYK GARY GRABARCZYK2010-10-13
5082009-01-01GARY GRABARCZYK GARY GRABARCZYK2010-10-12

Plan Statistics for ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN

401k plan membership statisitcs for ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN

Measure Date Value
2020: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01321
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-010
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-010
2019: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01312
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-01315
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01315
2018: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01250
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-01249
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01249
2017: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01243
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-01253
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01253
2016: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01239
Total number of active participants reported on line 7a of the Form 55002016-01-010
Number of retired or separated participants receiving benefits2016-01-01247
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01247
2015: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01244
Total number of active participants reported on line 7a of the Form 55002015-01-010
Number of retired or separated participants receiving benefits2015-01-01239
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01239
2014: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01244
Total number of active participants reported on line 7a of the Form 55002014-01-010
Number of retired or separated participants receiving benefits2014-01-01238
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-01238
2013: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01254
Total number of active participants reported on line 7a of the Form 55002013-01-010
Number of retired or separated participants receiving benefits2013-01-01244
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-01244
2012: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01231
Total number of active participants reported on line 7a of the Form 55002012-01-010
Number of retired or separated participants receiving benefits2012-01-01233
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-01233
2011: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01231
Total number of active participants reported on line 7a of the Form 55002011-01-010
Number of retired or separated participants receiving benefits2011-01-01231
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-01231
2009: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01224
Total number of active participants reported on line 7a of the Form 55002009-01-010
Number of retired or separated participants receiving benefits2009-01-01204
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01204
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-0117
Total participants2009-01-01221

