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WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 401k Plan overview

Plan NameWEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST
Plan identification number 501

WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS ASSOCIATION
Employer identification number (EIN):550691983
NAIC Classification:621498
NAIC Description:All Other Outpatient Care Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-07-01
5012017-07-01MARK DRENNAN
5012016-07-01
5012015-07-01
5012014-07-01
5012014-07-01MARK DRENNAN MARK DRENNAN2016-04-14
5012013-07-01

Plan Statistics for WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST

401k plan membership statisitcs for WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST

Measure Date Value
2018: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2018 401k membership
Total participants, beginning-of-year2018-07-010
Total number of active participants reported on line 7a of the Form 55002018-07-010
Number of retired or separated participants receiving benefits2018-07-010
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-010
2017: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2017 401k membership
Total participants, beginning-of-year2017-07-010
Total number of active participants reported on line 7a of the Form 55002017-07-010
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-010
2016: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2016 401k membership
Total participants, beginning-of-year2016-07-010
Total number of active participants reported on line 7a of the Form 55002016-07-010
Total of all active and inactive participants2016-07-010
2015: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2015 401k membership
Total participants, beginning-of-year2015-07-01214
Total number of active participants reported on line 7a of the Form 55002015-07-010
Total of all active and inactive participants2015-07-010
2014: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2014 401k membership
Total participants, beginning-of-year2014-07-01128
Total number of active participants reported on line 7a of the Form 55002014-07-01214
Total of all active and inactive participants2014-07-01214
Total participants2014-07-01214
2013: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2013 401k membership
Total participants, beginning-of-year2013-07-01111
Total number of active participants reported on line 7a of the Form 55002013-07-01128
Total of all active and inactive participants2013-07-01128

