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UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 401k Plan overview

Plan NameUFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND
Plan identification number 501

UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover
  • Collectively bargained welfare benefit arrangement under Code section 419A(f)(5).

401k Sponsoring company profile

UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH has sponsored the creation of one or more 401k plans.

Company Name:UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH
Employer identification number (EIN):042605866
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012020-05-01RICHARD CHARETTE2021-09-30
5012019-05-01RICHARD CHARETTE2021-02-09
5012018-05-01RICHARD CHARETTE2020-02-06
5012017-05-01
5012016-05-01
5012015-05-01
5012014-05-01RICHARD CHARETTE
5012013-05-01RICHARD CHARETTE
5012012-05-01RICHARD CHARETTE
5012011-05-01RICHARD CHARETTE
5012009-05-01RICHARD CHARETTE

Plan Statistics for UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND

401k plan membership statisitcs for UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND

Measure Date Value
2020: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2020 401k membership
Total participants, beginning-of-year2020-05-0116,076
Total number of active participants reported on line 7a of the Form 55002020-05-010
Number of retired or separated participants receiving benefits2020-05-010
Number of other retired or separated participants entitled to future benefits2020-05-010
Total of all active and inactive participants2020-05-010
Number of employers contributing to the scheme2020-05-018
2019: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2019 401k membership
Total participants, beginning-of-year2019-05-0115,794
Total number of active participants reported on line 7a of the Form 55002019-05-0115,517
Number of retired or separated participants receiving benefits2019-05-01465
Number of other retired or separated participants entitled to future benefits2019-05-0194
Total of all active and inactive participants2019-05-0116,076
Number of employers contributing to the scheme2019-05-019
2018: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2018 401k membership
Total participants, beginning-of-year2018-05-0116,035
Total number of active participants reported on line 7a of the Form 55002018-05-0115,229
Number of retired or separated participants receiving benefits2018-05-01463
Number of other retired or separated participants entitled to future benefits2018-05-01102
Total of all active and inactive participants2018-05-0115,794
Number of employers contributing to the scheme2018-05-019
2017: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2017 401k membership
Total participants, beginning-of-year2017-05-0115,767
Total number of active participants reported on line 7a of the Form 55002017-05-0115,065
Number of retired or separated participants receiving benefits2017-05-01485
Number of other retired or separated participants entitled to future benefits2017-05-01485
Total of all active and inactive participants2017-05-0116,035
Number of employers contributing to the scheme2017-05-0110
2016: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2016 401k membership
Total participants, beginning-of-year2016-05-0116,665
Total number of active participants reported on line 7a of the Form 55002016-05-0115,260
Number of retired or separated participants receiving benefits2016-05-01480
Number of other retired or separated participants entitled to future benefits2016-05-0127
Total of all active and inactive participants2016-05-0115,767
Number of employers contributing to the scheme2016-05-019
2015: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2015 401k membership
Total participants, beginning-of-year2015-05-0116,993
Total number of active participants reported on line 7a of the Form 55002015-05-0116,198
Number of retired or separated participants receiving benefits2015-05-01459
Number of other retired or separated participants entitled to future benefits2015-05-018
Total of all active and inactive participants2015-05-0116,665
Number of employers contributing to the scheme2015-05-018
2014: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2014 401k membership
Total participants, beginning-of-year2014-05-0114,654
Total number of active participants reported on line 7a of the Form 55002014-05-0116,594
Number of retired or separated participants receiving benefits2014-05-01399
Total of all active and inactive participants2014-05-0116,993
Total participants2014-05-0116,993
Number of employers contributing to the scheme2014-05-017
2013: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2013 401k membership
Total participants, beginning-of-year2013-05-0115,354
Total number of active participants reported on line 7a of the Form 55002013-05-0114,187
Number of retired or separated participants receiving benefits2013-05-01467
Total of all active and inactive participants2013-05-0114,654
Total participants2013-05-0114,654
2012: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2012 401k membership
Total participants, beginning-of-year2012-05-0115,020
Total number of active participants reported on line 7a of the Form 55002012-05-0114,951
Number of retired or separated participants receiving benefits2012-05-01403
Total of all active and inactive participants2012-05-0115,354
Total participants2012-05-0115,354
2011: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2011 401k membership
Total participants, beginning-of-year2011-05-0115,137
Total number of active participants reported on line 7a of the Form 55002011-05-0114,699
Number of retired or separated participants receiving benefits2011-05-01321
Total of all active and inactive participants2011-05-0115,020
Total participants2011-05-0115,020
2009: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2009 401k membership
Total participants, beginning-of-year2009-05-0113,298
Total number of active participants reported on line 7a of the Form 55002009-05-0114,742
Number of retired or separated participants receiving benefits2009-05-01425
Total of all active and inactive participants2009-05-0115,167
Total participants2009-05-0115,167

Financial Data on UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND

Measure Date Value
2020 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$377,819
Total unrealized appreciation/depreciation of assets2020-12-31$377,819
Total transfer of assets from this plan2020-12-31$51,142,828
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$6,150,178
Total income from all sources (including contributions)2020-12-31$51,374,608
Total loss/gain on sale of assets2020-12-31$487,860
Total of all expenses incurred2020-12-31$42,186,088
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$37,693,782
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-12-31$49,790,136
Value of total assets at end of year2020-12-31$0
Value of total assets at beginning of year2020-12-31$48,104,486
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$4,492,306
Total interest from all sources2020-12-31$289,131
Total dividends received (eg from common stock, registered investment company shares)2020-12-31$87,870
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2020-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$68,448
Administrative expenses professional fees incurred2020-12-31$583,953
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$4,359,195
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$2,100,831
Other income not declared elsewhere2020-12-31$92,636
Administrative expenses (other) incurred2020-12-31$2,430,542
Liabilities. Value of operating payables at end of year2020-12-31$0
Liabilities. Value of operating payables at beginning of year2020-12-31$164,194
Total non interest bearing cash at end of year2020-12-31$0
Total non interest bearing cash at beginning of year2020-12-31$2,549,840
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$9,188,520
Value of net assets at end of year (total assets less liabilities)2020-12-31$0
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$41,954,308
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
Investment advisory and management fees2020-12-31$49,760
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$2,322,998
Interest earned on other investments2020-12-31$3,781
Income. Interest from US Government securities2020-12-31$93,625
Income. Interest from corporate debt instruments2020-12-31$71,699
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$28,741,127
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$28,741,127
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$120,026
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$4,328,186
Asset value of US Government securities at end of year2020-12-31$0
Asset value of US Government securities at beginning of year2020-12-31$6,401,274
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-12-31$249,156
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$45,430,941
Employer contributions (assets) at end of year2020-12-31$0
Employer contributions (assets) at beginning of year2020-12-31$307,509
Income. Dividends from common stock2020-12-31$19,422
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$33,365,596
Asset. Corporate debt instrument debt (other) at end of year2020-12-31$0
Asset. Corporate debt instrument debt (other) at beginning of year2020-12-31$3,362,443
Contract administrator fees2020-12-31$1,428,051
Assets. Corporate common stocks other than exployer securities at end of year2020-12-31$0
