BD OF TR DERRICKMENS WELFARE FUND, LOCAL 197 has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan DERRICKMENS WELFARE FUND, LOCAL 197
| Measure | Date | Value |
|---|
| 2023 : DERRICKMENS WELFARE FUND, LOCAL 197 2023 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2023-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $952,355 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $596,947 |
| Total income from all sources (including contributions) | 2023-12-31 | $5,256,901 |
| Total loss/gain on sale of assets | 2023-12-31 | $0 |
| Total of all expenses incurred | 2023-12-31 | $5,720,772 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-12-31 | $5,453,326 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-12-31 | $4,930,573 |
| Value of total assets at end of year | 2023-12-31 | $4,727,261 |
| Value of total assets at beginning of year | 2023-12-31 | $4,835,724 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-12-31 | $267,446 |
| Total interest from all sources | 2023-12-31 | $10,265 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-12-31 | $93,929 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2023-12-31 | $93,929 |
| Was this plan covered by a fidelity bond | 2023-12-31 | Yes |
| Value of fidelity bond cover | 2023-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2023-12-31 | No |
| Contributions received from participants | 2023-12-31 | $3,246,201 |
| Participant contributions at end of year | 2023-12-31 | $153,000 |
| Participant contributions at beginning of year | 2023-12-31 | $239,000 |
| Assets. Other investments not covered elsewhere at end of year | 2023-12-31 | $165,257 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-12-31 | $200,671 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-12-31 | $241,356 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-12-31 | $166,884 |
| Administrative expenses (other) incurred | 2023-12-31 | $67,307 |
| Liabilities. Value of operating payables at end of year | 2023-12-31 | $98,909 |
| Liabilities. Value of operating payables at beginning of year | 2023-12-31 | $63,593 |
| Total non interest bearing cash at end of year | 2023-12-31 | $1,073,693 |
| Total non interest bearing cash at beginning of year | 2023-12-31 | $1,149,247 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Value of net income/loss | 2023-12-31 | $-463,871 |
| Value of net assets at end of year (total assets less liabilities) | 2023-12-31 | $3,774,906 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-12-31 | $4,238,777 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-12-31 | No |
| Investment advisory and management fees | 2023-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2023-12-31 | $2,992,530 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2023-12-31 | $2,388,468 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-12-31 | $17,609 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-12-31 | $653,045 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-12-31 | $653,045 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-12-31 | $10,265 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-12-31 | $1,926,482 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2023-12-31 | $222,134 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-12-31 | No |
| Contributions received in cash from employer | 2023-12-31 | $1,684,372 |
| Employer contributions (assets) at end of year | 2023-12-31 | $104,000 |
| Employer contributions (assets) at beginning of year | 2023-12-31 | $163,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-12-31 | $3,526,844 |
| Contract administrator fees | 2023-12-31 | $70,666 |
| Liabilities. Value of benefit claims payable at end of year | 2023-12-31 | $686,562 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-12-31 | $533,354 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2023-12-31 | $20,501 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2023-12-31 | $1,608 |
| Did the plan have assets held for investment | 2023-12-31 | Yes |
| 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 | 2023-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-12-31 | Unqualified |
| Accountancy firm name | 2023-12-31 | SCHULTHEIS&PANETTIERI,LLP |
| Accountancy firm EIN | 2023-12-31 | 131577780 |
| 2022 : DERRICKMENS WELFARE FUND, LOCAL 197 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $596,947 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $511,833 |
| Total income from all sources (including contributions) | 2022-12-31 | $2,909,430 |
| Total loss/gain on sale of assets | 2022-12-31 | $0 |
| Total of all expenses incurred | 2022-12-31 | $4,078,216 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $3,852,504 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $3,324,835 |
| Value of total assets at end of year | 2022-12-31 | $4,835,724 |
| Value of total assets at beginning of year | 2022-12-31 | $5,919,396 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $225,712 |
| Total interest from all sources | 2022-12-31 | $8,823 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $58,807 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2022-12-31 | $58,807 |
| Administrative expenses professional fees incurred | 2022-12-31 | $125,767 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $2,055,206 |
| Participant contributions at end of year | 2022-12-31 | $239,000 |
| Participant contributions at beginning of year | 2022-12-31 | $116,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $241,356 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $241,361 |
| Other income not declared elsewhere | 2022-12-31 | $0 |
| Administrative expenses (other) incurred | 2022-12-31 | $28,431 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $63,593 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $80,841 |
| Total non interest bearing cash at end of year | 2022-12-31 | $1,149,247 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $1,024,202 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-1,168,786 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $4,238,777 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $5,407,563 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Investment advisory and management fees | 2022-12-31 | $5,778 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $2,388,468 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $4,270,739 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $653,045 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $187,094 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $187,094 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $8,823 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $1,633,056 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2022-12-31 | $-483,035 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $1,269,629 |
| Employer contributions (assets) at end of year | 2022-12-31 | $163,000 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $80,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $2,219,448 |
| Contract administrator fees | 2022-12-31 | $65,736 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $533,354 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $430,992 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2022-12-31 | $1,608 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| 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 | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2022-12-31 | 131577780 |