Financial Data on ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN

Measure Date Value
2017 : ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$63,370
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$256,110
Total income from all sources (including contributions)2017-12-31$131,817
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$253,575
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$212,520
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$131,465
Value of total assets at end of year2017-12-31$63,370
Value of total assets at beginning of year2017-12-31$377,868
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$41,055
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$352
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$352
Administrative expenses professional fees incurred2017-12-31$41,055
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$15,000,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-12-31$212,520
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$68
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-12-31$23,865
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-12-31$226,635
Liabilities. Value of operating payables at end of year2017-12-31$39,505
Liabilities. Value of operating payables at beginning of year2017-12-31$29,475
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-121,758
Value of net assets at end of year (total assets less liabilities)2017-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$121,758
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$732
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$260,259
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$131,465
Employer contributions (assets) at end of year2017-12-31$62,638
Employer contributions (assets) at beginning of year2017-12-31$117,541
Did the plan have assets held for investment2017-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31PRICEWATERHOUSECOOPERS, LLP
Accountancy firm EIN2017-12-31134008324
2016 : ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$256,110
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$615,016
Total income from all sources (including contributions)2016-12-31$118,636
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$398,813
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$366,058
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$117,541
Value of total assets at end of year2016-12-31$377,868
Value of total assets at beginning of year2016-12-31$1,016,951
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$32,755
Total interest from all sources2016-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$1,095
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$1,095
Administrative expenses professional fees incurred2016-12-31$32,755
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$15,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-12-31$366,058
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$68
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$12
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$226,635
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$550,826
Liabilities. Value of operating payables at end of year2016-12-31$29,475
Liabilities. Value of operating payables at beginning of year2016-12-31$64,190
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-280,177
Value of net assets at end of year (total assets less liabilities)2016-12-31$121,758
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$401,935
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$260,259
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$587,472
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$117,541
Employer contributions (assets) at end of year2016-12-31$117,541
Employer contributions (assets) at beginning of year2016-12-31$429,467
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31PRICEWATERHOUSECOOPERS, LLP
Accountancy firm EIN2016-12-31134008324
2015 : ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$615,016
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$305,803
Total income from all sources (including contributions)2015-12-31$215,950
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$319,637
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$278,438
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$203,500
Value of total assets at end of year2015-12-31$1,016,951
Value of total assets at beginning of year2015-12-31$811,425
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$41,199
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$513
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$513
Administrative expenses professional fees incurred2015-12-31$41,199
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$15,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-12-31$278,438
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$12
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$86
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$550,826
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$272,388
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-103,687
Value of net assets at end of year (total assets less liabilities)2015-12-31$401,935
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$505,622
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$587,472
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$197,418
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$387,954
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$387,954
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$11,937
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$203,500
Employer contributions (assets) at end of year2015-12-31$429,467
Employer contributions (assets) at beginning of year2015-12-31$225,967
Liabilities. Value of benefit claims payable at end of year2015-12-31$64,190
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$33,415
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31PRICEWATERHOUSECOOPERS, LLP
Accountancy firm EIN2015-12-31134008324
2014 : ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$305,803
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$449,768
Total income from all sources (including contributions)2014-12-31$241,209
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$305,803
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$272,388
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$225,967
Value of total assets at end of year2014-12-31$811,425
Value of total assets at beginning of year2014-12-31$1,019,984
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$33,415
Total interest from all sources2014-12-31$1,043
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$9,292
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$9,292
Administrative expenses professional fees incurred2014-12-31$33,415
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$15,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-12-31$272,388
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$86
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$74
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$272,388
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$394,368
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-64,594
Value of net assets at end of year (total assets less liabilities)2014-12-31$505,622
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$570,216
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$197,418
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$183,219
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$387,954
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$349,283
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$349,283
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$1,043
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$4,907
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$225,967
Employer contributions (assets) at end of year2014-12-31$225,967
Employer contributions (assets) at beginning of year2014-12-31$487,408
Liabilities. Value of benefit claims payable at end of year2014-12-31$33,415
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$55,400
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31PRICEWATERHOUSECOOPERS, LLP
Accountancy firm EIN2014-12-31134008324
2013 : ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$40,407
Total unrealized appreciation/depreciation of assets2013-12-31$40,407
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$449,768
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$194,310
Total income from all sources (including contributions)2013-12-31$270,189
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$255,458
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$226,883
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$222,051
Value of total assets at end of year2013-12-31$1,019,984
Value of total assets at beginning of year2013-12-31$749,795
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$28,575
Total interest from all sources2013-12-31$835
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$6,896
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$6,896
Administrative expenses professional fees incurred2013-12-31$28,575
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$15,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-12-31$226,883
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$74
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$73
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$394,368
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$167,485
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$14,731
Value of net assets at end of year (total assets less liabilities)2013-12-31$570,216
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$555,485
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$183,219
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$161,262
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$349,283
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$323,103
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$323,103
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$835
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31Yes
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$222,051
Employer contributions (assets) at end of year2013-12-31$487,408
Employer contributions (assets) at beginning of year2013-12-31$265,357
Liabilities. Value of benefit claims payable at end of year2013-12-31$55,400
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$26,825
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31PRICEWATERHOUSECOOPERS, LLP
Accountancy firm EIN2013-12-31134008324
2012 : ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$192,849
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$208,764
Total income from all sources (including contributions)2012-12-31$297,833
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$192,849
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$166,024
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$265,357
Value of total assets at end of year2012-12-31$749,795
Value of total assets at beginning of year2012-12-31$660,726
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$26,825
Total interest from all sources2012-12-31$860
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$31,616
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$31,616
Administrative expenses professional fees incurred2012-12-31$26,825
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$15,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-12-31$166,024
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$73
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$2,606
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$166,024
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$161,164
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$104,984
Value of net assets at end of year (total assets less liabilities)2012-12-31$556,946
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$451,962
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$161,262
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$230,568
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$323,103
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$258,392
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$258,392
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$860
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$23,162
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$265,357
Employer contributions (assets) at end of year2012-12-31$265,357
Employer contributions (assets) at beginning of year2012-12-31$169,160
Liabilities. Value of benefit claims payable at end of year2012-12-31$26,825
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$47,600
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$37,104
Aggregate carrying amount (costs) on sale of assets2012-12-31$37,104
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31PRICEWATERHOUSECOOPERS, LLP
Accountancy firm EIN2012-12-31134008324
2011 : ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$208,764
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$523,899
Total income from all sources (including contributions)2011-12-31$161,870
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$208,764
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$161,164
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$151,633
Value of total assets at end of year2011-12-31$660,726
Value of total assets at beginning of year2011-12-31$1,022,755
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$47,600
Total interest from all sources2011-12-31$10,227
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$47,600
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$15,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-12-31$161,164
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$2,606
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$18
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$161,164
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$497,399
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-46,894
Value of net assets at end of year (total assets less liabilities)2011-12-31$451,962
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$498,856
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$230,568
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$805,631
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$258,392
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$13,399
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$13,399
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$10,227
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$10
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$151,633
Employer contributions (assets) at end of year2011-12-31$169,160
Employer contributions (assets) at beginning of year2011-12-31$203,707
Liabilities. Value of benefit claims payable at end of year2011-12-31$47,600
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$26,500
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$340,219
Aggregate carrying amount (costs) on sale of assets2011-12-31$340,219
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31PRICEWATERHOUSECOOPERS, LLP
Accountancy firm EIN2011-12-31134008324
2010 : ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$523,899
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$599,118
Total income from all sources (including contributions)2010-12-31$272,535
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$523,919
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$497,399
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$126,552
Value of total assets at end of year2010-12-31$1,022,755
Value of total assets at beginning of year2010-12-31$1,349,358
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$26,520
Total interest from all sources2010-12-31$51
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$21,629
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$21,629
Administrative expenses professional fees incurred2010-12-31$26,500
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$15,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2010-12-31$497,399
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$18
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$47
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$497,399
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$573,091
Administrative expenses (other) incurred2010-12-31$20
Total non interest bearing cash at end of year2010-12-31$203,707
Total non interest bearing cash at beginning of year2010-12-31$171,140
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-251,384
Value of net assets at end of year (total assets less liabilities)2010-12-31$498,856
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$750,240
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$805,631
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$1,168,255
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$13,399
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$9,916
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$9,916
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$51
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$124,303
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$126,552
Employer contributions (assets) at end of year2010-12-31$183,680
Employer contributions (assets) at beginning of year2010-12-31$93,985
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$26,500
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$26,027
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31PRICEWATERHOUSECOOPERS,LLP
Accountancy firm EIN2010-12-31134008324