Assets. Corporate common stocks other than exployer securities at beginning of year2020-12-31$2,318,464
Liabilities. Value of benefit claims payable at end of year2020-12-31$0
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$5,985,984
Did the plan have assets held for investment2020-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31Yes
Aggregate proceeds on sale of assets2020-12-31$15,541,194
Aggregate carrying amount (costs) on sale of assets2020-12-31$15,053,334
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31NOVAK FRANCELLA, LLC
Accountancy firm EIN2020-12-31611436956
Unrealized appreciation/depreciation of other (non real estate) assets2020-04-30$639,373
Total unrealized appreciation/depreciation of assets2020-04-30$639,373
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-04-30$6,150,178
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-04-30$6,028,753
Total income from all sources (including contributions)2020-04-30$71,083,733
Total loss/gain on sale of assets2020-04-30$201,141
Total of all expenses incurred2020-04-30$72,052,112
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-04-30$66,195,376
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-04-30$69,307,510
Value of total assets at end of year2020-04-30$48,104,486
Value of total assets at beginning of year2020-04-30$48,951,440
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-04-30$5,856,736
Total interest from all sources2020-04-30$801,220
Total dividends received (eg from common stock, registered investment company shares)2020-04-30$123,290
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-04-30No
Total dividends received from registered investment company shares (eg mutual funds)2020-04-30$99,106
Administrative expenses professional fees incurred2020-04-30$437,374
Was this plan covered by a fidelity bond2020-04-30Yes
Value of fidelity bond cover2020-04-30$500,000
Were there any nonexempt tranactions with any party-in-interest2020-04-30No
Contributions received from participants2020-04-30$6,487,276
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-04-30$2,100,831
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-04-30$2,146,334
Other income not declared elsewhere2020-04-30$85,266
Administrative expenses (other) incurred2020-04-30$3,254,334
Liabilities. Value of operating payables at end of year2020-04-30$164,194
Liabilities. Value of operating payables at beginning of year2020-04-30$51,720
Total non interest bearing cash at end of year2020-04-30$2,549,840
Total non interest bearing cash at beginning of year2020-04-30$1,297,240
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-04-30No
Value of net income/loss2020-04-30$-968,379
Value of net assets at end of year (total assets less liabilities)2020-04-30$41,954,308
Value of net assets at beginning of year (total assets less liabilities)2020-04-30$42,922,687
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-04-30No
Were any leases to which the plan was party in default or uncollectible2020-04-30No
Investment advisory and management fees2020-04-30$102,184
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-04-30$2,322,998
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-04-30$3,201,152
Income. Interest from US Government securities2020-04-30$189,754
Income. Interest from corporate debt instruments2020-04-30$25,228
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-04-30$28,741,127
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-04-30$31,439,355
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-04-30$31,439,355
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-04-30$586,238
Expenses. Payments to insurance carriers foe the provision of benefits2020-04-30$5,264,015
Asset value of US Government securities at end of year2020-04-30$6,401,274
Asset value of US Government securities at beginning of year2020-04-30$7,623,587
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-04-30$-74,067
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-04-30Yes
Was there a failure to transmit to the plan any participant contributions2020-04-30No
Has the plan failed to provide any benefit when due under the plan2020-04-30No
Contributions received in cash from employer2020-04-30$62,820,234
Employer contributions (assets) at end of year2020-04-30$307,509
Employer contributions (assets) at beginning of year2020-04-30$45,288
Income. Dividends from common stock2020-04-30$24,184
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-04-30$60,931,361
Asset. Corporate debt instrument debt (other) at end of year2020-04-30$3,362,443
Asset. Corporate debt instrument debt (other) at beginning of year2020-04-30$1,127,953
Contract administrator fees2020-04-30$2,062,844
Assets. Corporate common stocks other than exployer securities at end of year2020-04-30$2,318,464
Assets. Corporate common stocks other than exployer securities at beginning of year2020-04-30$2,070,531
Liabilities. Value of benefit claims payable at end of year2020-04-30$5,985,984
Liabilities. Value of benefit claims payable at beginning of year2020-04-30$5,977,033
Did the plan have assets held for investment2020-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-04-30No
Aggregate proceeds on sale of assets2020-04-30$15,280,689
Aggregate carrying amount (costs) on sale of assets2020-04-30$15,079,548
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-04-30No
Opinion of an independent qualified public accountant for this plan2020-04-30Unqualified
Accountancy firm name2020-04-30NOVAK FRANCELLA, LLC
Accountancy firm EIN2020-04-30611436956
2019 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-04-30$460,932
Total unrealized appreciation/depreciation of assets2019-04-30$460,932
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-04-30$6,028,753
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-04-30$5,947,992
Total income from all sources (including contributions)2019-04-30$76,985,361
Total loss/gain on sale of assets2019-04-30$50,523
Total of all expenses incurred2019-04-30$70,534,002
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-04-30$64,896,814
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-04-30$75,562,737
Value of total assets at end of year2019-04-30$48,951,440
Value of total assets at beginning of year2019-04-30$42,419,320
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-04-30$5,637,188
Total interest from all sources2019-04-30$663,855
Total dividends received (eg from common stock, registered investment company shares)2019-04-30$128,844
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-04-30No
Total dividends received from registered investment company shares (eg mutual funds)2019-04-30$103,999
Administrative expenses professional fees incurred2019-04-30$256,597
Was this plan covered by a fidelity bond2019-04-30Yes
Value of fidelity bond cover2019-04-30$500,000
Were there any nonexempt tranactions with any party-in-interest2019-04-30No
Contributions received from participants2019-04-30$5,851,922
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-04-30$2,146,334
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-04-30$688,515
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-04-30$5,878,536
Other income not declared elsewhere2019-04-30$169,745
Administrative expenses (other) incurred2019-04-30$3,223,319
Liabilities. Value of operating payables at end of year2019-04-30$51,720
Liabilities. Value of operating payables at beginning of year2019-04-30$69,456
Total non interest bearing cash at end of year2019-04-30$1,297,240
Total non interest bearing cash at beginning of year2019-04-30$20,736,172
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-04-30No
Value of net income/loss2019-04-30$6,451,359
Value of net assets at end of year (total assets less liabilities)2019-04-30$42,922,687
Value of net assets at beginning of year (total assets less liabilities)2019-04-30$36,471,328
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-04-30No
Were any leases to which the plan was party in default or uncollectible2019-04-30No
Investment advisory and management fees2019-04-30$72,667
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-04-30$3,201,152
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-04-30$3,336,542
Income. Interest from US Government securities2019-04-30$179,359
Income. Interest from corporate debt instruments2019-04-30$42,429
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-04-30$31,439,355
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-04-30$7,190,810
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-04-30$7,190,810
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-04-30$442,067
Expenses. Payments to insurance carriers foe the provision of benefits2019-04-30$4,116,410
Asset value of US Government securities at end of year2019-04-30$7,623,587
Asset value of US Government securities at beginning of year2019-04-30$6,837,933
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-04-30$-51,275
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-04-30Yes
Was there a failure to transmit to the plan any participant contributions2019-04-30No
Has the plan failed to provide any benefit when due under the plan2019-04-30No
Contributions received in cash from employer2019-04-30$69,710,815
Employer contributions (assets) at end of year2019-04-30$45,288
Employer contributions (assets) at beginning of year2019-04-30$51,386
Income. Dividends from common stock2019-04-30$24,845
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-04-30$60,780,404
Asset. Corporate debt instrument debt (other) at end of year2019-04-30$1,127,953
