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THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 401k Plan overview

Plan NameTHE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN
Plan identification number 510

THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)

401k Sponsoring company profile

CHARLES STARK DRAPER LABORATORY has sponsored the creation of one or more 401k plans.

Company Name:CHARLES STARK DRAPER LABORATORY
Employer identification number (EIN):042505372
NAIC Classification:813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5102023-01-01
5102022-01-01
5102021-01-01
5102021-01-01
5102020-01-01
5102019-01-01
5102018-01-01
5102017-01-01ELIZABETH MORA
5102017-01-01
5102016-01-01 DEBRA EDWARDS2018-05-22

Plan Statistics for THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN

401k plan membership statisitcs for THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN

Measure Date Value
2023: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2023 401k membership
Total participants, beginning-of-year2023-01-01741
Total number of active participants reported on line 7a of the Form 55002023-01-010
Number of retired or separated participants receiving benefits2023-01-01733
Number of other retired or separated participants entitled to future benefits2023-01-010
Total of all active and inactive participants2023-01-01733
2022: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01680
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-01648
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01648
2021: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01705
Total number of active participants reported on line 7a of the Form 55002021-01-010
Number of retired or separated participants receiving benefits2021-01-01680
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01680
2020: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01680
Total number of active participants reported on line 7a of the Form 55002020-01-010
Number of retired or separated participants receiving benefits2020-01-01705
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01705
2019: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01678
Total number of active participants reported on line 7a of the Form 55002019-01-010
Number of retired or separated participants receiving benefits2019-01-01680
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01680
2018: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01612
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-01678
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01678
2017: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01937
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-01606
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01606
2016: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-012,382
Total number of active participants reported on line 7a of the Form 55002016-01-011,636
Number of retired or separated participants receiving benefits2016-01-01937
Total of all active and inactive participants2016-01-012,573
Total participants2016-01-012,573