| 2021 : DERRICKMENS WELFARE FUND, LOCAL 197 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $511,833 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $730,572 |
| Total income from all sources (including contributions) | 2021-12-31 | $4,893,187 |
| Total loss/gain on sale of assets | 2021-12-31 | $0 |
| Total of all expenses incurred | 2021-12-31 | $5,092,308 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $4,877,257 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $4,443,832 |
| Value of total assets at end of year | 2021-12-31 | $5,919,396 |
| Value of total assets at beginning of year | 2021-12-31 | $6,337,256 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $215,051 |
| Total interest from all sources | 2021-12-31 | $408 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $77,556 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2021-12-31 | $77,556 |
| Administrative expenses professional fees incurred | 2021-12-31 | $114,903 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $2,682,306 |
| Participant contributions at end of year | 2021-12-31 | $116,000 |
| Participant contributions at beginning of year | 2021-12-31 | $232,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $241,361 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $451,903 |
| Other income not declared elsewhere | 2021-12-31 | $126,976 |
| Administrative expenses (other) incurred | 2021-12-31 | $28,472 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $80,841 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $134,726 |
| Total non interest bearing cash at end of year | 2021-12-31 | $1,024,202 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $1,340,485 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $-199,121 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $5,407,563 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $5,606,684 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Investment advisory and management fees | 2021-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-12-31 | $4,270,739 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-12-31 | $4,026,324 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $187,094 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $109,544 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $109,544 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-12-31 | $408 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $2,060,510 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2021-12-31 | $244,415 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $1,761,526 |
| Employer contributions (assets) at end of year | 2021-12-31 | $80,000 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $177,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $2,816,747 |
| Contract administrator fees | 2021-12-31 | $65,676 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $430,992 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $595,846 |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| 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 | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2021-12-31 | 131577780 |
| 2020 : DERRICKMENS WELFARE FUND, LOCAL 197 2020 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2020-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $730,572 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $828,235 |
| Total income from all sources (including contributions) | 2020-12-31 | $4,706,441 |
| Total loss/gain on sale of assets | 2020-12-31 | $0 |
| Total of all expenses incurred | 2020-12-31 | $5,187,366 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $4,936,803 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $4,342,606 |
| Value of total assets at end of year | 2020-12-31 | $6,337,256 |
| Value of total assets at beginning of year | 2020-12-31 | $6,915,844 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $250,563 |
| Total interest from all sources | 2020-12-31 | $1,018 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-12-31 | $86,230 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2020-12-31 | $86,230 |
| Administrative expenses professional fees incurred | 2020-12-31 | $147,636 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $2,522,398 |
| Participant contributions at end of year | 2020-12-31 | $232,000 |
| Participant contributions at beginning of year | 2020-12-31 | $284,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $451,903 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $118,885 |
| Other income not declared elsewhere | 2020-12-31 | $36,593 |
| Administrative expenses (other) incurred | 2020-12-31 | $31,689 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $134,726 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $97,904 |
| Total non interest bearing cash at end of year | 2020-12-31 | $1,340,485 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $2,477,326 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $-480,925 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $5,606,684 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $6,087,609 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Investment advisory and management fees | 2020-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-12-31 | $4,026,324 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-12-31 | $3,786,330 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $109,544 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $23,303 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $23,303 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-12-31 | $1,018 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $2,183,238 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2020-12-31 | $239,994 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $1,820,208 |
| Employer contributions (assets) at end of year | 2020-12-31 | $177,000 |
| Employer contributions (assets) at beginning of year | 2020-12-31 | $226,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $2,753,565 |
| Contract administrator fees | 2020-12-31 | $65,238 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $595,846 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $730,331 |
| Did the plan have assets held for investment | 2020-12-31 | Yes |
| 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 | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2020-12-31 | 131577780 |
| 2019 : DERRICKMENS WELFARE FUND, LOCAL 197 2019 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $828,235 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $907,004 |
| Total income from all sources (including contributions) | 2019-12-31 | $7,254,532 |
| Total loss/gain on sale of assets | 2019-12-31 | $0 |
| Total of all expenses incurred | 2019-12-31 | $6,210,259 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $5,974,807 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $6,866,396 |
| Value of total assets at end of year | 2019-12-31 | $6,915,844 |
| Value of total assets at beginning of year | 2019-12-31 | $5,950,340 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $235,452 |