Asset. Corporate debt instrument debt (other) at beginning of year2019-04-30$1,352,296
Contract administrator fees2019-04-30$2,084,605
Assets. Corporate common stocks other than exployer securities at end of year2019-04-30$2,070,531
Assets. Corporate common stocks other than exployer securities at beginning of year2019-04-30$2,225,666
Liabilities. Value of benefit claims payable at end of year2019-04-30$5,977,033
Did the plan have assets held for investment2019-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-04-30No
Aggregate proceeds on sale of assets2019-04-30$74,107,351
Aggregate carrying amount (costs) on sale of assets2019-04-30$74,056,828
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-04-30No
Opinion of an independent qualified public accountant for this plan2019-04-30Unqualified
Accountancy firm name2019-04-30NOVAK FRANCELLA LLC
Accountancy firm EIN2019-04-30611436956
2018 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-04-30$-119,485
Total unrealized appreciation/depreciation of assets2018-04-30$-119,485
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-04-30$5,947,992
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-04-30$5,978,822
Total income from all sources (including contributions)2018-04-30$70,246,086
Total loss/gain on sale of assets2018-04-30$94,043
Total of all expenses incurred2018-04-30$65,964,889
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-04-30$60,661,284
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-04-30$69,924,175
Value of total assets at end of year2018-04-30$42,419,320
Value of total assets at beginning of year2018-04-30$38,168,953
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-04-30$5,303,605
Total interest from all sources2018-04-30$251,739
Total dividends received (eg from common stock, registered investment company shares)2018-04-30$101,301
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-04-30No
Total dividends received from registered investment company shares (eg mutual funds)2018-04-30$76,257
Administrative expenses professional fees incurred2018-04-30$80,916
Was this plan covered by a fidelity bond2018-04-30Yes
Value of fidelity bond cover2018-04-30$5,000,000
If this is an individual account plan, was there a blackout period2018-04-30No
Were there any nonexempt tranactions with any party-in-interest2018-04-30No
Contributions received from participants2018-04-30$5,780,352
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-04-30$688,515
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-04-30$946,809
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-04-30$5,878,536
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-04-30$5,858,590
Administrative expenses (other) incurred2018-04-30$198,065
Liabilities. Value of operating payables at end of year2018-04-30$69,456
Liabilities. Value of operating payables at beginning of year2018-04-30$120,232
Total non interest bearing cash at end of year2018-04-30$20,736,172
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-04-30No
Value of net income/loss2018-04-30$4,281,197
Value of net assets at end of year (total assets less liabilities)2018-04-30$36,471,328
Value of net assets at beginning of year (total assets less liabilities)2018-04-30$32,190,131
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-04-30No
Were any leases to which the plan was party in default or uncollectible2018-04-30No
Investment advisory and management fees2018-04-30$66,758
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-04-30$3,336,542
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-04-30$3,480,032
Income. Interest from US Government securities2018-04-30$183,438
Income. Interest from corporate debt instruments2018-04-30$38,015
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-04-30$7,190,810
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-04-30$20,820,840
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-04-30$20,820,840
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-04-30$30,286
Expenses. Payments to insurance carriers foe the provision of benefits2018-04-30$4,185,824
Asset value of US Government securities at end of year2018-04-30$6,837,933
Asset value of US Government securities at beginning of year2018-04-30$8,192,198
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-04-30$-5,687
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-04-30Yes
Was there a failure to transmit to the plan any participant contributions2018-04-30No
Has the plan failed to provide any benefit when due under the plan2018-04-30No
Contributions received in cash from employer2018-04-30$64,143,823
Employer contributions (assets) at end of year2018-04-30$51,386
Employer contributions (assets) at beginning of year2018-04-30$173,444
Income. Dividends from common stock2018-04-30$25,044
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-04-30$56,475,460
Asset. Corporate debt instrument debt (other) at end of year2018-04-30$1,352,296
Asset. Corporate debt instrument debt (other) at beginning of year2018-04-30$697,254
Contract administrator fees2018-04-30$4,957,866
Assets. Corporate common stocks other than exployer securities at end of year2018-04-30$2,225,666
Assets. Corporate common stocks other than exployer securities at beginning of year2018-04-30$2,073,463
Assets. Value of buildings and other operty used in plan operation at end of year2018-04-30$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2018-04-30$1,784,913
Did the plan have assets held for investment2018-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-04-30No
Aggregate proceeds on sale of assets2018-04-30$228,579
Aggregate carrying amount (costs) on sale of assets2018-04-30$134,536
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-04-30No
Opinion of an independent qualified public accountant for this plan2018-04-30Unqualified
Accountancy firm name2018-04-30CROWE LLP
Accountancy firm EIN2018-04-30350921680
2017 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-04-30$161,438
Total unrealized appreciation/depreciation of assets2017-04-30$161,438
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-04-30$5,978,822
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-04-30$6,334,800
Total income from all sources (including contributions)2017-04-30$59,077,870
Total loss/gain on sale of assets2017-04-30$33,007
Total of all expenses incurred2017-04-30$65,519,760
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-04-30$59,781,290
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-04-30$58,578,337
Value of total assets at end of year2017-04-30$38,168,953
Value of total assets at beginning of year2017-04-30$44,966,821
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-04-30$5,738,470
Total interest from all sources2017-04-30$216,106
Total dividends received (eg from common stock, registered investment company shares)2017-04-30$33,712
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-04-30No
Administrative expenses professional fees incurred2017-04-30$301,731
Was this plan covered by a fidelity bond2017-04-30Yes
Value of fidelity bond cover2017-04-30$500,000
If this is an individual account plan, was there a blackout period2017-04-30No
Were there any nonexempt tranactions with any party-in-interest2017-04-30No
Contributions received from participants2017-04-30$5,747,490
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-04-30$946,809
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-04-30$213,750
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-04-30$5,858,590
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-04-30$6,219,331
Administrative expenses (other) incurred2017-04-30$534,858
Liabilities. Value of operating payables at end of year2017-04-30$120,232
Liabilities. Value of operating payables at beginning of year2017-04-30$115,469
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-04-30No
Value of net income/loss2017-04-30$-6,441,890
Value of net assets at end of year (total assets less liabilities)2017-04-30$32,190,131
Value of net assets at beginning of year (total assets less liabilities)2017-04-30$38,632,021
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-04-30No
Were any leases to which the plan was party in default or uncollectible2017-04-30No
Investment advisory and management fees2017-04-30$64,950
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-04-30$3,480,032
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-04-30$3,316,478
Interest earned on other investments2017-04-30$4,162
Income. Interest from US Government securities2017-04-30$152,696
Income. Interest from corporate debt instruments2017-04-30$58,506
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-04-30$20,820,840
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-04-30$28,996,887
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-04-30$28,996,887
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-04-30$742
Expenses. Payments to insurance carriers foe the provision of benefits2017-04-30$3,991,081
Asset value of US Government securities at end of year2017-04-30$8,192,198
Asset value of US Government securities at beginning of year2017-04-30$7,487,917
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-04-30$55,270
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-04-30Yes
Was there a failure to transmit to the plan any participant contributions2017-04-30No
Has the plan failed to provide any benefit when due under the plan2017-04-30No
Contributions received in cash from employer2017-04-30$52,830,847
Employer contributions (assets) at end of year2017-04-30$173,444