Financial Data on THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN

Measure Date Value
2023 : THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2023 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2023-12-31$2,525,033
Total unrealized appreciation/depreciation of assets2023-12-31$2,525,033
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-12-31$0
Total income from all sources (including contributions)2023-12-31$4,102,781
Total loss/gain on sale of assets2023-12-31$0
Total of all expenses incurred2023-12-31$1,457,512
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-12-31$1,253,910
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-12-31$973,220
Value of total assets at end of year2023-12-31$25,458,244
Value of total assets at beginning of year2023-12-31$22,812,975
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-12-31$203,602
Total interest from all sources2023-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2023-12-31$604,528
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2023-12-31$604,528
Was this plan covered by a fidelity bond2023-12-31Yes
Value of fidelity bond cover2023-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2023-12-31No
Contributions received from participants2023-12-31$244,285
Participant contributions at end of year2023-12-31$0
Participant contributions at beginning of year2023-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-12-31$46
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-12-31$73
Administrative expenses (other) incurred2023-12-31$203,602
Total non interest bearing cash at end of year2023-12-31$157,710
Total non interest bearing cash at beginning of year2023-12-31$144,233
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Value of net income/loss2023-12-31$2,645,269
Value of net assets at end of year (total assets less liabilities)2023-12-31$25,458,244
Value of net assets at beginning of year (total assets less liabilities)2023-12-31$22,812,975
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-12-31No
Were any leases to which the plan was party in default or uncollectible2023-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-12-31$15,204,877
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-12-31$12,108,699
Value of interest in common/collective trusts at end of year2023-12-31$10,095,611
Value of interest in common/collective trusts at beginning of year2023-12-31$10,559,970
Expenses. Payments to insurance carriers foe the provision of benefits2023-12-31$17,598
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-12-31Yes
Was there a failure to transmit to the plan any participant contributions2023-12-31No
Has the plan failed to provide any benefit when due under the plan2023-12-31No
Contributions received in cash from employer2023-12-31$728,935
Employer contributions (assets) at end of year2023-12-31$0
Employer contributions (assets) at beginning of year2023-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-12-31$1,236,312
Did the plan have assets held for investment2023-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-12-31No
Opinion of an independent qualified public accountant for this plan2023-12-31Unqualified
Accountancy firm name2023-12-31CARON & BLETZER
Accountancy firm EIN2023-12-31043499945
2022 : THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$-4,478,680
Total unrealized appreciation/depreciation of assets2022-12-31$-4,478,680
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$-3,256,272
Total loss/gain on sale of assets2022-12-31$0
Total of all expenses incurred2022-12-31$1,153,860
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$1,007,569
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$683,604
Value of total assets at end of year2022-12-31$22,812,975
Value of total assets at beginning of year2022-12-31$27,223,107
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$146,291
Total interest from all sources2022-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$538,804
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$538,804
Administrative expenses professional fees incurred2022-12-31$146,291
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$210,779
Participant contributions at end of year2022-12-31$0
Participant contributions at beginning of year2022-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$73
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$0
Total non interest bearing cash at end of year2022-12-31$144,233
Total non interest bearing cash at beginning of year2022-12-31$152,278
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-4,410,132
Value of net assets at end of year (total assets less liabilities)2022-12-31$22,812,975
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$27,223,107
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$12,108,699
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$14,648,398
Value of interest in common/collective trusts at end of year2022-12-31$10,559,970
Value of interest in common/collective trusts at beginning of year2022-12-31$12,422,431
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$14,400
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$472,825
Employer contributions (assets) at end of year2022-12-31$0
Employer contributions (assets) at beginning of year2022-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$993,169
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31CARON & BLETZER
Accountancy firm EIN2022-12-31043499945
2021 : THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$1,976,704
Total unrealized appreciation/depreciation of assets2021-12-31$1,976,704
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-12-31$0
Total income from all sources (including contributions)2021-12-31$4,120,732
Total loss/gain on sale of assets2021-12-31$0
Total of all expenses incurred2021-12-31$1,335,730
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$1,150,910
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-12-31$824,931
Value of total assets at end of year2021-12-31$27,198,332
Value of total assets at beginning of year2021-12-31$24,413,330
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$184,820
Total interest from all sources2021-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2021-12-31$1,319,097
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$1,319,097
Administrative expenses professional fees incurred2021-12-31$184,820
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$162,467
Participant contributions at end of year2021-12-31$0
Participant contributions at beginning of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$0
Total non interest bearing cash at end of year2021-12-31$127,503
Total non interest bearing cash at beginning of year2021-12-31$103,637
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$2,785,002
Value of net assets at end of year (total assets less liabilities)2021-12-31$27,198,332
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$24,413,330
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$14,648,398
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$14,270,863
Value of interest in common/collective trusts at end of year2021-12-31$12,422,431
Value of interest in common/collective trusts at beginning of year2021-12-31$10,038,830
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$336,818
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31Yes
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$824,931
Employer contributions (assets) at end of year2021-12-31$0
Employer contributions (assets) at beginning of year2021-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$814,092
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31CARON & BLETZER
Accountancy firm EIN2021-12-31043499945
2020 : THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$2,502,346
Total unrealized appreciation/depreciation of assets2020-12-31$2,502,346
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-12-31$0
Total income from all sources (including contributions)2020-12-31$3,448,547
Total loss/gain on sale of assets2020-12-31$0
Total of all expenses incurred2020-12-31$1,190,458
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$1,090,075
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$720,815
Value of total assets at end of year2020-12-31$24,413,330
Value of total assets at beginning of year2020-12-31$22,155,241
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$100,383
Total interest from all sources2020-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$225,386
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$225,386
Administrative expenses professional fees incurred2020-12-31$100,383
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$192,045
Participant contributions at end of year2020-12-31$0
Participant contributions at beginning of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$31
Total non interest bearing cash at end of year2020-12-31$103,637
Total non interest bearing cash at beginning of year2020-12-31$128,384
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$2,258,089
Value of net assets at end of year (total assets less liabilities)2020-12-31$24,413,330
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$22,155,241
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$14,270,863
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$23,671
Value of interest in common/collective trusts at end of year2020-12-31$10,038,830
Value of interest in common/collective trusts at beginning of year2020-12-31$22,003,155
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$232,970
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31Yes
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$528,770
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$857,105