Financial Data on WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST

Measure Date Value
2019 : WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2019 401k financial data
Total plan liabilities at end of year2019-06-30$0
Total plan liabilities at beginning of year2019-06-30$3,664
Total income from all sources2019-06-30$41
Expenses. Total of all expenses incurred2019-06-30$42,473
Benefits paid (including direct rollovers)2019-06-30$0
Total plan assets at end of year2019-06-30$0
Total plan assets at beginning of year2019-06-30$46,096
Expenses. Other expenses not covered elsewhere2019-06-30$27,328
Other income received2019-06-30$41
Net income (gross income less expenses)2019-06-30$-42,432
Net plan assets at end of year (total assets less liabilities)2019-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2019-06-30$42,432
Expenses. Administrative service providers (salaries,fees and commissions)2019-06-30$15,145
2018 : WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2018 401k financial data
Total plan liabilities at end of year2018-06-30$3,664
Total plan liabilities at beginning of year2018-06-30$15,532
Total income from all sources2018-06-30$4,565
Expenses. Total of all expenses incurred2018-06-30$35,321
Benefits paid (including direct rollovers)2018-06-30$201
Total plan assets at end of year2018-06-30$46,096
Total plan assets at beginning of year2018-06-30$88,720
Expenses. Other expenses not covered elsewhere2018-06-30$22,791
Other income received2018-06-30$4,565
Net income (gross income less expenses)2018-06-30$-30,756
Net plan assets at end of year (total assets less liabilities)2018-06-30$42,432
Net plan assets at beginning of year (total assets less liabilities)2018-06-30$73,188
Expenses. Administrative service providers (salaries,fees and commissions)2018-06-30$12,329
2017 : WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2017 401k financial data
Total plan liabilities at end of year2017-06-30$15,532
Total plan liabilities at beginning of year2017-06-30$557,471
Total income from all sources2017-06-30$19,591
Expenses. Total of all expenses incurred2017-06-30$-174,469
Benefits paid (including direct rollovers)2017-06-30$-198,085
Total plan assets at end of year2017-06-30$88,720
Total plan assets at beginning of year2017-06-30$436,599
Expenses. Other expenses not covered elsewhere2017-06-30$8,491
Other income received2017-06-30$19,591
Net income (gross income less expenses)2017-06-30$194,060
Net plan assets at end of year (total assets less liabilities)2017-06-30$73,188
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$-120,872
Total contributions received or receivable from employer(s)2017-06-30$0
Expenses. Administrative service providers (salaries,fees and commissions)2017-06-30$15,125
2016 : WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$557,471
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$463,646
Total income from all sources (including contributions)2016-06-30$2,442,913
Total of all expenses incurred2016-06-30$3,221,879
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$2,985,348
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$2,427,166
Value of total assets at end of year2016-06-30$436,599
Value of total assets at beginning of year2016-06-30$1,121,740
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$236,531
Total interest from all sources2016-06-30$43
Total dividends received (eg from common stock, registered investment company shares)2016-06-30$32,818
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-06-30$0
Total dividends received from registered investment company shares (eg mutual funds)2016-06-30$32,818
Administrative expenses professional fees incurred2016-06-30$75,043
Was this plan covered by a fidelity bond2016-06-30No
If this is an individual account plan, was there a blackout period2016-06-30No
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Participant contributions at end of year2016-06-30$0
Participant contributions at beginning of year2016-06-30$54,100
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-06-30$86,541
Administrative expenses (other) incurred2016-06-30$46,079
Liabilities. Value of operating payables at end of year2016-06-30$99,527
Liabilities. Value of operating payables at beginning of year2016-06-30$92,243
Total non interest bearing cash at end of year2016-06-30$9,621
Total non interest bearing cash at beginning of year2016-06-30$100,302
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$-778,966
Value of net assets at end of year (total assets less liabilities)2016-06-30$-120,872
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$658,094
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Investment advisory and management fees2016-06-30$6,655
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-06-30$426,978
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-06-30$967,338
Interest earned on other investments2016-06-30$43
Expenses. Payments to insurance carriers foe the provision of benefits2016-06-30$26,076
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-06-30$-17,114
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30No
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$2,427,166
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-06-30$2,872,731
Contract administrator fees2016-06-30$108,754
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-06-30No
Liabilities. Value of benefit claims payable at end of year2016-06-30$457,944
Liabilities. Value of benefit claims payable at beginning of year2016-06-30$371,403
Did the plan have assets held for investment2016-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30No
Opinion of an independent qualified public accountant for this plan2016-06-30Unqualified
Accountancy firm name2016-06-30GRAY, GRIFFITH & MAYS, A.C.
Accountancy firm EIN2016-06-30550621482
2015 : WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$463,646
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$403,509
Total income from all sources (including contributions)2015-06-30$2,280,123
Total loss/gain on sale of assets2015-06-30$0
Total of all expenses incurred2015-06-30$2,641,280
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$2,479,046
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$2,265,105
Value of total assets at end of year2015-06-30$1,121,740
Value of total assets at beginning of year2015-06-30$1,422,760
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$162,234
Total interest from all sources2015-06-30$42,836
Total dividends received (eg from common stock, registered investment company shares)2015-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-06-30No
Administrative expenses professional fees incurred2015-06-30$34,145
Was this plan covered by a fidelity bond2015-06-30No
If this is an individual account plan, was there a blackout period2015-06-30No
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Participant contributions at end of year2015-06-30$54,100
Participant contributions at beginning of year2015-06-30$14,162
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-06-30$-500
Administrative expenses (other) incurred2015-06-30$32,411
Liabilities. Value of operating payables at end of year2015-06-30$92,243
Liabilities. Value of operating payables at beginning of year2015-06-30$31,606
Total non interest bearing cash at end of year2015-06-30$100,302
Total non interest bearing cash at beginning of year2015-06-30$147,187
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$-361,157
Value of net assets at end of year (total assets less liabilities)2015-06-30$658,094
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$1,019,251
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Investment advisory and management fees2015-06-30$8,682
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-06-30$967,338
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-06-30$1,261,411
Interest earned on other investments2015-06-30$42,836
Expenses. Payments to insurance carriers foe the provision of benefits2015-06-30$21,925
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-06-30$-27,818
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30Yes
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Contributions received in cash from employer2015-06-30$2,265,105
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-06-30$2,457,621
Contract administrator fees2015-06-30$86,996
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-06-30No
Liabilities. Value of benefit claims payable at end of year2015-06-30$371,403
Liabilities. Value of benefit claims payable at beginning of year2015-06-30$371,903
Did the plan have assets held for investment2015-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30No
Opinion of an independent qualified public accountant for this plan2015-06-30Unqualified
Accountancy firm name2015-06-30GRAY, GRIFFITH & MAYS, A.C.
Accountancy firm EIN2015-06-30550621482
2014 : WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$402,510
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$294,298
Total income from all sources (including contributions)2014-06-30$1,811,686
Total of all expenses incurred2014-06-30$2,140,268
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$1,979,960
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$1,685,601
Value of total assets at end of year2014-06-30$1,439,147
Value of total assets at beginning of year2014-06-30$1,659,517
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$160,308
Total interest from all sources2014-06-30$47,813
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-06-30No
Administrative expenses professional fees incurred2014-06-30$43,592
Was this plan covered by a fidelity bond2014-06-30No
If this is an individual account plan, was there a blackout period2014-06-30No
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Participant contributions at end of year2014-06-30$14,162
Participant contributions at beginning of year2014-06-30$120,012
Administrative expenses (other) incurred2014-06-30$18,635
Liabilities. Value of operating payables at end of year2014-06-30$30,607
Total non interest bearing cash at end of year2014-06-30$163,574
Total non interest bearing cash at beginning of year2014-06-30$369,774
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Value of net income/loss2014-06-30$-328,582
Value of net assets at end of year (total assets less liabilities)2014-06-30$1,036,637
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$1,365,219
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Investment advisory and management fees2014-06-30$9,406
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-06-30$1,261,411
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-06-30$1,169,731
Interest earned on other investments2014-06-30$47,813
Expenses. Payments to insurance carriers foe the provision of benefits2014-06-30$26,094
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-06-30$78,272
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30No
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Contributions received in cash from employer2014-06-30$1,685,601
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$1,953,866
Contract administrator fees2014-06-30$88,675
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-06-30No
Liabilities. Value of benefit claims payable at end of year2014-06-30$371,903
Liabilities. Value of benefit claims payable at beginning of year2014-06-30$294,298
Did the plan have assets held for investment2014-06-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30No
Opinion of an independent qualified public accountant for this plan2014-06-30Unqualified
Accountancy firm name2014-06-30GRAY, GRIFFITH & MAYS, A.C.
Accountancy firm EIN2014-06-30550621482

