SID HARVEY INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.
Additional information about SID HARVEY INDUSTRIES, INC.
Submission information for form 5500 for 401k plan SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION
401k plan membership statisitcs for SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION
| Measure | Date | Value |
|---|
| 2023 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2023 401k financial data |
|---|
| Total income from all sources (including contributions) | 2023-03-31 | $3,321,058 |
| Total of all expenses incurred | 2023-03-31 | $3,321,058 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-03-31 | $3,321,058 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-03-31 | $3,321,058 |
| Value of total assets at end of year | 2023-03-31 | $1,000 |
| Value of total assets at beginning of year | 2023-03-31 | $1,000 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-03-31 | No |
| Was this plan covered by a fidelity bond | 2023-03-31 | Yes |
| Value of fidelity bond cover | 2023-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2023-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-03-31 | No |
| Total non interest bearing cash at end of year | 2023-03-31 | $1,000 |
| Total non interest bearing cash at beginning of year | 2023-03-31 | $1,000 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-03-31 | No |
| Value of net income/loss | 2023-03-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2023-03-31 | $1,000 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-03-31 | $1,000 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-03-31 | $3,321,058 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-03-31 | No |
| Contributions received in cash from employer | 2023-03-31 | $3,321,058 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2023-03-31 | No |
| Did the plan have assets held for investment | 2023-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-03-31 | Unqualified |
| Accountancy firm name | 2023-03-31 | MACIAS GINI & O'CONNOLL LLP |
| Accountancy firm EIN | 2023-03-31 | 680300457 |
| 2022 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-03-31 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-03-31 | $37,577 |
| Total income from all sources (including contributions) | 2022-03-31 | $2,992,774 |
| Total of all expenses incurred | 2022-03-31 | $2,992,774 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-03-31 | $2,991,951 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-03-31 | $2,992,774 |
| Value of total assets at end of year | 2022-03-31 | $1,000 |
| Value of total assets at beginning of year | 2022-03-31 | $38,577 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-03-31 | $823 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-03-31 | No |
| Was this plan covered by a fidelity bond | 2022-03-31 | Yes |
| Value of fidelity bond cover | 2022-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2022-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-03-31 | No |
| Administrative expenses (other) incurred | 2022-03-31 | $823 |
| Liabilities. Value of operating payables at end of year | 2022-03-31 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2022-03-31 | $37,577 |
| Total non interest bearing cash at end of year | 2022-03-31 | $1,000 |
| Total non interest bearing cash at beginning of year | 2022-03-31 | $38,577 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-03-31 | No |
| Value of net income/loss | 2022-03-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2022-03-31 | $1,000 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-03-31 | $1,000 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-03-31 | $2,991,951 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-03-31 | No |
| Contributions received in cash from employer | 2022-03-31 | $2,992,774 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-03-31 | No |
| Did the plan have assets held for investment | 2022-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-03-31 | Unqualified |
| Accountancy firm name | 2022-03-31 | MACIAS GINI & O'CONNOLL LLP |
| Accountancy firm EIN | 2022-03-31 | 680300457 |
| 2021 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-03-31 | $37,577 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-03-31 | $12,262 |
| Total income from all sources (including contributions) | 2021-03-31 | $2,715,802 |
| Total of all expenses incurred | 2021-03-31 | $2,925,324 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-03-31 | $2,912,224 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-03-31 | $2,715,802 |
| Value of total assets at end of year | 2021-03-31 | $38,577 |
| Value of total assets at beginning of year | 2021-03-31 | $222,784 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-03-31 | $13,100 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-03-31 | No |
| Was this plan covered by a fidelity bond | 2021-03-31 | Yes |
| Value of fidelity bond cover | 2021-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-03-31 | No |
| Administrative expenses (other) incurred | 2021-03-31 | $13,100 |
| Liabilities. Value of operating payables at end of year | 2021-03-31 | $37,577 |
| Liabilities. Value of operating payables at beginning of year | 2021-03-31 | $12,262 |
| Total non interest bearing cash at end of year | 2021-03-31 | $38,577 |
| Total non interest bearing cash at beginning of year | 2021-03-31 | $222,784 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-03-31 | No |
| Value of net income/loss | 2021-03-31 | $-209,522 |
| Value of net assets at end of year (total assets less liabilities) | 2021-03-31 | $1,000 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-03-31 | $210,522 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-03-31 | $2,912,224 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-03-31 | No |
| Contributions received in cash from employer | 2021-03-31 | $2,715,802 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-03-31 | No |
| Did the plan have assets held for investment | 2021-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-03-31 | Unqualified |
