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PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 401k Plan overview

Plan NamePLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND
Plan identification number 501

PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND Benefits

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

401k Sponsoring company profile

PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND, BD OF TTEES has sponsored the creation of one or more 401k plans.

Company Name:PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND, BD OF TTEES
Employer identification number (EIN):050368202
NAIC Classification:238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012018-07-01VALERIE CAMPANA2019-12-09
5012017-07-01JAMES DWYER2019-04-10
5012016-07-01
5012015-07-01VALERIE CAMPANA
5012014-07-01VALERIE CAMPANA
5012013-07-01
5012012-07-01VALERIE E. CAMPANA
5012011-07-01VALERIE E. CAMPANA
5012009-07-01VALERIE E. CAMPANA
5012009-07-01VALERIE E. CAMPANA
5012009-07-01VALERIE E. CAMPANA
5012009-07-01VALERIE E. CAMPANA

Plan Statistics for PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND

401k plan membership statisitcs for PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND

Measure Date Value
2018: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2018 401k membership
Total participants, beginning-of-year2018-07-0160
Total number of active participants reported on line 7a of the Form 55002018-07-010
Number of retired or separated participants receiving benefits2018-07-010
Total of all active and inactive participants2018-07-010
2017: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2017 401k membership
Total participants, beginning-of-year2017-07-0155
Total number of active participants reported on line 7a of the Form 55002017-07-0160
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-0160
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-07-010
Number of employers contributing to the scheme2017-07-0125
2016: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2016 401k membership
Total participants, beginning-of-year2016-07-0156
Total number of active participants reported on line 7a of the Form 55002016-07-0155
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-0155
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-07-010
2015: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2015 401k membership
Total participants, beginning-of-year2015-07-0158
Total number of active participants reported on line 7a of the Form 55002015-07-0156
Number of retired or separated participants receiving benefits2015-07-010
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-0156
Number of employers contributing to the scheme2015-07-0127
2014: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2014 401k membership
Total participants, beginning-of-year2014-07-0153
Total number of active participants reported on line 7a of the Form 55002014-07-0158
Number of retired or separated participants receiving benefits2014-07-010
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-0158
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-07-010
2013: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2013 401k membership
Total participants, beginning-of-year2013-07-0151
Total number of active participants reported on line 7a of the Form 55002013-07-0153
Number of retired or separated participants receiving benefits2013-07-010
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-0153
Total participants2013-07-0153
2012: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2012 401k membership
Total participants, beginning-of-year2012-07-0148
Total number of active participants reported on line 7a of the Form 55002012-07-0151
Number of retired or separated participants receiving benefits2012-07-010
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-0151
2011: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2011 401k membership
Total participants, beginning-of-year2011-07-0147
Total number of active participants reported on line 7a of the Form 55002011-07-0148
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-0148
2009: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2009 401k membership
Total participants, beginning-of-year2009-07-0156
Total number of active participants reported on line 7a of the Form 55002009-07-0152
Number of retired or separated participants receiving benefits2009-07-010
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-0152