Employer contributions (assets) at beginning of year2017-04-30$115,754
Income. Dividends from common stock2017-04-30$33,712
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-04-30$55,790,209
Asset. Corporate debt instrument debt (other) at end of year2017-04-30$697,254
Asset. Corporate debt instrument debt (other) at beginning of year2017-04-30$1,008,713
Contract administrator fees2017-04-30$4,836,931
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-04-30No
Assets. Corporate common stocks other than exployer securities at end of year2017-04-30$2,073,463
Assets. Corporate common stocks other than exployer securities at beginning of year2017-04-30$2,116,109
Assets. Value of buildings and other operty used in plan operation at end of year2017-04-30$1,784,913
Assets. Value of buildings and other operty used in plan operation at beginning of year2017-04-30$1,711,213
Did the plan have assets held for investment2017-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-04-30No
Aggregate proceeds on sale of assets2017-04-30$7,724,940
Aggregate carrying amount (costs) on sale of assets2017-04-30$7,691,933
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-04-30No
Opinion of an independent qualified public accountant for this plan2017-04-30Unqualified
Accountancy firm name2017-04-30CROWE HORWATH LLP
Accountancy firm EIN2017-04-30350921680
2016 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2016 401k financial data
Unrealized appreciation/depreciation of real estate assets2016-04-30$-83,677
Total unrealized appreciation/depreciation of assets2016-04-30$-83,677
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-04-30$6,334,800
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-04-30$4,646,759
Total income from all sources (including contributions)2016-04-30$71,304,304
Total loss/gain on sale of assets2016-04-30$-103,663
Total of all expenses incurred2016-04-30$65,011,363
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-04-30$59,302,488
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-04-30$71,137,790
Value of total assets at end of year2016-04-30$44,966,821
Value of total assets at beginning of year2016-04-30$36,985,839
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-04-30$5,708,875
Total interest from all sources2016-04-30$276,625
Total dividends received (eg from common stock, registered investment company shares)2016-04-30$77,229
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-04-30No
Administrative expenses professional fees incurred2016-04-30$232,572
Was this plan covered by a fidelity bond2016-04-30Yes
Value of fidelity bond cover2016-04-30$500,000
If this is an individual account plan, was there a blackout period2016-04-30No
Were there any nonexempt tranactions with any party-in-interest2016-04-30No
Contributions received from participants2016-04-30$5,699,540
Participant contributions at beginning of year2016-04-30$3,489
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-04-30$213,750
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-04-30$236,850
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-04-30$6,219,331
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-04-30$4,184,327
Administrative expenses (other) incurred2016-04-30$689,283
Liabilities. Value of operating payables at end of year2016-04-30$115,469
Liabilities. Value of operating payables at beginning of year2016-04-30$172,793
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-04-30No
Value of net income/loss2016-04-30$6,292,941
Value of net assets at end of year (total assets less liabilities)2016-04-30$38,632,021
Value of net assets at beginning of year (total assets less liabilities)2016-04-30$32,339,080
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-04-30No
Were any leases to which the plan was party in default or uncollectible2016-04-30No
Investment advisory and management fees2016-04-30$58,874
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-04-30$3,316,478
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-04-30$2,177,357
Interest earned on other investments2016-04-30$1,735
Income. Interest from US Government securities2016-04-30$262,585
Income. Interest from corporate debt instruments2016-04-30$12,266
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-04-30$28,996,887
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-04-30$21,272,532
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-04-30$21,272,532
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-04-30$39
Expenses. Payments to insurance carriers foe the provision of benefits2016-04-30$3,940,966
Asset value of US Government securities at end of year2016-04-30$7,487,917
Asset value of US Government securities at beginning of year2016-04-30$7,369,214
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-04-30Yes
Was there a failure to transmit to the plan any participant contributions2016-04-30No
Has the plan failed to provide any benefit when due under the plan2016-04-30No
Contributions received in cash from employer2016-04-30$65,438,250
Employer contributions (assets) at end of year2016-04-30$115,754
Employer contributions (assets) at beginning of year2016-04-30$93,228
Income. Dividends from preferred stock2016-04-30$77,229
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-04-30$55,361,522
Asset. Corporate debt instrument debt (other) at end of year2016-04-30$1,008,713
Asset. Corporate debt instrument debt (other) at beginning of year2016-04-30$1,918,409
Contract administrator fees2016-04-30$4,728,146
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-04-30No
Assets. Corporate common stocks other than exployer securities at end of year2016-04-30$2,116,109
Assets. Corporate common stocks other than exployer securities at beginning of year2016-04-30$1,874,329
Liabilities. Value of benefit claims payable at beginning of year2016-04-30$289,639
Assets. Value of buildings and other operty used in plan operation at end of year2016-04-30$1,711,213
Assets. Value of buildings and other operty used in plan operation at beginning of year2016-04-30$2,040,431
Did the plan have assets held for investment2016-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-04-30No
Aggregate proceeds on sale of assets2016-04-30$6,110,739
Aggregate carrying amount (costs) on sale of assets2016-04-30$6,214,402
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-04-30No
Opinion of an independent qualified public accountant for this plan2016-04-30Unqualified
Accountancy firm name2016-04-30CROWE HORWATH LLP
Accountancy firm EIN2016-04-30350921680
2015 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-04-30$-31,704
Total unrealized appreciation/depreciation of assets2015-04-30$-31,704
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-04-30$4,646,759
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-04-30$7,070,354
Total income from all sources (including contributions)2015-04-30$66,715,080
Total loss/gain on sale of assets2015-04-30$30,664
Total of all expenses incurred2015-04-30$60,643,842
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-04-30$57,872,069
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-04-30$66,239,534
Value of total assets at end of year2015-04-30$36,985,839
Value of total assets at beginning of year2015-04-30$33,338,196
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-04-30$2,771,773
Total interest from all sources2015-04-30$323,689
Total dividends received (eg from common stock, registered investment company shares)2015-04-30$152,897
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-04-30No
Total dividends received from registered investment company shares (eg mutual funds)2015-04-30$69,270
Administrative expenses professional fees incurred2015-04-30$334,572
Was this plan covered by a fidelity bond2015-04-30Yes
Value of fidelity bond cover2015-04-30$500,000
If this is an individual account plan, was there a blackout period2015-04-30No
Were there any nonexempt tranactions with any party-in-interest2015-04-30No
Contributions received from participants2015-04-30$5,257,575
Participant contributions at end of year2015-04-30$3,489
Participant contributions at beginning of year2015-04-30$901
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-04-30$729,813
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-04-30$236,850
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-04-30$328,540
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-04-30$4,184,327
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-04-30$6,377,059
Administrative expenses (other) incurred2015-04-30$222,691
Liabilities. Value of operating payables at end of year2015-04-30$172,793
Liabilities. Value of operating payables at beginning of year2015-04-30$379,422
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-04-30No
Value of net income/loss2015-04-30$6,071,238
Value of net assets at end of year (total assets less liabilities)2015-04-30$32,339,080
Value of net assets at beginning of year (total assets less liabilities)2015-04-30$26,267,842
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-04-30No
Were any leases to which the plan was party in default or uncollectible2015-04-30No
Investment advisory and management fees2015-04-30$63,616
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-04-30$2,177,357
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-04-30$2,117,944
Income. Interest from US Government securities2015-04-30$200,569
Income. Interest from corporate debt instruments2015-04-30$110,272
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-04-30$21,272,532
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-04-30$17,673,191