| Accountancy firm name | 2021-03-31 | NUSSBAUM BERG KLEIN WOLPOW CPAS LLP |
| Accountancy firm EIN | 2021-03-31 | 260221653 |
| 2020 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-03-31 | $12,262 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-03-31 | $34,588 |
| Total income from all sources (including contributions) | 2020-03-31 | $2,874,886 |
| Total of all expenses incurred | 2020-03-31 | $2,829,355 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-03-31 | $2,697,735 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-03-31 | $2,874,886 |
| Value of total assets at end of year | 2020-03-31 | $222,784 |
| Value of total assets at beginning of year | 2020-03-31 | $199,579 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-03-31 | $131,620 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-03-31 | No |
| Was this plan covered by a fidelity bond | 2020-03-31 | Yes |
| Value of fidelity bond cover | 2020-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2020-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-03-31 | No |
| Administrative expenses (other) incurred | 2020-03-31 | $131,620 |
| Liabilities. Value of operating payables at end of year | 2020-03-31 | $12,262 |
| Liabilities. Value of operating payables at beginning of year | 2020-03-31 | $34,588 |
| Total non interest bearing cash at end of year | 2020-03-31 | $222,784 |
| Total non interest bearing cash at beginning of year | 2020-03-31 | $199,579 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-03-31 | No |
| Value of net income/loss | 2020-03-31 | $45,531 |
| Value of net assets at end of year (total assets less liabilities) | 2020-03-31 | $210,522 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-03-31 | $164,991 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-03-31 | $2,697,735 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-03-31 | No |
| Contributions received in cash from employer | 2020-03-31 | $2,874,886 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-03-31 | No |
| Did the plan have assets held for investment | 2020-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-03-31 | Unqualified |
| Accountancy firm name | 2020-03-31 | NUSSBAUM BERG KLEIN WOLPOW CPAS LLP |
| Accountancy firm EIN | 2020-03-31 | 260221653 |
| 2019 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-03-31 | $34,588 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-03-31 | $38,377 |
| Total income from all sources (including contributions) | 2019-03-31 | $2,587,826 |
| Total of all expenses incurred | 2019-03-31 | $2,529,396 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-03-31 | $2,476,688 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-03-31 | $2,587,826 |
| Value of total assets at end of year | 2019-03-31 | $199,579 |
| Value of total assets at beginning of year | 2019-03-31 | $144,938 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-03-31 | $52,708 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-03-31 | No |
| Was this plan covered by a fidelity bond | 2019-03-31 | Yes |
| Value of fidelity bond cover | 2019-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-03-31 | No |
| Administrative expenses (other) incurred | 2019-03-31 | $52,708 |
| Liabilities. Value of operating payables at end of year | 2019-03-31 | $34,588 |
| Liabilities. Value of operating payables at beginning of year | 2019-03-31 | $38,377 |
| Total non interest bearing cash at end of year | 2019-03-31 | $199,579 |
| Total non interest bearing cash at beginning of year | 2019-03-31 | $144,938 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-03-31 | No |
| Value of net income/loss | 2019-03-31 | $58,430 |
| Value of net assets at end of year (total assets less liabilities) | 2019-03-31 | $164,991 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-03-31 | $106,561 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-03-31 | $2,476,688 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-03-31 | No |
| Contributions received in cash from employer | 2019-03-31 | $2,587,826 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-03-31 | No |
| Did the plan have assets held for investment | 2019-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-03-31 | Unqualified |
| Accountancy firm name | 2019-03-31 | NUSSBAUM BERG KLEIN WOLPOW CPAS LLP |
| Accountancy firm EIN | 2019-03-31 | 260221653 |
| 2018 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-03-31 | $38,377 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-03-31 | $41,545 |
| Total income from all sources (including contributions) | 2018-03-31 | $2,077,446 |
| Total of all expenses incurred | 2018-03-31 | $2,053,213 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-03-31 | $1,998,998 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-03-31 | $2,077,446 |
| Value of total assets at end of year | 2018-03-31 | $144,938 |
| Value of total assets at beginning of year | 2018-03-31 | $123,873 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-03-31 | $54,215 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-03-31 | No |
| Was this plan covered by a fidelity bond | 2018-03-31 | Yes |
| Value of fidelity bond cover | 2018-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2018-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-03-31 | No |
| Administrative expenses (other) incurred | 2018-03-31 | $54,215 |
| Liabilities. Value of operating payables at end of year | 2018-03-31 | $38,377 |
| Liabilities. Value of operating payables at beginning of year | 2018-03-31 | $41,545 |
| Total non interest bearing cash at end of year | 2018-03-31 | $144,938 |
| Total non interest bearing cash at beginning of year | 2018-03-31 | $123,873 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-03-31 | No |
| Value of net income/loss | 2018-03-31 | $24,233 |
| Value of net assets at end of year (total assets less liabilities) | 2018-03-31 | $106,561 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-03-31 | $82,328 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-03-31 | $1,998,998 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-03-31 | No |