| Total interest from all sources | 2019-12-31 | $865 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $97,538 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2019-12-31 | $97,538 |
| Administrative expenses professional fees incurred | 2019-12-31 | $128,289 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $3,923,722 |
| Participant contributions at end of year | 2019-12-31 | $284,000 |
| Participant contributions at beginning of year | 2019-12-31 | $360,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $118,885 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $947,879 |
| Administrative expenses (other) incurred | 2019-12-31 | $40,905 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $97,904 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $95,653 |
| Total non interest bearing cash at end of year | 2019-12-31 | $2,477,326 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $913,019 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $1,044,273 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $6,087,609 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $5,043,336 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Investment advisory and management fees | 2019-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-12-31 | $3,786,330 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-12-31 | $3,376,597 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $23,303 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $45,845 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $45,845 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $865 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $1,868,657 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2019-12-31 | $289,733 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $2,942,674 |
| Employer contributions (assets) at end of year | 2019-12-31 | $226,000 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $307,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $4,106,150 |
| Contract administrator fees | 2019-12-31 | $60,258 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $730,331 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $811,351 |
| Did the plan have assets held for investment | 2019-12-31 | Yes |
| 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 | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2019-12-31 | 131577780 |
| 2018 : DERRICKMENS WELFARE FUND, LOCAL 197 2018 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2018-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $907,004 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $441,359 |
| Total income from all sources (including contributions) | 2018-12-31 | $5,463,568 |
| Total loss/gain on sale of assets | 2018-12-31 | $0 |
| Total of all expenses incurred | 2018-12-31 | $4,941,209 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $4,698,386 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $5,475,863 |
| Value of total assets at end of year | 2018-12-31 | $5,950,340 |
| Value of total assets at beginning of year | 2018-12-31 | $4,962,336 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $242,823 |
| Total interest from all sources | 2018-12-31 | $204 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-12-31 | $83,840 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2018-12-31 | $83,840 |
| Administrative expenses professional fees incurred | 2018-12-31 | $145,682 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $3,017,162 |
| Participant contributions at end of year | 2018-12-31 | $360,000 |
| Participant contributions at beginning of year | 2018-12-31 | $150,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $947,879 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $727,711 |
| Administrative expenses (other) incurred | 2018-12-31 | $31,381 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $95,653 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $48,393 |
| Total non interest bearing cash at end of year | 2018-12-31 | $913,019 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $515,888 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $522,359 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $5,043,336 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $4,520,977 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Investment advisory and management fees | 2018-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-12-31 | $3,376,597 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2018-12-31 | $3,289,926 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $45,845 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $144,811 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $144,811 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-12-31 | $204 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $1,434,527 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2018-12-31 | $-96,339 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $2,458,701 |
| Employer contributions (assets) at end of year | 2018-12-31 | $307,000 |
| Employer contributions (assets) at beginning of year | 2018-12-31 | $134,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $3,263,859 |
| Contract administrator fees | 2018-12-31 | $59,760 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $811,351 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $392,966 |
| Did the plan have assets held for investment | 2018-12-31 | Yes |
| 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 | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2018-12-31 | 131577780 |
| 2017 : DERRICKMENS WELFARE FUND, LOCAL 197 2017 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2017-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $441,359 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $640,766 |
| Total income from all sources (including contributions) | 2017-12-31 | $3,810,347 |
| Total loss/gain on sale of assets | 2017-12-31 | $0 |
| Total of all expenses incurred | 2017-12-31 | $3,705,628 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $3,444,917 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $3,632,079 |
| Value of total assets at end of year | 2017-12-31 | $4,962,336 |
| Value of total assets at beginning of year | 2017-12-31 | $5,057,024 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $260,711 |
| Total interest from all sources | 2017-12-31 | $649 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-12-31 | $59,402 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2017-12-31 | $59,402 |
| Administrative expenses professional fees incurred | 2017-12-31 | $111,316 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $1,977,413 |
| Participant contributions at end of year | 2017-12-31 | $150,000 |
| Participant contributions at beginning of year | 2017-12-31 | $165,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $727,711 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $113,699 |
| Administrative expenses (other) incurred | 2017-12-31 | $80,525 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $48,393 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $65,823 |