Form 5500 Responses for ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN

2020: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingYes
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan benefit arrangement – InsuranceYes
2019: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan benefit arrangement – InsuranceYes
2018: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2018 form 5500 responses
2018-01-01Type of plan entityMulitple employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entityMulitple employer plan
2017-01-01Submission has been amendedYes
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement - TrustYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entityMulitple employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement - TrustYes
2015: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2015 form 5500 responses
2015-01-01Type of plan entityMulitple employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2014 form 5500 responses
2014-01-01Type of plan entityMulitple employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2013 form 5500 responses
2013-01-01Type of plan entityMulitple employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2012 form 5500 responses
2012-01-01Type of plan entityMulitple employer plan
2012-01-01Submission has been amendedYes
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2011 form 5500 responses
2011-01-01Type of plan entityMulitple employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: ROBERT BOSCH FUEL SYSTEM LLC RETIREE HEALTH CARE PREMIUM PAYMENT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number44380/600
Policy instance 1
Insurance contract or identification number44380/600
Number of Individuals Covered6
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $26,052
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number104842 FS
Policy instance 2
Insurance contract or identification number104842 FS
Number of Individuals Covered220
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 BenefitNo
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 $10,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00274541/0002
Policy instance 3
Insurance contract or identification number00274541/0002
Number of Individuals Covered245
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,600
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare 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 $918,311
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,600
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number44380/600
Policy instance 1
Insurance contract or identification number44380/600
Number of Individuals Covered5
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $20,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number104842 FS
Policy instance 2
Insurance contract or identification number104842 FS
Number of Individuals Covered216
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 BenefitNo
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 $10,717
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00274541/0002
Policy instance 3
Insurance contract or identification number00274541/0002
Number of Individuals Covered245
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 $912,045
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number104842
Policy instance 1
Insurance contract or identification number104842
Number of Individuals Covered214
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating 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 BenefitNo
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 $12,139
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CARE NETWORK OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 95610 )
Policy contract number00274541/0002
Policy instance 2
Insurance contract or identification number00274541/0002
Number of Individuals Covered241
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $15,237
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare 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 $965,522
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,237
Insurance broker organization code?3
BLUE CROSS BLUE SHIELD OF MICHIGAN (National Association of Insurance Commissioners NAIC id number: 54291 )
Policy contract number44380/600
Policy instance 3
Insurance contract or identification number44380/600
Number of Individuals Covered6
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $-450
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare 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 $30,385
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-450
Insurance broker organization code?3

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