| Contributions received in cash from employer | 2018-03-31 | $2,077,446 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-03-31 | No |
| Did the plan have assets held for investment | 2018-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-03-31 | Unqualified |
| Accountancy firm name | 2018-03-31 | NUSSBAUM YATES BERG KLEIN & WOLPOW |
| Accountancy firm EIN | 2018-03-31 | 260221653 |
| 2017 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-03-31 | $41,545 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-03-31 | $27,081 |
| Total income from all sources (including contributions) | 2017-03-31 | $1,940,937 |
| Total of all expenses incurred | 2017-03-31 | $1,973,967 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-03-31 | $1,921,101 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-03-31 | $1,940,937 |
| Value of total assets at end of year | 2017-03-31 | $123,873 |
| Value of total assets at beginning of year | 2017-03-31 | $142,439 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-03-31 | $52,866 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-03-31 | No |
| Was this plan covered by a fidelity bond | 2017-03-31 | Yes |
| Value of fidelity bond cover | 2017-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2017-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-03-31 | No |
| Administrative expenses (other) incurred | 2017-03-31 | $52,866 |
| Liabilities. Value of operating payables at end of year | 2017-03-31 | $41,545 |
| Liabilities. Value of operating payables at beginning of year | 2017-03-31 | $27,081 |
| Total non interest bearing cash at end of year | 2017-03-31 | $123,873 |
| Total non interest bearing cash at beginning of year | 2017-03-31 | $142,439 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-03-31 | No |
| Value of net income/loss | 2017-03-31 | $-33,030 |
| Value of net assets at end of year (total assets less liabilities) | 2017-03-31 | $82,328 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-03-31 | $115,358 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-03-31 | $1,921,101 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-03-31 | No |
| Contributions received in cash from employer | 2017-03-31 | $1,940,937 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-03-31 | No |
| Did the plan have assets held for investment | 2017-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-03-31 | Unqualified |
| Accountancy firm name | 2017-03-31 | NUSSBAUM YATES BERG KLEIN & WOLPOW |
| Accountancy firm EIN | 2017-03-31 | 260221653 |
| 2016 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-03-31 | $27,081 |
| Total income from all sources (including contributions) | 2016-03-31 | $2,222,001 |
| Total of all expenses incurred | 2016-03-31 | $2,215,143 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-03-31 | $2,161,086 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-03-31 | $2,222,001 |
| Value of total assets at end of year | 2016-03-31 | $142,439 |
| Value of total assets at beginning of year | 2016-03-31 | $108,500 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-03-31 | $54,057 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-03-31 | No |
| Was this plan covered by a fidelity bond | 2016-03-31 | Yes |
| Value of fidelity bond cover | 2016-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2016-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-03-31 | No |
| Administrative expenses (other) incurred | 2016-03-31 | $54,057 |
| Liabilities. Value of operating payables at end of year | 2016-03-31 | $27,081 |
| Total non interest bearing cash at end of year | 2016-03-31 | $142,439 |
| Total non interest bearing cash at beginning of year | 2016-03-31 | $108,500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-03-31 | No |
| Value of net income/loss | 2016-03-31 | $6,858 |
| Value of net assets at end of year (total assets less liabilities) | 2016-03-31 | $115,358 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-03-31 | $108,500 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-03-31 | $2,161,086 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-03-31 | No |
| Contributions received in cash from employer | 2016-03-31 | $2,222,001 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-03-31 | No |
| Did the plan have assets held for investment | 2016-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-03-31 | Unqualified |
| Accountancy firm name | 2016-03-31 | NUSSBAUM YATES BERG KLEIN & WOLPOW |
| Accountancy firm EIN | 2016-03-31 | 260221653 |
| 2015 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-03-31 | $2,242,283 |
| Total of all expenses incurred | 2015-03-31 | $2,134,283 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-03-31 | $2,087,657 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-03-31 | $2,242,283 |
| Value of total assets at end of year | 2015-03-31 | $108,500 |
| Value of total assets at beginning of year | 2015-03-31 | $500 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-03-31 | $46,626 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-03-31 | No |
| Was this plan covered by a fidelity bond | 2015-03-31 | Yes |
| Value of fidelity bond cover | 2015-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2015-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-03-31 | No |
| Administrative expenses (other) incurred | 2015-03-31 | $46,626 |
| Total non interest bearing cash at end of year | 2015-03-31 | $108,500 |
| Total non interest bearing cash at beginning of year | 2015-03-31 | $500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-03-31 | No |
| Value of net income/loss | 2015-03-31 | $108,000 |
| Value of net assets at end of year (total assets less liabilities) | 2015-03-31 | $108,500 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-03-31 | $500 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-03-31 | $2,087,657 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-03-31 | No |