Financial Data on PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND

Measure Date Value
2019 : PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2019 401k financial data
Transfers to/from the plan2019-06-30$-3,510,756
Total plan liabilities at end of year2019-06-30$0
Total plan liabilities at beginning of year2019-06-30$72,532
Total income from all sources2019-06-30$1,465,227
Expenses. Total of all expenses incurred2019-06-30$1,095,990
Benefits paid (including direct rollovers)2019-06-30$1,039,731
Total plan assets at end of year2019-06-30$0
Total plan assets at beginning of year2019-06-30$3,214,051
Value of fidelity bond covering the plan2019-06-30$1,000,000
Expenses. Other expenses not covered elsewhere2019-06-30$2,336
Other income received2019-06-30$161,062
Net income (gross income less expenses)2019-06-30$369,237
Net plan assets at end of year (total assets less liabilities)2019-06-30$0
Net plan assets at beginning of year (total assets less liabilities)2019-06-30$3,141,519
Total contributions received or receivable from employer(s)2019-06-30$1,304,165
Expenses. Administrative service providers (salaries,fees and commissions)2019-06-30$53,923
2017 : PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2017 401k financial data
Total plan liabilities at end of year2017-06-30$31,537
Total plan liabilities at beginning of year2017-06-30$17,008
Total income from all sources2017-06-30$1,241,204
Expenses. Total of all expenses incurred2017-06-30$885,734
Benefits paid (including direct rollovers)2017-06-30$852,775
Total plan assets at end of year2017-06-30$2,696,786
Total plan assets at beginning of year2017-06-30$2,326,787
Value of fidelity bond covering the plan2017-06-30$500,000
Total contributions received or receivable from participants2017-06-30$587
Expenses. Other expenses not covered elsewhere2017-06-30$1,808
Other income received2017-06-30$130,788
Net income (gross income less expenses)2017-06-30$355,470
Net plan assets at end of year (total assets less liabilities)2017-06-30$2,665,249
Net plan assets at beginning of year (total assets less liabilities)2017-06-30$2,309,779
Total contributions received or receivable from employer(s)2017-06-30$1,109,829
Expenses. Administrative service providers (salaries,fees and commissions)2017-06-30$31,151
2016 : PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2016 401k financial data
Total plan liabilities at end of year2016-06-30$17,008
Total plan liabilities at beginning of year2016-06-30$10,457
Total income from all sources2016-06-30$1,200,455
Expenses. Total of all expenses incurred2016-06-30$869,440
Benefits paid (including direct rollovers)2016-06-30$836,158
Total plan assets at end of year2016-06-30$2,326,787
Total plan assets at beginning of year2016-06-30$1,989,221
Value of fidelity bond covering the plan2016-06-30$500,000
Total contributions received or receivable from participants2016-06-30$10,697
Expenses. Other expenses not covered elsewhere2016-06-30$1,699
Other income received2016-06-30$60,721
Net income (gross income less expenses)2016-06-30$331,015
Net plan assets at end of year (total assets less liabilities)2016-06-30$2,309,779
Net plan assets at beginning of year (total assets less liabilities)2016-06-30$1,978,764
Total contributions received or receivable from employer(s)2016-06-30$1,129,037
Expenses. Administrative service providers (salaries,fees and commissions)2016-06-30$31,583
2015 : PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2015 401k financial data
Total plan liabilities at end of year2015-06-30$10,457
Total plan liabilities at beginning of year2015-06-30$27,797
Total income from all sources2015-06-30$1,109,858
Expenses. Total of all expenses incurred2015-06-30$802,363
Benefits paid (including direct rollovers)2015-06-30$767,408
Total plan assets at end of year2015-06-30$1,989,221
Total plan assets at beginning of year2015-06-30$1,699,066
Value of fidelity bond covering the plan2015-06-30$500,000
Total contributions received or receivable from participants2015-06-30$7,745
Expenses. Other expenses not covered elsewhere2015-06-30$2,173
Other income received2015-06-30$-7,028
Net income (gross income less expenses)2015-06-30$307,495
Net plan assets at end of year (total assets less liabilities)2015-06-30$1,978,764
Net plan assets at beginning of year (total assets less liabilities)2015-06-30$1,671,269
Total contributions received or receivable from employer(s)2015-06-30$1,109,141
Expenses. Administrative service providers (salaries,fees and commissions)2015-06-30$32,782