Form 5500 Responses for WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST

2018: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2018 form 5500 responses
2018-07-01Type of plan entityMulitple employer plan
2018-07-01This submission is the final filingYes
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2017 form 5500 responses
2017-07-01Type of plan entityMulitple employer plan
2017-07-01Submission has been amendedYes
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2016 form 5500 responses
2016-07-01Type of plan entityMulitple employer plan
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2015 form 5500 responses
2015-07-01Type of plan entityMulitple employer plan
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2014 form 5500 responses
2014-07-01Type of plan entityMulitple employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: WEST VIRGINIA BEHAVIORAL HEALTHCARE PROVIDERS BENEFIT PLAN TRUST 2013 form 5500 responses
2013-07-01Type of plan entityMulitple employer plan
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberN04857148
Policy instance 1
Insurance contract or identification numberN04857148
Number of Individuals Covered210
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $26,966
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $285,715
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,966
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerCOMMERCIAL INSURANCE
Insurance broker organization code?3
Insurance broker nameCOMMERCIAL INSURANCE
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberN04857148
Policy instance 1
Insurance contract or identification numberN04857148
Number of Individuals Covered214
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $25,154
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $267,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Insurance broker organization code?3
Insurance broker nameCOMMERCIAL INSURANCE SERVICES
HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 )
Policy contract numberN04857148
Policy instance 1
Insurance contract or identification numberN04857148
Number of Individuals Covered128
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $131,805
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameCOMMERCIAL INSURANCE SERVICES
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number370967
Policy instance 2
Insurance contract or identification number370967
Number of Individuals Covered128
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
Insurance broker nameCOMMERCIAL INSURANCE SERVICES

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