| Contributions received in cash from employer | 2015-03-31 | $2,242,283 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-03-31 | No |
| Did the plan have assets held for investment | 2015-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-03-31 | Unqualified |
| Accountancy firm name | 2015-03-31 | NUSSBAUM YATES BERG KLEIN & WOLPOW, |
| Accountancy firm EIN | 2015-03-31 | 260221653 |
| 2014 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2014 401k financial data |
|---|
| Total income from all sources (including contributions) | 2014-03-31 | $2,346,581 |
| Total of all expenses incurred | 2014-03-31 | $2,346,581 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-03-31 | $2,346,581 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-03-31 | $2,346,581 |
| Value of total assets at end of year | 2014-03-31 | $500 |
| Value of total assets at beginning of year | 2014-03-31 | $500 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-03-31 | No |
| Was this plan covered by a fidelity bond | 2014-03-31 | Yes |
| Value of fidelity bond cover | 2014-03-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-03-31 | No |
| Total non interest bearing cash at end of year | 2014-03-31 | $500 |
| Total non interest bearing cash at beginning of year | 2014-03-31 | $500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-03-31 | No |
| Value of net income/loss | 2014-03-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2014-03-31 | $500 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-03-31 | $500 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-03-31 | $2,346,581 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-03-31 | No |
| Contributions received in cash from employer | 2014-03-31 | $2,346,581 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-03-31 | No |
| Did the plan have assets held for investment | 2014-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-03-31 | Unqualified |
| Accountancy firm name | 2014-03-31 | NUSSBAUM YATES BERG KLEIN & WOLPOW, |
| Accountancy firm EIN | 2014-03-31 | 260221653 |
| 2013 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2013 401k financial data |
|---|
| Total income from all sources (including contributions) | 2013-03-31 | $2,167,024 |
| Total of all expenses incurred | 2013-03-31 | $2,167,024 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-03-31 | $2,167,024 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-03-31 | $2,167,024 |
| Value of total assets at end of year | 2013-03-31 | $500 |
| Value of total assets at beginning of year | 2013-03-31 | $500 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-03-31 | No |
| Was this plan covered by a fidelity bond | 2013-03-31 | Yes |
| Value of fidelity bond cover | 2013-03-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-03-31 | No |
| Total non interest bearing cash at end of year | 2013-03-31 | $500 |
| Total non interest bearing cash at beginning of year | 2013-03-31 | $500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-03-31 | No |
| Value of net income/loss | 2013-03-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2013-03-31 | $500 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-03-31 | $500 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-03-31 | $2,167,024 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-03-31 | No |
| Contributions received in cash from employer | 2013-03-31 | $2,167,024 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-03-31 | No |
| Did the plan have assets held for investment | 2013-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-03-31 | Unqualified |
| Accountancy firm name | 2013-03-31 | NUSSBAUM YATES BERG KLEIN & WOLPOW, |
| Accountancy firm EIN | 2013-03-31 | 260221653 |
| 2012 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-03-31 | $1,911,219 |
| Total of all expenses incurred | 2012-03-31 | $1,911,219 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-03-31 | $1,911,219 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-03-31 | $1,911,219 |
| Value of total assets at end of year | 2012-03-31 | $500 |
| Value of total assets at beginning of year | 2012-03-31 | $500 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-03-31 | No |
| Was this plan covered by a fidelity bond | 2012-03-31 | Yes |
| Value of fidelity bond cover | 2012-03-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-03-31 | No |
| Total non interest bearing cash at end of year | 2012-03-31 | $500 |
| Total non interest bearing cash at beginning of year | 2012-03-31 | $500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-03-31 | No |
| Value of net income/loss | 2012-03-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2012-03-31 | $500 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-03-31 | $500 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-03-31 | $1,911,219 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-03-31 | No |
| Contributions received in cash from employer | 2012-03-31 | $1,911,219 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-03-31 | No |
| Did the plan have assets held for investment | 2012-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-03-31 | Unqualified |
| Accountancy firm name | 2012-03-31 | NUSSBAUM YATES BERG KLEIN & WOLPOW, |
| Accountancy firm EIN | 2012-03-31 | 260221653 |
| 2011 : SID HARVEY INDUSTRIES, INC. VOLUNTARY EMPLOYEES' BENEFICIARY ASSOCIATION 2011 401k financial data |
|---|
| Total income from all sources (including contributions) | 2011-03-31 | $1,761,807 |
| Total of all expenses incurred | 2011-03-31 | $1,761,807 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-03-31 | $1,761,807 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-03-31 | $1,761,807 |
| Value of total assets at end of year | 2011-03-31 | $500 |
| Value of total assets at beginning of year | 2011-03-31 | $500 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-03-31 | No |
| Was this plan covered by a fidelity bond | 2011-03-31 | Yes |