2014 : PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2014 401k financial data
Total plan liabilities at end of year2014-06-30$27,797
Total plan liabilities at beginning of year2014-06-30$54,110
Total income from all sources2014-06-30$1,187,504
Expenses. Total of all expenses incurred2014-06-30$799,929
Benefits paid (including direct rollovers)2014-06-30$766,022
Total plan assets at end of year2014-06-30$1,699,066
Total plan assets at beginning of year2014-06-30$1,337,804
Value of fidelity bond covering the plan2014-06-30$500,000
Total contributions received or receivable from participants2014-06-30$17,104
Expenses. Other expenses not covered elsewhere2014-06-30$1,912
Other income received2014-06-30$93,683
Net income (gross income less expenses)2014-06-30$387,575
Net plan assets at end of year (total assets less liabilities)2014-06-30$1,671,269
Net plan assets at beginning of year (total assets less liabilities)2014-06-30$1,283,694
Total contributions received or receivable from employer(s)2014-06-30$1,076,717
Expenses. Administrative service providers (salaries,fees and commissions)2014-06-30$31,995
2013 : PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2013 401k financial data
Total plan liabilities at end of year2013-06-30$54,110
Total plan liabilities at beginning of year2013-06-30$38,413
Total income from all sources2013-06-30$935,158
Expenses. Total of all expenses incurred2013-06-30$824,697
Benefits paid (including direct rollovers)2013-06-30$796,163
Total plan assets at end of year2013-06-30$1,337,804
Total plan assets at beginning of year2013-06-30$1,211,646
Value of fidelity bond covering the plan2013-06-30$500,000
Total contributions received or receivable from participants2013-06-30$8,266
Other income received2013-06-30$66,275
Net income (gross income less expenses)2013-06-30$110,461
Net plan assets at end of year (total assets less liabilities)2013-06-30$1,283,694
Net plan assets at beginning of year (total assets less liabilities)2013-06-30$1,173,233
Total contributions received or receivable from employer(s)2013-06-30$860,617
Expenses. Administrative service providers (salaries,fees and commissions)2013-06-30$28,534
2012 : PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2012 401k financial data
Total plan liabilities at end of year2012-06-30$38,413
Total plan liabilities at beginning of year2012-06-30$35,913
Total income from all sources2012-06-30$784,591
Expenses. Total of all expenses incurred2012-06-30$765,885
Benefits paid (including direct rollovers)2012-06-30$736,527
Total plan assets at end of year2012-06-30$1,211,646
Total plan assets at beginning of year2012-06-30$1,190,440
Value of fidelity bond covering the plan2012-06-30$500,000
Total contributions received or receivable from participants2012-06-30$3,264
Expenses. Other expenses not covered elsewhere2012-06-30$1,809
Contributions received from other sources (not participants or employers)2012-06-30$694
Other income received2012-06-30$22,936
Net income (gross income less expenses)2012-06-30$18,706
Net plan assets at end of year (total assets less liabilities)2012-06-30$1,173,233
Net plan assets at beginning of year (total assets less liabilities)2012-06-30$1,154,527
Total contributions received or receivable from employer(s)2012-06-30$757,697
Expenses. Administrative service providers (salaries,fees and commissions)2012-06-30$27,549
2011 : PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2011 401k financial data
Total plan liabilities at end of year2011-06-30$35,913
Total plan liabilities at beginning of year2011-06-30$73,662
Total income from all sources2011-06-30$828,672
Expenses. Total of all expenses incurred2011-06-30$778,406
Benefits paid (including direct rollovers)2011-06-30$754,038
Total plan assets at end of year2011-06-30$1,190,440
Total plan assets at beginning of year2011-06-30$1,177,923
Value of fidelity bond covering the plan2011-06-30$500,000
Total contributions received or receivable from participants2011-06-30$4,269
Contributions received from other sources (not participants or employers)2011-06-30$11,546
Other income received2011-06-30$83,116
Net income (gross income less expenses)2011-06-30$50,266
Net plan assets at end of year (total assets less liabilities)2011-06-30$1,154,527
Net plan assets at beginning of year (total assets less liabilities)2011-06-30$1,104,261
Total contributions received or receivable from employer(s)2011-06-30$729,741
Expenses. Administrative service providers (salaries,fees and commissions)2011-06-30$24,368