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-04-30$17,673,191
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-04-30$12,848
Expenses. Payments to insurance carriers foe the provision of benefits2015-04-30$7,357,324
Asset value of US Government securities at end of year2015-04-30$7,369,214
Asset value of US Government securities at beginning of year2015-04-30$6,415,714
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-04-30Yes
Was there a failure to transmit to the plan any participant contributions2015-04-30No
Has the plan failed to provide any benefit when due under the plan2015-04-30No
Contributions received in cash from employer2015-04-30$60,981,959
Employer contributions (assets) at end of year2015-04-30$93,228
Employer contributions (assets) at beginning of year2015-04-30$154,913
Income. Dividends from common stock2015-04-30$83,627
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-04-30$49,784,932
Asset. Corporate debt instrument debt (other) at end of year2015-04-30$1,918,409
Asset. Corporate debt instrument debt (other) at beginning of year2015-04-30$2,251,621
Contract administrator fees2015-04-30$2,150,894
Assets. Corporate common stocks other than exployer securities at end of year2015-04-30$1,874,329
Assets. Corporate common stocks other than exployer securities at beginning of year2015-04-30$2,334,857
Liabilities. Value of benefit claims payable at end of year2015-04-30$289,639
Liabilities. Value of benefit claims payable at beginning of year2015-04-30$313,873
Assets. Value of buildings and other operty used in plan operation at end of year2015-04-30$2,040,431
Assets. Value of buildings and other operty used in plan operation at beginning of year2015-04-30$2,060,515
Did the plan have assets held for investment2015-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-04-30No
Aggregate proceeds on sale of assets2015-04-30$7,008,019
Aggregate carrying amount (costs) on sale of assets2015-04-30$6,977,355
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-04-30No
Opinion of an independent qualified public accountant for this plan2015-04-30Unqualified
Accountancy firm name2015-04-30MICHAEL J SMITH CPA
Accountancy firm EIN2015-04-30811266091
2014 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-04-30$94,511
Total unrealized appreciation/depreciation of assets2014-04-30$94,511
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-04-30$7,070,354
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-04-30$1,824,553
Total income from all sources (including contributions)2014-04-30$78,252,609
Total loss/gain on sale of assets2014-04-30$5,679
Total of all expenses incurred2014-04-30$77,279,153
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-04-30$74,644,855
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-04-30$77,660,842
Value of total assets at end of year2014-04-30$33,338,196
Value of total assets at beginning of year2014-04-30$27,118,939
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-04-30$2,634,298
Total interest from all sources2014-04-30$428,270
Total dividends received (eg from common stock, registered investment company shares)2014-04-30$63,307
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-04-30No
Total dividends received from registered investment company shares (eg mutual funds)2014-04-30$42,409
Administrative expenses professional fees incurred2014-04-30$402,123
Was this plan covered by a fidelity bond2014-04-30Yes
Value of fidelity bond cover2014-04-30$500,000
Were there any nonexempt tranactions with any party-in-interest2014-04-30No
Contributions received from participants2014-04-30$5,117,194
Participant contributions at end of year2014-04-30$901
Participant contributions at beginning of year2014-04-30$1,266
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-04-30$5,125,933
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-04-30$328,540
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-04-30$325,773
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-04-30$6,377,059
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-04-30$1,289,907
Administrative expenses (other) incurred2014-04-30$258,419
Liabilities. Value of operating payables at end of year2014-04-30$379,422
Liabilities. Value of operating payables at beginning of year2014-04-30$251,306
Total non interest bearing cash at beginning of year2014-04-30$115,087
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Value of net income/loss2014-04-30$973,456
Value of net assets at end of year (total assets less liabilities)2014-04-30$26,267,842
Value of net assets at beginning of year (total assets less liabilities)2014-04-30$25,294,386
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-04-30No
Were any leases to which the plan was party in default or uncollectible2014-04-30No
Investment advisory and management fees2014-04-30$59,333
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-04-30$2,117,944
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-04-30$1,446,553
Income. Interest from US Government securities2014-04-30$310,767
Income. Interest from corporate debt instruments2014-04-30$106,303
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-04-30$17,673,191
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-04-30$353,365
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-04-30$353,365
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-04-30$11,200
Expenses. Payments to insurance carriers foe the provision of benefits2014-04-30$52,718,064
Asset value of US Government securities at end of year2014-04-30$6,415,714
Asset value of US Government securities at beginning of year2014-04-30$5,039,721
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-04-30Yes
Was there a failure to transmit to the plan any participant contributions2014-04-30No
Has the plan failed to provide any benefit when due under the plan2014-04-30No
Contributions received in cash from employer2014-04-30$72,543,648
Employer contributions (assets) at end of year2014-04-30$154,913
Employer contributions (assets) at beginning of year2014-04-30$105,885
Income. Dividends from common stock2014-04-30$20,898
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-04-30$16,800,858
Asset. Corporate debt instrument debt (other) at end of year2014-04-30$2,251,621
Asset. Corporate debt instrument debt (other) at beginning of year2014-04-30$18,881,403
Contract administrator fees2014-04-30$1,914,423
Assets. Corporate common stocks other than exployer securities at end of year2014-04-30$2,334,857
Assets. Corporate common stocks other than exployer securities at beginning of year2014-04-30$843,815
Liabilities. Value of benefit claims payable at end of year2014-04-30$313,873
Liabilities. Value of benefit claims payable at beginning of year2014-04-30$283,340
Assets. Value of buildings and other operty used in plan operation at end of year2014-04-30$2,060,515
Assets. Value of buildings and other operty used in plan operation at beginning of year2014-04-30$6,071
Did the plan have assets held for investment2014-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-04-30No
Aggregate proceeds on sale of assets2014-04-30$20,574,927
Aggregate carrying amount (costs) on sale of assets2014-04-30$20,569,248
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-04-30No
Opinion of an independent qualified public accountant for this plan2014-04-30Unqualified
Accountancy firm name2014-04-30MICHAEL J. SMITH, CPA
Accountancy firm EIN2014-04-30028429746
2013 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-04-30$227,826
Total unrealized appreciation/depreciation of assets2013-04-30$227,826
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-04-30$1,824,553
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-04-30$1,775,585
Total income from all sources (including contributions)2013-04-30$75,674,212
Total loss/gain on sale of assets2013-04-30$-26,560
Total of all expenses incurred2013-04-30$74,982,778
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-04-30$72,488,794
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-04-30$75,251,312
Value of total assets at end of year2013-04-30$27,118,939
Value of total assets at beginning of year2013-04-30$26,378,537
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-04-30$2,493,984
Total interest from all sources2013-04-30$209,201
Total dividends received (eg from common stock, registered investment company shares)2013-04-30$12,433
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-04-30No
Total dividends received from registered investment company shares (eg mutual funds)2013-04-30$4,004
Administrative expenses professional fees incurred2013-04-30$372,538
Was this plan covered by a fidelity bond2013-04-30Yes
Value of fidelity bond cover2013-04-30$500,000
Were there any nonexempt tranactions with any party-in-interest2013-04-30No
Contributions received from participants2013-04-30$5,086,958
Participant contributions at end of year2013-04-30$1,266
Participant contributions at beginning of year2013-04-30$837
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-04-30$-22,039
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-04-30$325,773
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-04-30$306,550
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-04-30$1,289,907
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-04-30$1,266,062
Administrative expenses (other) incurred2013-04-30$171,722
Liabilities. Value of operating payables at end of year2013-04-30$251,306
Liabilities. Value of operating payables at beginning of year2013-04-30$195,444