| Value of fidelity bond cover | 2011-03-31 | $2,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-03-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-03-31 | No |
| Total non interest bearing cash at end of year | 2011-03-31 | $500 |
| Total non interest bearing cash at beginning of year | 2011-03-31 | $500 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-03-31 | No |
| Value of net income/loss | 2011-03-31 | $0 |
| Value of net assets at end of year (total assets less liabilities) | 2011-03-31 | $500 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-03-31 | $500 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-03-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-03-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-03-31 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-03-31 | $1,761,807 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-03-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-03-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-03-31 | No |
| Contributions received in cash from employer | 2011-03-31 | $1,761,807 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-03-31 | No |
| Did the plan have assets held for investment | 2011-03-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-03-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-03-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-03-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-03-31 | Unqualified |
| Accountancy firm name | 2011-03-31 | NUSSBAUM YATES BERG KLEIN & WOLPOW |
| Accountancy firm EIN | 2011-03-31 | 260221653 |
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 10106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 10106225 | | Number of Individuals Covered | 55 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $404,769 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497-00 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2021-08-01 | | Insurance policy end date | 2022-07-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $841 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | 300457 |
| Policy instance | 4 |
| Insurance contract or identification number | 300457 | | Number of Individuals Covered | 437 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,259,789 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA DENTAL HEALTH PLAN OF COLORADO, INC. (National Association of Insurance Commissioners NAIC id number: 11175 ) |
| Policy contract number | 3214388 |
| Policy instance | 5 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,658 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA DENTAL HEALTH OF DELAWARE, INC. (National Association of Insurance Commissioners NAIC id number: 95380 ) |
| Policy contract number | 3214388 |
| Policy instance | 6 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $906 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA DENTAL HEALTH OF KENTUCKY, INC. (National Association of Insurance Commissioners NAIC id number: 52108 ) |
| Policy contract number | 3214388 |
| Policy instance | 7 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 4 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,020 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA DENTAL HEALTH OF NEW JERSEY, INC. (National Association of Insurance Commissioners NAIC id number: 11167 ) |
| Policy contract number | 3214388 |
| Policy instance | 8 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 14 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,269 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA DENTAL HEALTH OF NORTH CAROLINA, INC. (National Association of Insurance Commissioners NAIC id number: 95179 ) |
| Policy contract number | 3214388 |
| Policy instance | 9 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,416 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA DENTAL HEALTH OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47041 ) |
| Policy contract number | 3214388 |
| Policy instance | 10 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,800 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTHCARE OF CONNECTICUT, INC. (National Association of Insurance Commissioners NAIC id number: 95660 ) |
| Policy contract number | 3214388 |
| Policy instance | 11 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2021-06-01 | | Insurance policy end date | 2022-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 928007 |
| Policy instance | 12 |
| Insurance contract or identification number | 928007 | | Number of Individuals Covered | 498 | | Insurance policy start date | 2022-06-01 | | Insurance policy end date | 2023-05-31 | | Total amount of commissions paid to insurance broker | USD $5,941 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,767,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $5,941 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 259 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $92,393 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 10106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 10106225 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2021-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $429,719 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | 300457 |
| Policy instance | 4 |
| Insurance contract or identification number | 300457 | | Number of Individuals Covered | 389 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $7,140 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,414,920 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 7140 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497-00 | | Number of Individuals Covered | 34 | | Insurance policy start date | 2020-08-01 | | Insurance policy end date | 2021-07-31 | | Total amount of commissions paid to insurance broker | USD $2,106 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,106 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 250 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $91,192 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497-00 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2019-08-01 | | Insurance policy end date | 2020-07-31 | | Total amount of commissions paid to insurance broker | USD $1,251 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,251 | | Insurance broker organization code? | 3 |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 10106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 10106225 | | Number of Individuals Covered | 77 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $401,613 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 71-31799 |