| Total non interest bearing cash at end of year | 2017-12-31 | $515,888 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $1,364,856 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $104,719 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $4,520,977 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $4,416,258 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Investment advisory and management fees | 2017-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2017-12-31 | $3,289,926 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2017-12-31 | $3,256,469 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $144,811 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-12-31 | $649 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $1,190,655 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2017-12-31 | $118,217 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $1,654,666 |
| Employer contributions (assets) at end of year | 2017-12-31 | $134,000 |
| Employer contributions (assets) at beginning of year | 2017-12-31 | $157,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $2,254,262 |
| Contract administrator fees | 2017-12-31 | $62,870 |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $392,966 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $574,943 |
| Did the plan have assets held for investment | 2017-12-31 | Yes |
| 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 | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2017-12-31 | 131577780 |
| 2016 : DERRICKMENS WELFARE FUND, LOCAL 197 2016 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $640,766 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $462,315 |
| Total income from all sources (including contributions) | 2016-12-31 | $4,446,207 |
| Total loss/gain on sale of assets | 2016-12-31 | $0 |
| Total of all expenses incurred | 2016-12-31 | $3,945,840 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $3,665,550 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $4,357,022 |
| Value of total assets at end of year | 2016-12-31 | $5,057,024 |
| Value of total assets at beginning of year | 2016-12-31 | $4,378,206 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $280,290 |
| Total interest from all sources | 2016-12-31 | $506 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $42,372 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2016-12-31 | $42,372 |
| Administrative expenses professional fees incurred | 2016-12-31 | $108,623 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $2,151,461 |
| Participant contributions at end of year | 2016-12-31 | $165,000 |
| Participant contributions at beginning of year | 2016-12-31 | $139,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $113,699 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $481,294 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-12-31 | $0 |
| Administrative expenses (other) incurred | 2016-12-31 | $110,887 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $65,823 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $56,620 |
| Total non interest bearing cash at end of year | 2016-12-31 | $1,364,856 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $1,772,597 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $500,367 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $4,416,258 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $3,915,891 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Investment advisory and management fees | 2016-12-31 | $6,000 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2016-12-31 | $3,256,469 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2016-12-31 | $1,767,285 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-12-31 | $506 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $1,158,923 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2016-12-31 | $46,307 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $2,205,561 |
| Employer contributions (assets) at end of year | 2016-12-31 | $157,000 |
| Employer contributions (assets) at beginning of year | 2016-12-31 | $197,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $2,506,627 |
| Contract administrator fees | 2016-12-31 | $54,780 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $574,943 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $405,695 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2016-12-31 | $21,030 |
| Did the plan have assets held for investment | 2016-12-31 | Yes |
| 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 | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | SHULTHEIS & PANETTIERI LLP |
| Accountancy firm EIN | 2016-12-31 | 131577780 |
| 2015 : DERRICKMENS WELFARE FUND, LOCAL 197 2015 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2015-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $462,315 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $373,798 |
| Total income from all sources (including contributions) | 2015-12-31 | $3,795,410 |
| Total loss/gain on sale of assets | 2015-12-31 | $0 |
| Total of all expenses incurred | 2015-12-31 | $3,230,632 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $2,918,006 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $3,786,348 |
| Value of total assets at end of year | 2015-12-31 | $4,378,206 |
| Value of total assets at beginning of year | 2015-12-31 | $3,724,911 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $312,626 |
| Total interest from all sources | 2015-12-31 | $3,063 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $18,154 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2015-12-31 | $18,154 |
| Administrative expenses professional fees incurred | 2015-12-31 | $123,918 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $1,541,659 |
| Participant contributions at end of year | 2015-12-31 | $139,000 |
| Participant contributions at beginning of year | 2015-12-31 | $92,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $481,294 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $308,846 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-12-31 | $8,290 |
| Administrative expenses (other) incurred | 2015-12-31 | $123,109 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $56,620 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $47,328 |
| Total non interest bearing cash at end of year | 2015-12-31 | $1,772,597 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $1,423,443 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $564,778 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $3,915,891 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $3,351,113 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Investment advisory and management fees | 2015-12-31 | $5,839 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2015-12-31 | $1,767,285 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2015-12-31 | $610,259 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $1,147,963 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $1,147,963 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-12-31 | $3,063 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $1,024,688 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2015-12-31 | $-12,155 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $2,244,689 |
| Employer contributions (assets) at end of year | 2015-12-31 | $197,000 |
