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DERRICKMENS WELFARE FUND, LOCAL 197 401k Plan overview

Plan NameDERRICKMENS WELFARE FUND, LOCAL 197
Plan identification number 501

DERRICKMENS WELFARE FUND, LOCAL 197 Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Death benefits (include travel accident but not life insurance)
  • Other welfare benefit cover
  • Collectively bargained welfare benefit arrangement under Code section 419A(f)(5).

401k Sponsoring company profile

BD OF TR DERRICKMENS WELFARE FUND, LOCAL 197 has sponsored the creation of one or more 401k plans.

Company Name:BD OF TR DERRICKMENS WELFARE FUND, LOCAL 197
Employer identification number (EIN):136121369
NAIC Classification:238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DERRICKMENS WELFARE FUND, LOCAL 197

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01WILLIAM HAYES2023-10-05 ROBERT WEISS2023-10-09
5012021-01-01WILLIAM HAYES2022-07-27 ROBERT WEISS2022-07-27
5012020-01-01WILLIAM HAYES2021-07-08 ROBERT WEISS2021-07-08
5012019-01-01WILLIAM HAYES2020-08-02 ROBERT WEISS2020-08-02
5012018-01-01WILLIAM HAYES2019-09-22 ROBERT WEISS2019-09-22
5012017-01-01
5012016-01-01CAROL WESTFALL
5012015-01-01CAROL WESTFALL
5012014-01-01CAROL WESTFALL
5012013-01-01CAROL WESTFALL
5012012-01-01CAROL WESTFALL
5012011-01-01CAROL WESTFALL
5012009-01-01VINCENT F. PANETTIERI
5012009-01-01VINCENT F. PANETTIERI

Plan Statistics for DERRICKMENS WELFARE FUND, LOCAL 197

401k plan membership statisitcs for DERRICKMENS WELFARE FUND, LOCAL 197

Measure Date Value
2022: DERRICKMENS WELFARE FUND, LOCAL 197 2022 401k membership
Total participants, beginning-of-year2022-01-01342
Total number of active participants reported on line 7a of the Form 55002022-01-01183
Number of other retired or separated participants entitled to future benefits2022-01-01132
Total of all active and inactive participants2022-01-01315
Number of employers contributing to the scheme2022-01-0130
2021: DERRICKMENS WELFARE FUND, LOCAL 197 2021 401k membership
Total participants, beginning-of-year2021-01-01341
Total number of active participants reported on line 7a of the Form 55002021-01-01222
Number of other retired or separated participants entitled to future benefits2021-01-01120
Total of all active and inactive participants2021-01-01342
Number of employers contributing to the scheme2021-01-0132
2020: DERRICKMENS WELFARE FUND, LOCAL 197 2020 401k membership
Total participants, beginning-of-year2020-01-01389
Total number of active participants reported on line 7a of the Form 55002020-01-01221
Number of other retired or separated participants entitled to future benefits2020-01-01120
Total of all active and inactive participants2020-01-01341
Number of employers contributing to the scheme2020-01-0127
2019: DERRICKMENS WELFARE FUND, LOCAL 197 2019 401k membership
Total participants, beginning-of-year2019-01-01352
Total number of active participants reported on line 7a of the Form 55002019-01-01268
Number of other retired or separated participants entitled to future benefits2019-01-01121
Total of all active and inactive participants2019-01-01389
Number of employers contributing to the scheme2019-01-0134
2018: DERRICKMENS WELFARE FUND, LOCAL 197 2018 401k membership
Total participants, beginning-of-year2018-01-01292
Total number of active participants reported on line 7a of the Form 55002018-01-01229
Number of other retired or separated participants entitled to future benefits2018-01-01123
Total of all active and inactive participants2018-01-01352
Number of employers contributing to the scheme2018-01-0139
2017: DERRICKMENS WELFARE FUND, LOCAL 197 2017 401k membership
Total participants, beginning-of-year2017-01-01314
Total number of active participants reported on line 7a of the Form 55002017-01-01174
Number of other retired or separated participants entitled to future benefits2017-01-01118
Total of all active and inactive participants2017-01-01292
Number of employers contributing to the scheme2017-01-0142
2016: DERRICKMENS WELFARE FUND, LOCAL 197 2016 401k membership
Total participants, beginning-of-year2016-01-01282
Total number of active participants reported on line 7a of the Form 55002016-01-01187
Number of other retired or separated participants entitled to future benefits2016-01-01127
Total of all active and inactive participants2016-01-01314
Number of employers contributing to the scheme2016-01-0141
2015: DERRICKMENS WELFARE FUND, LOCAL 197 2015 401k membership
Total participants, beginning-of-year2015-01-01285
Total number of active participants reported on line 7a of the Form 55002015-01-01173
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-01109
Total of all active and inactive participants2015-01-01282
2014: DERRICKMENS WELFARE FUND, LOCAL 197 2014 401k membership
Total participants, beginning-of-year2014-01-01281
Total number of active participants reported on line 7a of the Form 55002014-01-01175
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-01110
Total of all active and inactive participants2014-01-01285
2013: DERRICKMENS WELFARE FUND, LOCAL 197 2013 401k membership
Total participants, beginning-of-year2013-01-01142
Total number of active participants reported on line 7a of the Form 55002013-01-01172
Number of other retired or separated participants entitled to future benefits2013-01-01109
Total of all active and inactive participants2013-01-01281
2012: DERRICKMENS WELFARE FUND, LOCAL 197 2012 401k membership
Total participants, beginning-of-year2012-01-01210
Total number of active participants reported on line 7a of the Form 55002012-01-0151
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0191
Total of all active and inactive participants2012-01-01142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Number of participants with account balances2012-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: DERRICKMENS WELFARE FUND, LOCAL 197 2011 401k membership
Total participants, beginning-of-year2011-01-01287
Total number of active participants reported on line 7a of the Form 55002011-01-0170
Number of retired or separated participants receiving benefits2011-01-01110
Number of other retired or separated participants entitled to future benefits2011-01-0130
Total of all active and inactive participants2011-01-01210
2009: DERRICKMENS WELFARE FUND, LOCAL 197 2009 401k membership
Total participants, beginning-of-year2009-01-01359
Total number of active participants reported on line 7a of the Form 55002009-01-01225
Number of retired or separated participants receiving benefits2009-01-01108
Number of other retired or separated participants entitled to future benefits2009-01-0131
Total of all active and inactive participants2009-01-01364
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-015
Number of employers contributing to the scheme2009-01-0122