Total non interest bearing cash at end of year2013-04-30$115,087
Total non interest bearing cash at beginning of year2013-04-30$109,178
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-04-30No
Value of net income/loss2013-04-30$691,434
Value of net assets at end of year (total assets less liabilities)2013-04-30$25,294,386
Value of net assets at beginning of year (total assets less liabilities)2013-04-30$24,602,952
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-04-30No
Were any leases to which the plan was party in default or uncollectible2013-04-30No
Investment advisory and management fees2013-04-30$30,479
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-04-30$1,446,553
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-04-30$803,943
Income. Interest from US Government securities2013-04-30$140,828
Income. Interest from corporate debt instruments2013-04-30$68,295
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-04-30$353,365
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-04-30$542,091
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-04-30$542,091
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-04-30$78
Expenses. Payments to insurance carriers foe the provision of benefits2013-04-30$67,184,216
Asset value of US Government securities at end of year2013-04-30$5,039,721
Asset value of US Government securities at beginning of year2013-04-30$3,317,168
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-04-30Yes
Was there a failure to transmit to the plan any participant contributions2013-04-30No
Has the plan failed to provide any benefit when due under the plan2013-04-30No
Contributions received in cash from employer2013-04-30$70,164,354
Employer contributions (assets) at end of year2013-04-30$105,885
Employer contributions (assets) at beginning of year2013-04-30$81,625
Income. Dividends from common stock2013-04-30$8,429
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-04-30$5,326,617
Asset. Corporate debt instrument debt (other) at end of year2013-04-30$18,881,403
Asset. Corporate debt instrument debt (other) at beginning of year2013-04-30$20,784,732
Contract administrator fees2013-04-30$1,919,245
Assets. Corporate common stocks other than exployer securities at end of year2013-04-30$843,815
Assets. Corporate common stocks other than exployer securities at beginning of year2013-04-30$412,165
Liabilities. Value of benefit claims payable at end of year2013-04-30$283,340
Liabilities. Value of benefit claims payable at beginning of year2013-04-30$314,079
Assets. Value of buildings and other operty used in plan operation at end of year2013-04-30$6,071
Assets. Value of buildings and other operty used in plan operation at beginning of year2013-04-30$20,248
Did the plan have assets held for investment2013-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-04-30No
Aggregate proceeds on sale of assets2013-04-30$3,802,618
Aggregate carrying amount (costs) on sale of assets2013-04-30$3,829,178
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-04-30No
Opinion of an independent qualified public accountant for this plan2013-04-30Unqualified
Accountancy firm name2013-04-30MICHAEL J SMITH, CPA
Accountancy firm EIN2013-04-30028429746
2012 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-04-30$101,866
Total unrealized appreciation/depreciation of assets2012-04-30$101,866
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-04-30$1,775,585
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-04-30$1,991,541
Total income from all sources (including contributions)2012-04-30$72,378,097
Total loss/gain on sale of assets2012-04-30$-3,824
Total of all expenses incurred2012-04-30$68,684,414
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-04-30$66,228,190
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-04-30$72,141,284
Value of total assets at end of year2012-04-30$26,378,537
Value of total assets at beginning of year2012-04-30$22,900,810
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-04-30$2,456,224
Total interest from all sources2012-04-30$138,106
Total dividends received (eg from common stock, registered investment company shares)2012-04-30$665
Administrative expenses professional fees incurred2012-04-30$374,211
Was this plan covered by a fidelity bond2012-04-30Yes
Value of fidelity bond cover2012-04-30$500,000
Were there any nonexempt tranactions with any party-in-interest2012-04-30No
Contributions received from participants2012-04-30$4,672,992
Participant contributions at end of year2012-04-30$837
Participant contributions at beginning of year2012-04-30$3,518
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-04-30$43,995
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-04-30$306,550
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-04-30$307,346
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-04-30$1,266,062
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-04-30$1,577,978
Administrative expenses (other) incurred2012-04-30$166,330
Liabilities. Value of operating payables at end of year2012-04-30$195,444
Liabilities. Value of operating payables at beginning of year2012-04-30$152,579
Total non interest bearing cash at end of year2012-04-30$109,178
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-04-30No
Value of net income/loss2012-04-30$3,693,683
Value of net assets at end of year (total assets less liabilities)2012-04-30$24,602,952
Value of net assets at beginning of year (total assets less liabilities)2012-04-30$20,909,269
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-04-30No
Were any leases to which the plan was party in default or uncollectible2012-04-30No
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-04-30$803,943
Income. Interest from US Government securities2012-04-30$115,972
Income. Interest from corporate debt instruments2012-04-30$22,134
Expenses. Payments to insurance carriers foe the provision of benefits2012-04-30$60,368,206
Asset value of US Government securities at end of year2012-04-30$3,317,168
Asset value of US Government securities at beginning of year2012-04-30$1,480,996
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-04-30Yes
Was there a failure to transmit to the plan any participant contributions2012-04-30No
Has the plan failed to provide any benefit when due under the plan2012-04-30No
Contributions received in cash from employer2012-04-30$67,468,292
Employer contributions (assets) at end of year2012-04-30$81,625
Employer contributions (assets) at beginning of year2012-04-30$63,011
Income. Dividends from common stock2012-04-30$665
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-04-30$5,815,989
Asset. Corporate debt instrument preferred debt at end of year2012-04-30$542,091
Asset. Corporate debt instrument preferred debt at beginning of year2012-04-30$1,130,024
Asset. Corporate debt instrument debt (other) at end of year2012-04-30$20,784,732
Asset. Corporate debt instrument debt (other) at beginning of year2012-04-30$19,892,567
Contract administrator fees2012-04-30$1,915,683
Assets. Corporate common stocks other than exployer securities at end of year2012-04-30$412,165
Liabilities. Value of benefit claims payable at end of year2012-04-30$314,079
Liabilities. Value of benefit claims payable at beginning of year2012-04-30$260,984
Assets. Value of buildings and other operty used in plan operation at end of year2012-04-30$20,248
Assets. Value of buildings and other operty used in plan operation at beginning of year2012-04-30$23,348
Did the plan have assets held for investment2012-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-04-30No
Aggregate proceeds on sale of assets2012-04-30$3,995,226
Aggregate carrying amount (costs) on sale of assets2012-04-30$3,999,050
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-04-30No
Opinion of an independent qualified public accountant for this plan2012-04-30Unqualified
Accountancy firm name2012-04-30MICHAEL P. ROSS, CPA
Accountancy firm EIN2012-04-30300293272
2011 : UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-04-30$-2,732
Total unrealized appreciation/depreciation of assets2011-04-30$-2,732
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-04-30$1,991,541
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-04-30$1,820,103
Total income from all sources (including contributions)2011-04-30$66,661,540
Total loss/gain on sale of assets2011-04-30$3,772
Total of all expenses incurred2011-04-30$64,919,058
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-04-30$62,537,174
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-04-30$66,596,922
Value of total assets at end of year2011-04-30$22,900,810
Value of total assets at beginning of year2011-04-30$20,986,890
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-04-30$2,381,884
Total interest from all sources2011-04-30$63,578
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-04-30No
Administrative expenses professional fees incurred2011-04-30$329,533
Was this plan covered by a fidelity bond2011-04-30Yes
Value of fidelity bond cover2011-04-30$500,000
Were there any nonexempt tranactions with any party-in-interest2011-04-30No
Contributions received from participants2011-04-30$3,101,373
Participant contributions at end of year2011-04-30$3,518
Participant contributions at beginning of year2011-04-30$1,177
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-04-30$5,537,013
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-04-30$307,346
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-04-30$324,071
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-04-30$1,577,978