| Employer contributions (assets) at beginning of year | 2015-12-31 | $142,400 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $1,893,318 |
| Contract administrator fees | 2015-12-31 | $59,760 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $405,695 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $318,180 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2015-12-31 | $21,030 |
| Did the plan have assets held for investment | 2015-12-31 | Yes |
| 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 | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2015-12-31 | 131577780 |
| 2014 : DERRICKMENS WELFARE FUND, LOCAL 197 2014 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2014-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $373,798 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $382,898 |
| Total income from all sources (including contributions) | 2014-12-31 | $3,860,691 |
| Total loss/gain on sale of assets | 2014-12-31 | $0 |
| Total of all expenses incurred | 2014-12-31 | $2,892,640 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $2,626,460 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $3,847,811 |
| Value of total assets at end of year | 2014-12-31 | $3,724,911 |
| Value of total assets at beginning of year | 2014-12-31 | $2,765,960 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $266,180 |
| Total interest from all sources | 2014-12-31 | $4,042 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $1,143 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2014-12-31 | $1,143 |
| Administrative expenses professional fees incurred | 2014-12-31 | $103,300 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $1,470,988 |
| Participant contributions at end of year | 2014-12-31 | $92,000 |
| Participant contributions at beginning of year | 2014-12-31 | $102,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $308,846 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $69,555 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-12-31 | $8,290 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-12-31 | $8,290 |
| Administrative expenses (other) incurred | 2014-12-31 | $97,270 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $47,328 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $53,266 |
| Total non interest bearing cash at end of year | 2014-12-31 | $1,423,443 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $1,566,653 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $968,051 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $3,351,113 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $2,383,062 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Investment advisory and management fees | 2014-12-31 | $5,850 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2014-12-31 | $610,259 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2014-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-12-31 | $1,147,963 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $845,352 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $845,352 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $4,042 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $920,135 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2014-12-31 | $7,695 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $2,376,823 |
| Employer contributions (assets) at end of year | 2014-12-31 | $142,400 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $182,400 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $1,706,325 |
| Contract administrator fees | 2014-12-31 | $59,760 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $318,180 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $321,342 |
| Did the plan have assets held for investment | 2014-12-31 | Yes |
| 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 | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2014-12-31 | 131577780 |
| 2013 : DERRICKMENS WELFARE FUND, LOCAL 197 2013 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2013-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $382,898 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $329,914 |
| Total income from all sources (including contributions) | 2013-12-31 | $3,182,363 |
| Total loss/gain on sale of assets | 2013-12-31 | $0 |
| Total of all expenses incurred | 2013-12-31 | $2,380,108 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $2,103,873 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $3,180,448 |
| Value of total assets at end of year | 2013-12-31 | $2,765,960 |
| Value of total assets at beginning of year | 2013-12-31 | $1,910,721 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $276,235 |
| Total interest from all sources | 2013-12-31 | $1,915 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Administrative expenses professional fees incurred | 2013-12-31 | $105,090 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $1,093,787 |
| Participant contributions at end of year | 2013-12-31 | $102,000 |
| Participant contributions at beginning of year | 2013-12-31 | $81,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $69,555 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $48,994 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-12-31 | $8,290 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-12-31 | $7,717 |
| Administrative expenses (other) incurred | 2013-12-31 | $106,769 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $53,266 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $45,880 |
| Total non interest bearing cash at end of year | 2013-12-31 | $1,566,653 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $774,290 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $802,255 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $2,383,062 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $1,580,807 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Investment advisory and management fees | 2013-12-31 | $5,616 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $845,352 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $843,437 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $843,437 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-12-31 | $1,915 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $832,257 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $2,086,661 |
| Employer contributions (assets) at end of year | 2013-12-31 | $182,400 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $163,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $1,271,616 |
| Contract administrator fees | 2013-12-31 | $58,760 |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $321,342 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $276,317 |
| Did the plan have assets held for investment | 2013-12-31 | Yes |
| 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 | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2013-12-31 | 131577780 |
| 2012 : DERRICKMENS WELFARE FUND, LOCAL 197 2012 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2012-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $329,914 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $554,816 |
| Total income from all sources (including contributions) | 2012-12-31 | $2,834,375 |
| Total loss/gain on sale of assets | 2012-12-31 | $0 |