| Policy instance | 4 |
| Insurance contract or identification number | 71-31799 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL34172 |
| Policy instance | 5 |
| Insurance contract or identification number | HCL34172 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $506,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CORESOURCE (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | SHM834 |
| Policy instance | 6 |
| Insurance contract or identification number | SHM834 | | Number of Individuals Covered | 242 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497-00 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2018-08-01 | | Insurance policy end date | 2019-07-31 | | Total amount of commissions paid to insurance broker | USD $1,216 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,216 | | Insurance broker organization code? | 3 |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,450 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCL34172 |
| Policy instance | 5 |
| Insurance contract or identification number | HCL34172 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $370,735 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 71-31799 |
| Policy instance | 6 |
| Insurance contract or identification number | 71-31799 | | Number of Individuals Covered | 233 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2019-07-01 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 71-31799 |
| Policy instance | 4 |
| Insurance contract or identification number | 71-31799 | | Number of Individuals Covered | 222 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 10106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 10106225 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $367,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 207 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,203 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 106225 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $345,688 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST SYMETRA NATIONAL LIFE INS CO OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 78417 ) |
| Policy contract number | 16-013142-000 |
| Policy instance | 5 |
| Insurance contract or identification number | 16-013142-000 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $348,381 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497-00 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2017-08-01 | | Insurance policy end date | 2018-08-01 | | Total amount of commissions paid to insurance broker | USD $387 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $387 | | Insurance broker organization code? | 3 |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 71-31799-99 |
| Policy instance | 4 |
| Insurance contract or identification number | 71-31799-99 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| FIRST SYMETRA NATIONAL LIFE INS CO OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 78417 ) |
| Policy contract number | 16-013142-000 |
| Policy instance | 5 |
| Insurance contract or identification number | 16-013142-000 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2016-06-01 | | Insurance policy end date | 2017-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $342,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 71-31799-99 |
| Policy instance | 4 |
| Insurance contract or identification number | 71-31799-99 | | Number of Individuals Covered | 198 | | Insurance policy start date | 2016-06-01 | | Insurance policy end date | 2017-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 106225 | | Number of Individuals Covered | 63 | | Insurance policy start date | 2016-06-01 | | Insurance policy end date | 2017-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $341,684 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497-00 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2016-08-01 | | Insurance policy end date | 2017-08-01 | | Total amount of commissions paid to insurance broker | USD $1,199 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,199 | | Insurance broker organization code? | 3 | | Insurance broker name | JOSEPH SCHAUB |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 205 | | Insurance policy start date | 2016-06-01 | | Insurance policy end date | 2017-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,065 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 106225 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $309,866 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497-00 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2014-08-01 | | Insurance policy end date | 2015-08-01 | | Total amount of commissions paid to insurance broker | USD $1,366 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,366 | | Insurance broker organization code? | 3 | | Insurance broker name | JOSEPH SCHAUB |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $84,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-31799-00 |
| Policy instance | 4 |
| Insurance contract or identification number | 70-31799-00 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497-00 | | Number of Individuals Covered | 29 | | Insurance policy start date | 2013-08-01 | | Insurance policy end date | 2014-08-01 | | Total amount of commissions paid to insurance broker | USD $1,661 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,661 | | Insurance broker organization code? | 3 | | Insurance broker name | JOSEPH SCHAUB |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 106225 | | Number of Individuals Covered | 59 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $280,263 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-31799-00 |