Form 5500 Responses for PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND

2018: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2018 form 5500 responses
2018-07-01Type of plan entityMulti-employer plan
2018-07-01Submission has been amendedNo
2018-07-01This submission is the final filingYes
2018-07-01This return/report is a short plan year return/report (less than 12 months)No
2018-07-01Plan is a collectively bargained planYes
2018-07-01Plan funding arrangement – InsuranceYes
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement - TrustYes
2017: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2017 form 5500 responses
2017-07-01Type of plan entityMulti-employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planYes
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan funding arrangement – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2016: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2016 form 5500 responses
2016-07-01Type of plan entityMulti-employer plan
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planYes
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan funding arrangement – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2015: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2015 form 5500 responses
2015-07-01Type of plan entityMulti-employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planYes
2015-07-01Plan funding arrangement – InsuranceYes
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2014: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2014 form 5500 responses
2014-07-01Type of plan entityMulti-employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planYes
2014-07-01Plan funding arrangement – InsuranceYes
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2013: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2013 form 5500 responses
2013-07-01Type of plan entityMulti-employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planYes
2013-07-01Plan funding arrangement – InsuranceYes
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2012: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2012 form 5500 responses
2012-07-01Type of plan entityMulti-employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planYes
2012-07-01Plan funding arrangement – InsuranceYes
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2011: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2011 form 5500 responses
2011-07-01Type of plan entityMulti-employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planYes
2011-07-01Plan funding arrangement – InsuranceYes
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes
2009: PLASTERERS & CEMENT MASONS LOCAL 40 HEALTH & WELFARE FUND 2009 form 5500 responses
2009-07-01Type of plan entityMulti-employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planYes
2009-07-01Plan funding arrangement – InsuranceYes
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number1F472
Policy instance 1
Insurance contract or identification number1F472
Number of Individuals Covered190
Insurance policy start date2018-06-01
Insurance policy end date2019-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $844,071
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 number1F472
Policy instance 2
Insurance contract or identification number1F472
Number of Individuals Covered190
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
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 BenefitYes
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 $71,337
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 number1F472
Policy instance 2
Insurance contract or identification number1F472
Number of Individuals Covered186
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
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 BenefitYes
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 $67,723
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 number1F472
Policy instance 1
Insurance contract or identification number1F472
Number of Individuals Covered186
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $741,383
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 number1F472
Policy instance 1
Insurance contract or identification number1F472
Number of Individuals Covered186
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 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 $696,874
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 number1F472
Policy instance 2
Insurance contract or identification number1F472
Number of Individuals Covered186
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
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 BenefitYes
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 $68,777
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 number1F472
Policy instance 1
Insurance contract or identification number1F472
Number of Individuals Covered182
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
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 $65,896
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number1F472
Policy instance 2
Insurance contract or identification number1F472
Number of Individuals Covered182
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 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 $648,682
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number1F472
Policy instance 1
Insurance contract or identification number1F472
Number of Individuals Covered172
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
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 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 $696,499
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 number1F472
Policy instance 2
Insurance contract or identification number1F472
Number of Individuals Covered172
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
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 BenefitYes
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 $59,182
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 number1F472
Policy instance 1
Insurance contract or identification number1F472
Number of Individuals Covered162
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
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 $29,285
BLUE CROSS AND BLUE SHIELD OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 53473 )
Policy contract number1F472
Policy instance 2
Insurance contract or identification number1F472
Number of Individuals Covered162
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 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 $547,179
DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 55301 )
Policy contract number5835-0001
Policy instance 1
Insurance contract or identification number5835-0001
Number of Individuals Covered168
Insurance policy start date2011-04-01
Insurance policy end date2012-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
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 $8,955
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number495243
Policy instance 2
Insurance contract or identification number495243
Number of Individuals Covered168
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 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 $568,985
UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )
Policy contract number495243
Policy instance 2
Insurance contract or identification number495243
Number of Individuals Covered151
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 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 $698,758
DELTA DENTAL OF RHODE ISLAND (National Association of Insurance Commissioners NAIC id number: 55301 )
Policy contract number5835-0001
Policy instance 1
Insurance contract or identification number5835-0001
Number of Individuals Covered160
Insurance policy start date2010-04-01
Insurance policy end date2011-03-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
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 $52,739

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