| Total of all expenses incurred | 2012-12-31 | $2,184,944 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $1,924,106 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $2,833,274 |
| Value of total assets at end of year | 2012-12-31 | $1,910,721 |
| Value of total assets at beginning of year | 2012-12-31 | $1,486,192 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $260,838 |
| Total interest from all sources | 2012-12-31 | $1,101 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $85,858 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $1,005,593 |
| Participant contributions at end of year | 2012-12-31 | $81,000 |
| Participant contributions at beginning of year | 2012-12-31 | $32,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $48,994 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $32,258 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-12-31 | $7,717 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-12-31 | $5,531 |
| Administrative expenses (other) incurred | 2012-12-31 | $116,138 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $45,880 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $50,360 |
| Total non interest bearing cash at end of year | 2012-12-31 | $774,290 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $199,764 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $649,431 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $1,580,807 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $931,376 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Investment advisory and management fees | 2012-12-31 | $4,717 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $843,437 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $1,177,170 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $1,177,170 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $1,101 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $606,087 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $1,827,681 |
| Employer contributions (assets) at end of year | 2012-12-31 | $163,000 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $45,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $1,318,019 |
| Contract administrator fees | 2012-12-31 | $54,125 |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $276,317 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $498,925 |
| Did the plan have assets held for investment | 2012-12-31 | Yes |
| 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 | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2012-12-31 | 131577780 |
| 2011 : DERRICKMENS WELFARE FUND, LOCAL 197 2011 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2011-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $554,816 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $504,914 |
| Total income from all sources (including contributions) | 2011-12-31 | $2,560,342 |
| Total loss/gain on sale of assets | 2011-12-31 | $0 |
| Total of all expenses incurred | 2011-12-31 | $3,171,078 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $2,864,041 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $2,556,872 |
| Value of total assets at end of year | 2011-12-31 | $1,486,192 |
| Value of total assets at beginning of year | 2011-12-31 | $2,047,026 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $307,037 |
| Total interest from all sources | 2011-12-31 | $3,470 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $85,828 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $1,086,853 |
| Participant contributions at end of year | 2011-12-31 | $32,000 |
| Participant contributions at beginning of year | 2011-12-31 | $42,000 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $32,258 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-12-31 | $5,531 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-12-31 | $232,716 |
| Administrative expenses (other) incurred | 2011-12-31 | $167,700 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $50,360 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $47,904 |
| Total non interest bearing cash at end of year | 2011-12-31 | $199,764 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $202,616 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $-610,736 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $931,376 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $1,542,112 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $1,177,170 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $1,743,410 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $1,743,410 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $3,470 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $1,435,041 |
| Asset value of US Government securities at beginning of year | 2011-12-31 | $0 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $1,470,019 |
| Employer contributions (assets) at end of year | 2011-12-31 | $45,000 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $59,000 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $1,429,000 |
| Contract administrator fees | 2011-12-31 | $53,509 |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $498,925 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $224,294 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2011-12-31 | $0 |
| Did the plan have assets held for investment | 2011-12-31 | Yes |
| 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 | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2011-12-31 | 131577780 |
| 2010 : DERRICKMENS WELFARE FUND, LOCAL 197 2010 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $504,914 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $912,167 |
| Total income from all sources (including contributions) | 2010-12-31 | $2,766,079 |
| Total loss/gain on sale of assets | 2010-12-31 | $0 |
| Total of all expenses incurred | 2010-12-31 | $3,469,826 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $3,183,262 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $2,762,382 |
| Value of total assets at end of year | 2010-12-31 | $2,047,026 |
| Value of total assets at beginning of year | 2010-12-31 | $3,158,026 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $286,564 |
| Total interest from all sources | 2010-12-31 | $3,697 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2010-12-31 | No |
| Administrative expenses professional fees incurred | 2010-12-31 | $86,608 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $1,210,043 |
| Participant contributions at end of year | 2010-12-31 | $42,000 |
| Participant contributions at beginning of year | 2010-12-31 | $78,000 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $0 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2010-12-31 | $232,716 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2010-12-31 | $303,885 |
| Administrative expenses (other) incurred | 2010-12-31 | $140,215 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $47,904 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $68,119 |
| Total non interest bearing cash at end of year | 2010-12-31 | $202,616 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $239,064 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2010-12-31 | No |