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31CARON & BLETZER
Accountancy firm EIN2020-12-31043499945
2019 : THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$0
Total income from all sources (including contributions)2019-12-31$4,830,346
Total income from all sources (including contributions)2019-12-31$4,830,346
Total loss/gain on sale of assets2019-12-31$0
Total loss/gain on sale of assets2019-12-31$0
Total of all expenses incurred2019-12-31$1,205,573
Total of all expenses incurred2019-12-31$1,205,573
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,117,623
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$1,117,623
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$754,069
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-12-31$754,069
Value of total assets at end of year2019-12-31$22,155,241
Value of total assets at beginning of year2019-12-31$18,530,468
Value of total assets at beginning of year2019-12-31$18,530,468
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$87,950
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$87,950
Total interest from all sources2019-12-31$0
Total interest from all sources2019-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$440,884
Total dividends received (eg from common stock, registered investment company shares)2019-12-31$440,884
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$440,884
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$440,884
Administrative expenses professional fees incurred2019-12-31$87,950
Administrative expenses professional fees incurred2019-12-31$87,950
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$191,312
Contributions received from participants2019-12-31$191,312
Participant contributions at end of year2019-12-31$0
Participant contributions at end of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Participant contributions at beginning of year2019-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$31
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$13,341
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$13,341
Total non interest bearing cash at end of year2019-12-31$128,384
Total non interest bearing cash at end of year2019-12-31$128,384
Total non interest bearing cash at beginning of year2019-12-31$121,078
Total non interest bearing cash at beginning of year2019-12-31$121,078
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$3,624,773
Value of net income/loss2019-12-31$3,624,773
Value of net assets at end of year (total assets less liabilities)2019-12-31$22,155,241
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$18,530,468
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$18,530,468
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$23,671
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$18,396,049
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$18,396,049
Value of interest in common/collective trusts at end of year2019-12-31$22,003,155
Value of interest in common/collective trusts at beginning of year2019-12-31$0
Value of interest in common/collective trusts at beginning of year2019-12-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$272,071
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$272,071
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$3,635,393
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-12-31$3,635,393
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$562,757
Contributions received in cash from employer2019-12-31$562,757
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at end of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Employer contributions (assets) at beginning of year2019-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$845,552
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$845,552
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31CARON & BLETZER
Accountancy firm name2019-12-31CARON & BLETZER
Accountancy firm EIN2019-12-31043499945
Accountancy firm EIN2019-12-31043499945
2018 : THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$0
Total income from all sources (including contributions)2018-12-31$-833,650
Total loss/gain on sale of assets2018-12-31$0
Total of all expenses incurred2018-12-31$1,224,150
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$1,105,843
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-12-31$328,006
Value of total assets at end of year2018-12-31$18,530,468
Value of total assets at beginning of year2018-12-31$20,588,268
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$118,307
Total interest from all sources2018-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2018-12-31$917,873
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$917,873
Administrative expenses professional fees incurred2018-12-31$118,307
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$191,662
Participant contributions at end of year2018-12-31$0
Participant contributions at beginning of year2018-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$13,341
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$11,143
Total non interest bearing cash at end of year2018-12-31$121,078
Total non interest bearing cash at beginning of year2018-12-31$100,787
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-2,057,800
Value of net assets at end of year (total assets less liabilities)2018-12-31$18,530,468
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$20,588,268
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$18,396,049
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$20,450,061
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$238,618
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-2,079,529
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31Yes
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$136,344
Employer contributions (assets) at end of year2018-12-31$0
Employer contributions (assets) at beginning of year2018-12-31$26,277
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$867,225
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31CARON & BLETZER
Accountancy firm EIN2018-12-31043499945
2017 : THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$0
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$0
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$0
Value of total assets at end of year2017-12-31$69,498
Value of total assets at beginning of year2017-12-31$69,498
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$0
Total interest from all sources2017-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$853,924
Administrative expenses professional fees incurred2017-12-31$73,611
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$232,877
Participant contributions at end of year2017-12-31$0
Participant contributions at beginning of year2017-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$11,143
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$10,005
Total non interest bearing cash at end of year2017-12-31$69,498
Total non interest bearing cash at beginning of year2017-12-31$69,498
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$0
Value of net assets at end of year (total assets less liabilities)2017-12-31$69,498
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$69,498
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$20,450,061
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$17,788,946
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$343,314
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$1,881,941
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$1,035,662
Employer contributions (assets) at end of year2017-12-31$26,277
Employer contributions (assets) at beginning of year2017-12-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$867,660
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party 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 name2017-12-31CARON & BLETZER
Accountancy firm EIN2017-12-31043499945
2016 : THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS 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$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$3,178,371
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$1,366,329
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$1,300,459
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$1,369,957
Value of total assets at end of year2016-12-31$17,868,449
Value of total assets at beginning of year2016-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$65,870
Total interest from all sources2016-12-31$556,228
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Administrative expenses professional fees incurred2016-12-31$65,870
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$2,000,000
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$319,681
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$10,005
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$0
Total non interest bearing cash at end of year2016-12-31$69,498
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$1,812,042
Value of net assets at end of year (total assets less liabilities)2016-12-31$17,868,449
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$0
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$17,788,946
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$0
Interest earned on other investments2016-12-31$556,228
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$465,786
Net gain/loss from 103.12 investment entities2016-12-31$1,252,186
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
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$1,050,276
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$834,673
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 name2016-12-31CARON & BLETZER
Accountancy firm EIN2016-12-31043499945