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-04-30$1,247,700
Administrative expenses (other) incurred2011-04-30$161,290
Liabilities. Value of operating payables at end of year2011-04-30$152,579
Liabilities. Value of operating payables at beginning of year2011-04-30$325,569
Total non interest bearing cash at beginning of year2011-04-30$101,291
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-04-30No
Value of net income/loss2011-04-30$1,742,482
Value of net assets at end of year (total assets less liabilities)2011-04-30$20,909,269
Value of net assets at beginning of year (total assets less liabilities)2011-04-30$19,166,787
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-04-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-04-30No
Were any leases to which the plan was party in default or uncollectible2011-04-30No
Income. Interest from US Government securities2011-04-30$39,486
Income. Interest from corporate debt instruments2011-04-30$24,092
Expenses. Payments to insurance carriers foe the provision of benefits2011-04-30$51,781,728
Asset value of US Government securities at end of year2011-04-30$1,480,996
Asset value of US Government securities at beginning of year2011-04-30$2,102,721
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-04-30Yes
Was there a failure to transmit to the plan any participant contributions2011-04-30No
Has the plan failed to provide any benefit when due under the plan2011-04-30No
Contributions received in cash from employer2011-04-30$63,495,549
Employer contributions (assets) at end of year2011-04-30$63,011
Employer contributions (assets) at beginning of year2011-04-30$46,476
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-04-30$5,218,433
Asset. Corporate debt instrument preferred debt at end of year2011-04-30$1,130,024
Asset. Corporate debt instrument preferred debt at beginning of year2011-04-30$465,778
Asset. Corporate debt instrument debt (other) at end of year2011-04-30$19,892,567
Asset. Corporate debt instrument debt (other) at beginning of year2011-04-30$17,941,303
Contract administrator fees2011-04-30$1,891,061
Liabilities. Value of benefit claims payable at end of year2011-04-30$260,984
Liabilities. Value of benefit claims payable at beginning of year2011-04-30$246,834
Assets. Value of buildings and other operty used in plan operation at end of year2011-04-30$23,348
Assets. Value of buildings and other operty used in plan operation at beginning of year2011-04-30$4,073
Did the plan have assets held for investment2011-04-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-04-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-04-30No
Aggregate proceeds on sale of assets2011-04-30$5,506,957
Aggregate carrying amount (costs) on sale of assets2011-04-30$5,503,185
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-04-30No
Opinion of an independent qualified public accountant for this plan2011-04-30Unqualified
Accountancy firm name2011-04-30MICHAEL P. ROSS, CPA
Accountancy firm EIN2011-04-30300293272

Form 5500 Responses for UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND

2020: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2020 form 5500 responses
2020-05-01Type of plan entityMulti-employer plan
2020-05-01This submission is the final filingYes
2020-05-01This return/report is a short plan year return/report (less than 12 months)Yes
2020-05-01Plan is a collectively bargained planYes
2020-05-01Plan funding arrangement – TrustYes
2020-05-01Plan benefit arrangement – InsuranceYes
2020-05-01Plan benefit arrangement - TrustYes
2019: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2019 form 5500 responses
2019-05-01Type of plan entityMulti-employer plan
2019-05-01Plan is a collectively bargained planYes
2019-05-01Plan funding arrangement – TrustYes
2019-05-01Plan benefit arrangement – InsuranceYes
2019-05-01Plan benefit arrangement - TrustYes
2018: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2018 form 5500 responses
2018-05-01Type of plan entityMulti-employer plan
2018-05-01Plan is a collectively bargained planYes
2018-05-01Plan funding arrangement – InsuranceYes
2018-05-01Plan funding arrangement – TrustYes
2018-05-01Plan benefit arrangement – InsuranceYes
2018-05-01Plan benefit arrangement - TrustYes
2017: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2017 form 5500 responses
2017-05-01Type of plan entityMulti-employer plan
2017-05-01Submission has been amendedNo
2017-05-01This submission is the final filingNo
2017-05-01This return/report is a short plan year return/report (less than 12 months)No
2017-05-01Plan is a collectively bargained planYes
2017-05-01Plan funding arrangement – TrustYes
2017-05-01Plan benefit arrangement – InsuranceYes
2017-05-01Plan benefit arrangement - TrustYes
2016: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2016 form 5500 responses
2016-05-01Type of plan entityMulti-employer plan
2016-05-01Plan is a collectively bargained planYes
2016-05-01Plan funding arrangement – TrustYes
2016-05-01Plan benefit arrangement – InsuranceYes
2016-05-01Plan benefit arrangement - TrustYes
2015: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2015 form 5500 responses
2015-05-01Type of plan entityMulti-employer plan
2015-05-01Plan is a collectively bargained planYes
2015-05-01Plan funding arrangement – TrustYes
2015-05-01Plan benefit arrangement – InsuranceYes
2015-05-01Plan benefit arrangement - TrustYes
2014: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2014 form 5500 responses
2014-05-01Type of plan entityMulti-employer plan
2014-05-01Submission has been amendedNo
2014-05-01This submission is the final filingNo
2014-05-01This return/report is a short plan year return/report (less than 12 months)No
2014-05-01Plan is a collectively bargained planYes
2014-05-01Plan funding arrangement – TrustYes
2014-05-01Plan benefit arrangement – InsuranceYes
2014-05-01Plan benefit arrangement - TrustYes
2013: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2013 form 5500 responses
2013-05-01Type of plan entityMulti-employer plan
2013-05-01Submission has been amendedNo
2013-05-01This submission is the final filingNo
2013-05-01This return/report is a short plan year return/report (less than 12 months)No
2013-05-01Plan is a collectively bargained planYes
2013-05-01Plan funding arrangement – TrustYes
2013-05-01Plan benefit arrangement – InsuranceYes
2013-05-01Plan benefit arrangement - TrustYes
2012: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2012 form 5500 responses
2012-05-01Type of plan entityMulti-employer plan
2012-05-01Submission has been amendedNo
2012-05-01This submission is the final filingNo
2012-05-01This return/report is a short plan year return/report (less than 12 months)No
2012-05-01Plan is a collectively bargained planYes
2012-05-01Plan funding arrangement – TrustYes
2012-05-01Plan benefit arrangement – InsuranceYes
2012-05-01Plan benefit arrangement - TrustYes
2011: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2011 form 5500 responses
2011-05-01Type of plan entityMulti-employer plan
2011-05-01Submission has been amendedNo
2011-05-01This submission is the final filingNo
2011-05-01This return/report is a short plan year return/report (less than 12 months)No
2011-05-01Plan is a collectively bargained planYes
2011-05-01Plan funding arrangement – TrustYes
2011-05-01Plan benefit arrangement – InsuranceYes
2011-05-01Plan benefit arrangement - TrustYes
2009: UFCW AND PARTICIPATING EMPLOYERS INTERSTATE HEALTH AND WELFARE FUND 2009 form 5500 responses
2009-05-01Type of plan entityMulti-employer plan
2009-05-01Submission has been amendedNo
2009-05-01This submission is the final filingNo
2009-05-01This return/report is a short plan year return/report (less than 12 months)No
2009-05-01Plan is a collectively bargained planYes
2009-05-01Plan funding arrangement – TrustYes
2009-05-01Plan benefit arrangement – InsuranceYes
2009-05-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number7328-ALL
Policy instance 6
Insurance contract or identification number7328-ALL
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $3,003,072
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number1A307002
Policy instance 5
Insurance contract or identification number1A307002
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $143,492
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 number4955229
Policy instance 4
Insurance contract or identification number4955229
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedMEDICARE
Welfare Benefit Premiums Paid to CarrierUSD $1,713,740
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number000000MCA_0035
Policy instance 3
Insurance contract or identification number000000MCA_0035
Number of Individuals Covered0
Insurance policy start date2020-05-01
Insurance policy end date2021-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Other welfare benefits providedMEDICARE
Welfare Benefit Premiums Paid to CarrierUSD $195,095
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67629-2
Policy instance 2
Insurance contract or identification number67629-2
Number of Individuals Covered0
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $216,782
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,083,911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $216,782
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 1
Insurance contract or identification numberMLN00694
Number of Individuals Covered0
Insurance policy start date2020-05-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $10,370
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $346,695
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,370