| Value of net income/loss | 2010-12-31 | $-703,747 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $1,542,112 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $2,245,859 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2010-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2010-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2010-12-31 | No |
| Income. Interest from US Government securities | 2010-12-31 | $597 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $1,743,410 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $1,897,850 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $1,897,850 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $3,100 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $1,851,549 |
| Asset value of US Government securities at end of year | 2010-12-31 | $0 |
| Asset value of US Government securities at beginning of year | 2010-12-31 | $829,402 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2010-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2010-12-31 | No |
| Contributions received in cash from employer | 2010-12-31 | $1,552,339 |
| Employer contributions (assets) at end of year | 2010-12-31 | $59,000 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $104,120 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $1,331,713 |
| Contract administrator fees | 2010-12-31 | $59,741 |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $224,294 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $540,163 |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2010-12-31 | $0 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2010-12-31 | $9,590 |
| Did the plan have assets held for investment | 2010-12-31 | Yes |
| 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 | 2010-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2010-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2010-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2010-12-31 | Unqualified |
| Accountancy firm name | 2010-12-31 | SCHULTHEIS & PANETTIERI, LLP |
| Accountancy firm EIN | 2010-12-31 | 131577780 |
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | CP4423 |
| Policy instance | 4 |
| Insurance contract or identification number | CP4423 | | Number of Individuals Covered | 56 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | PAID FAMILY LEAVE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $34,648 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 3 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2022-07-01 | | Insurance policy end date | 2023-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $17,131 | | 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 | G1921 |
| Policy instance | 2 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2022-11-01 | | Insurance policy end date | 2023-10-31 | | Total amount of commissions paid to insurance broker | USD $48,652 | | Total amount of fees paid to insurance company | USD $14,745 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,694,437 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) |
| Policy contract number | G0458 |
| Policy instance | 1 |
| Insurance contract or identification number | G0458 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2022-02-01 | | Insurance policy end date | 2023-01-31 | | Total amount of commissions paid to insurance broker | USD $902 | | Total amount of fees paid to insurance company | USD $615 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $9,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) |
| Policy contract number | G0458 |
| Policy instance | 1 |
| Insurance contract or identification number | G0458 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2021-02-01 | | Insurance policy end date | 2022-01-31 | | Total amount of commissions paid to insurance broker | USD $902 | | Total amount of fees paid to insurance company | USD $615 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $9,712 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $902 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION & TRAINING |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 2 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2021-11-01 | | Insurance policy end date | 2022-10-31 | | Total amount of commissions paid to insurance broker | USD $58,932 | | Total amount of fees paid to insurance company | USD $18,615 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,859,183 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,466 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 18615 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 3 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $17,876 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | CP4423 |
| Policy instance | 4 |
| Insurance contract or identification number | CP4423 | | Number of Individuals Covered | 67 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | PAID FAMILY LEAVE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $23,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) |
| Policy contract number | G0458 |
| Policy instance | 1 |
| Insurance contract or identification number | G0458 | | Number of Individuals Covered | 120 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2021-01-31 | | Total amount of commissions paid to insurance broker | USD $1,229 | | Total amount of fees paid to insurance company | USD $615 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $14,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,035 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 615 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 2 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 118 | | Insurance policy start date | 2020-11-01 | | Insurance policy end date | 2021-10-31 | | Total amount of commissions paid to insurance broker | USD $67,464 | | Total amount of fees paid to insurance company | USD $21,945 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,874,001 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $33,732 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 21945 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 3 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 179 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $21,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | CP4423 |
| Policy instance | 4 |
| Insurance contract or identification number | CP4423 | | Number of Individuals Covered | 54 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | PAID FAMILY LEAVE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $29,466 | | 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 | G1921 |
| Policy instance | 2 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2019-11-01 | | Insurance policy end date | 2020-10-31 | | Total amount of commissions paid to insurance broker | USD $76,545 | | Total amount of fees paid to insurance company | USD $25,635 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,105,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $38,272 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 25635 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING |
|
| ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) |
| Policy contract number | G0458 |
| Policy instance | 1 |