Form 5500 Responses for THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN

2023: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2023 form 5500 responses
2023-01-01Type of plan entitySingle employer plan
2023-01-01Submission has been amendedNo
2023-01-01This submission is the final filingNo
2023-01-01This return/report is a short plan year return/report (less than 12 months)No
2023-01-01Plan is a collectively bargained planNo
2023-01-01Plan funding arrangement – InsuranceYes
2023-01-01Plan funding arrangement – TrustYes
2023-01-01Plan funding arrangement – General assets of the sponsorYes
2023-01-01Plan benefit arrangement – InsuranceYes
2023-01-01Plan benefit arrangement - TrustYes
2023-01-01Plan benefit arrangement – General assets of the sponsorYes
2022: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan funding arrangement – General assets of the sponsorYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2022-01-01Plan benefit arrangement – General assets of the sponsorYes
2021: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planNo
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan funding arrangement – General assets of the sponsorYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2021-01-01Plan benefit arrangement – General assets of the sponsorYes
2020: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS 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 filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planNo
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan funding arrangement – General assets of the sponsorYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2020-01-01Plan benefit arrangement – General assets of the sponsorYes
2019: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS 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 planNo
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan funding arrangement – General assets of the sponsorYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2019-01-01Plan benefit arrangement – General assets of the sponsorYes
2018: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle 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 planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan funding arrangement – General assets of the sponsorYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2018-01-01Plan benefit arrangement – General assets of the sponsorYes
2017: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
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 planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan funding arrangement – General assets of the sponsorYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2017-01-01Plan benefit arrangement – General assets of the sponsorYes
2016: THE CHARLES STARK DRAPER LABORATORY, INC. RETIRED EMPLOYEES MEDICAL BENEFITS PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01First time form 5500 has been submittedYes
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 planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4958955
Policy instance 1
Insurance contract or identification number4958955
Number of Individuals Covered0
Insurance policy start date2023-01-01
Insurance policy end date2023-12-31
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 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 $17,598
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4958955
Policy instance 1
Insurance contract or identification number4958955
Number of Individuals Covered0
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
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 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 $14,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4958955
Policy instance 1
Insurance contract or identification number4958955
Number of Individuals Covered0
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4958955
Policy instance 1
Insurance contract or identification number4958955
Number of Individuals Covered32
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 $235,785
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4958955
Policy instance 1
Insurance contract or identification number4958955
Number of Individuals Covered5095
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 $28,026,777
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number011646
Policy instance 1
Insurance contract or identification number011646
Number of Individuals Covered21
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 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 $241,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number016420
Policy instance 2
Insurance contract or identification number016420
Number of Individuals Covered185
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 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 $2,349,257
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number011646
Policy instance 1
Insurance contract or identification number011646
Number of Individuals Covered32
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 $311,352
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HARVARD PILGRIM HEALTH CARE, INC. (National Association of Insurance Commissioners NAIC id number: 96911 )
Policy contract number011647
Policy instance 2
Insurance contract or identification number011647
Number of Individuals Covered0
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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 $16,486
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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