| Policy instance | 4 |
| Insurance contract or identification number | 70-31799-00 | | Number of Individuals Covered | 203 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-06-01 | | Total amount of commissions paid to insurance broker | USD $54,845 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $54,845 | | Insurance broker organization code? | 3 | | Insurance broker name | ALPINE AGENCY |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 201 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $65 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $81,052 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 65 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $126 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $82,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 126 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 106225 | | Number of Individuals Covered | 60 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $258,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-31799-00 |
| Policy instance | 4 |
| Insurance contract or identification number | 70-31799-00 | | Number of Individuals Covered | 215 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-06-01 | | Total amount of commissions paid to insurance broker | USD $55,796 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,796 | | Insurance broker organization code? | 3 | | Insurance broker name | ALPINE AGENCY |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 055649700 |
| Policy instance | 2 |
| Insurance contract or identification number | 055649700 | | Number of Individuals Covered | 30 | | Insurance policy start date | 2012-08-01 | | Insurance policy end date | 2013-07-31 | | Total amount of commissions paid to insurance broker | USD $1,980 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,980 | | Insurance broker organization code? | 3 | | Insurance broker name | JOSEPH SCHAUB |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-31799-00 |
| Policy instance | 4 |
| Insurance contract or identification number | 70-31799-00 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-06-01 | | Total amount of commissions paid to insurance broker | USD $48,935 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,935 | | Insurance broker organization code? | 3 | | Insurance broker name | ALPINE AGENCY |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 106225 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $224,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2011-08-01 | | Insurance policy end date | 2012-07-31 | | Total amount of commissions paid to insurance broker | USD $1,380 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,380 | | Insurance broker organization code? | 3 | | Insurance broker name | ALPINE AGENCY |
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| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 188 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $143 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Other welfare benefits provided | PREPAID DENTAL | | Welfare Benefit Premiums Paid to Carrier | USD $77,921 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 143 | | Additional information about fees paid to insurance broker | GENERAL AGENT PAYMENTS | | Insurance broker organization code? | 3 | | Insurance broker name | MERCER HEALTH & BENEFITS |
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| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-31799-00 |
| Policy instance | 4 |
| Insurance contract or identification number | 70-31799-00 | | Number of Individuals Covered | 206 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-06-01 | | Total amount of commissions paid to insurance broker | USD $45,223 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 106225 | | Number of Individuals Covered | 58 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $190,843 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Total amount of commissions paid to insurance broker | USD $1,432 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,799 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 181 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $85 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,981 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3214388 |
| Policy instance | 1 |
| Insurance contract or identification number | 3214388 | | Number of Individuals Covered | 158 | | Insurance policy start date | 2009-06-01 | | Insurance policy end date | 2010-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $60,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 05-56497-00-2 |
| Policy instance | 2 |
| Insurance contract or identification number | 05-56497-00-2 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Total amount of commissions paid to insurance broker | USD $1,485 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,471 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| GEISINGER QUALITY OPTIONS, INC (National Association of Insurance Commissioners NAIC id number: 95923 ) |
| Policy contract number | 106225 |
| Policy instance | 3 |
| Insurance contract or identification number | 106225 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2009-06-01 | | Insurance policy end date | 2010-05-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $152,233 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BLUE CROSS BLUE SHIELD OF SOUTH CAROLINA (National Association of Insurance Commissioners NAIC id number: 38520 ) |
| Policy contract number | 70-31799-00 |
| Policy instance | 4 |
| Insurance contract or identification number | 70-31799-00 | | Number of Individuals Covered | 202 | | Insurance policy start date | 2009-06-01 | | Insurance policy end date | 2010-06-01 | | Total amount of commissions paid to insurance broker | USD $42,970 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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