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 1
Insurance contract or identification numberMLN00694
Number of Individuals Covered15204
Insurance policy start date2019-03-01
Insurance policy end date2020-02-29
Total amount of commissions paid to insurance brokerUSD $15,452
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $515,054
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,452
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67629-2
Policy instance 2
Insurance contract or identification number67629-2
Number of Individuals Covered2277
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $241,088
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,205,442
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $241,088
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number000000MCA_0035
Policy instance 3
Insurance contract or identification number000000MCA_0035
Number of Individuals Covered95
Insurance policy start date2019-05-01
Insurance policy end date2020-04-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $288,180
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 number4955229
Policy instance 4
Insurance contract or identification number4955229
Number of Individuals Covered454
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,921,738
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number1A307002
Policy instance 5
Insurance contract or identification number1A307002
Number of Individuals Covered78
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $185,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number1A307002
Policy instance 5
Insurance contract or identification number1A307002
Number of Individuals Covered72
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $179,849
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 number4955229
Policy instance 4
Insurance contract or identification number4955229
Number of Individuals Covered456
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,865,074
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number000000MCA_0035
Policy instance 3
Insurance contract or identification number000000MCA_0035
Number of Individuals Covered85
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $262,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67629-2
Policy instance 2
Insurance contract or identification number67629-2
Number of Individuals Covered2277
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $236,509
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,304,650
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $236,509
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 1
Insurance contract or identification numberMLN00694
Number of Individuals Covered15420
Insurance policy start date2018-03-01
Insurance policy end date2019-02-28
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $520,568
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Insurance broker organization code?3
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract numberS2893
Policy instance 5
Insurance contract or identification numberS2893
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
BLUE CROSS BLUE SHIELD OF MASSACHUSETTS, INC. (National Association of Insurance Commissioners NAIC id number: 53228 )
Policy contract number4955229
Policy instance 4
Insurance contract or identification number4955229
Number of Individuals Covered451
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 $956,477
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number000000MCA_0035
Policy instance 3
Insurance contract or identification number000000MCA_0035
Number of Individuals Covered88
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 $269,068
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67629-2
Policy instance 2
Insurance contract or identification number67629-2
Number of Individuals Covered2277
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $279,900
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,399,499
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 1
Insurance contract or identification numberMLN00694
Number of Individuals Covered15686
Insurance policy start date2017-03-01
Insurance policy end date2018-02-28
Total amount of commissions paid to insurance brokerUSD $15,156
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $505,210
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 1
Insurance contract or identification numberMLN00694
Number of Individuals Covered16547
Insurance policy start date2015-03-01
Insurance policy end date2016-02-29
Total amount of commissions paid to insurance brokerUSD $15,518
Total amount of fees paid to insurance companyUSD $731
Life Insurance Welfare BenefitYes
Other welfare benefits providedAD&D
Welfare Benefit Premiums Paid to CarrierUSD $517,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,518
Amount paid for insurance broker fees731
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker organization code?3
Insurance broker nameTHE LONDON AGENCY LTD
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67629-2
Policy instance 2
Insurance contract or identification number67629-2
Number of Individuals Covered2400
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $281,983
Total amount of fees paid to insurance companyUSD $0
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,409,916
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $281,983
Additional information about fees paid to insurance brokerWRITING AGENT
Insurance broker organization code?3
Insurance broker nameLONDON HEALTH ADMINISTRATORS, INC
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67629-2
Policy instance 2
Insurance contract or identification number67629-2
Number of Individuals Covered2277
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $299,123
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
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,495,614
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $299,123
Additional information about fees paid to insurance brokerWRITING AGENT
Insurance broker organization code?3
Insurance broker nameLONDON HEALTH ADMINISTRATORS, INC
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 1
Insurance contract or identification numberMLN00694
Number of Individuals Covered16859
Insurance policy start date2014-03-01
Insurance policy end date2015-02-28
Total amount of commissions paid to insurance brokerUSD $15,888
Total amount of fees paid to insurance companyUSD $700
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
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $529,595
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,888
Amount paid for insurance broker fees700
Additional information about fees paid to insurance brokerADDITIONAL COMPENSATION
Insurance broker nameTHE LONDON AGENCY, LTD.
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67629-2
Policy instance 2
Insurance contract or identification number67629-2
Number of Individuals Covered2277
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $269,065
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
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 BenefitYes
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,345,324
Insurance broker nameTHE LONDON AGENCY
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 1
Insurance contract or identification numberMLN00694
Number of Individuals Covered18734
Insurance policy start date2013-03-01
Insurance policy end date2014-02-28
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
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $549,326
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,480
Amount paid for insurance broker fees494
Insurance broker nameTHE LONDON AGENCY, LTD.
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 2
Insurance contract or identification numberMLN00694
Number of Individuals Covered18165
Insurance policy start date2012-05-01
Insurance policy end date2013-04-30
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
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 $586,576
Insurance broker nameTHE LONDON AGENCY, LTD.
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number67629-2
Policy instance 1
Insurance contract or identification number67629-2
Number of Individuals Covered2277
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $248,771
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
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
Commission paid to Insurance BrokerUSD $248,771
Additional information about fees paid to insurance brokerWRITING AGENT
Insurance broker organization code?3
Insurance broker nameTHE LONDON AGENCY
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 1
Insurance contract or identification numberMLN00694
Number of Individuals Covered18165
Insurance policy start date2011-03-01
Insurance policy end date2012-02-28
Total amount of commissions paid to insurance brokerUSD $15,977
Total amount of fees paid to insurance companyUSD $921
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $532,563
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMLN00694
Policy instance 1
Insurance contract or identification numberMLN00694
Number of Individuals Covered18220
Insurance policy start date2010-03-01
Insurance policy end date2011-02-28
Total amount of commissions paid to insurance brokerUSD $15,989
Total amount of fees paid to insurance companyUSD $963
Life Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $532,958
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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