| Insurance contract or identification number | G0458 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Total amount of commissions paid to insurance broker | USD $1,145 | | Total amount of fees paid to insurance company | USD $596 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $10,991 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $596 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 596 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 3 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 240 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $27,385 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | CP4423 |
| Policy instance | 4 |
| Insurance contract or identification number | CP4423 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | PAID FAMILY LEAVE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $17,115 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 ) |
| Policy contract number | G0458 |
| Policy instance | 1 |
| Insurance contract or identification number | G0458 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Total amount of commissions paid to insurance broker | USD $356 | | Total amount of fees paid to insurance company | USD $431 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $9,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $356 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 431 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 3 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 250 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $24,986 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | CP4423 |
| Policy instance | 4 |
| Insurance contract or identification number | CP4423 | | Number of Individuals Covered | 105 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | PAID FAMILY LEAVE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $11,339 | | 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 | G1921 |
| Policy instance | 2 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 126 | | Insurance policy start date | 2018-11-01 | | Insurance policy end date | 2019-10-31 | | Total amount of commissions paid to insurance broker | USD $60,950 | | Total amount of fees paid to insurance company | USD $26,862 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,878,039 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $30,475 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 26862 | | Additional information about fees paid to insurance broker | INCENTIVES, EDUCATION, COMMUNICATION AND TRAINING |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | CP4423 |
| Policy instance | 3 |
| Insurance contract or identification number | CP4423 | | Number of Individuals Covered | 108 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | PAID FAMILY LEAVE | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $8,975 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 2 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 219 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $20,845 | | 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 | G1921 |
| Policy instance | 1 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $46,366 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,390,329 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,917 | | Insurance broker organization code? | 3 |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 2 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 165 | | Insurance policy start date | 2016-07-01 | | Insurance policy end date | 2017-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $20,059 | | 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 | G1921 |
| Policy instance | 1 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 80 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $51,352 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,194,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,850 | | Insurance broker organization code? | 3 | | Insurance broker name | CENTERSTONE INS & FINANCIAL S |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 1 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 83 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $51,827 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,005,437 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,807 | | Insurance broker organization code? | 3 | | Insurance broker name | CENTERSTONE INS & FINANCIAL S |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 2 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $19,101 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 1 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 177 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $17,259 | | 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 | G1921 |
| Policy instance | 2 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $38,148 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $983,331 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $16,029 | | Insurance broker organization code? | 3 | | Insurance broker name | CENTERSTONE INS & FINANCIAL S |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 1 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 151 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,686 | | 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 | G1921 |
| Policy instance | 2 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $36,751 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $735,976 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $15,390 | | Insurance broker organization code? | 3 | | Insurance broker name | CENTERSTONE INS & FINANCIAL S |
|
| EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 ) |
| Policy contract number | G1921 |
| Policy instance | 2 |
| Insurance contract or identification number | G1921 | | Number of Individuals Covered | 51 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $34,861 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $647,253 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $12,492 | | Insurance broker organization code? | 3 | | Insurance broker name | TOM Z DUSI |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 1 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 155 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $12,772 | | 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 | 3330840 |
| Policy instance | 2 |
| Insurance contract or identification number | 3330840 | | Number of Individuals Covered | 75 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,271,170 |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 1 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $15,485 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 69744 ) |
| Policy contract number | G-3139 C-4423 |
| Policy instance | 1 |
| Insurance contract or identification number | G-3139 C-4423 | | Number of Individuals Covered | 182 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $20,087 |
|
| CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 ) |
| Policy contract number | 3330840 |
| Policy instance | 2 |
| Insurance contract or identification number | 3330840 | | Number of Individuals Covered | 119 | | Insurance policy start date | 2009-07-01 | | Insurance policy end date | 2010-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | No | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,730,817 |
|