Financial Data on DERRICKMENS WELFARE FUND, LOCAL 197

Measure Date Value
2022 : DERRICKMENS WELFARE FUND, LOCAL 197 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-12-31$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 assets2022-12-31$0
Total of all expenses incurred2022-12-31$4,078,216
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$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 year2022-12-31$4,835,724
Value of total assets at beginning of year2022-12-31$5,919,396
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$225,712
Total interest from all sources2022-12-31$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 year2022-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2022-12-31$58,807
Administrative expenses professional fees incurred2022-12-31$125,767
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Contributions received from participants2022-12-31$2,055,206
Participant contributions at end of year2022-12-31$239,000
Participant contributions at beginning of year2022-12-31$116,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-12-31$241,356
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-12-31$241,361
Other income not declared elsewhere2022-12-31$0
Administrative expenses (other) incurred2022-12-31$28,431
Liabilities. Value of operating payables at end of year2022-12-31$63,593
Liabilities. Value of operating payables at beginning of year2022-12-31$80,841
Total non interest bearing cash at end of year2022-12-31$1,149,247
Total non interest bearing cash at beginning of year2022-12-31$1,024,202
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-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)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$5,778
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-12-31$2,388,468
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-12-31$4,270,739
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$653,045
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$187,094
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$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 benefits2022-12-31$1,633,056
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-12-31$-483,035
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31No
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Contributions received in cash from employer2022-12-31$1,269,629
Employer contributions (assets) at end of year2022-12-31$163,000
Employer contributions (assets) at beginning of year2022-12-31$80,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$2,219,448
Contract administrator fees2022-12-31$65,736
Liabilities. Value of benefit claims payable at end of year2022-12-31$533,354
Liabilities. Value of benefit claims payable at beginning of year2022-12-31$430,992
Assets. Value of buildings and other operty used in plan operation at end of year2022-12-31$1,608
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2022-12-31131577780
2021 : DERRICKMENS WELFARE FUND, LOCAL 197 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-12-31$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 assets2021-12-31$0
Total of all expenses incurred2021-12-31$5,092,308
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$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 year2021-12-31$5,919,396
Value of total assets at beginning of year2021-12-31$6,337,256
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$215,051
Total interest from all sources2021-12-31$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 year2021-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2021-12-31$77,556
Administrative expenses professional fees incurred2021-12-31$114,903
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Contributions received from participants2021-12-31$2,682,306
Participant contributions at end of year2021-12-31$116,000
Participant contributions at beginning of year2021-12-31$232,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-12-31$241,361
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-12-31$451,903
Other income not declared elsewhere2021-12-31$126,976
Administrative expenses (other) incurred2021-12-31$28,472
Liabilities. Value of operating payables at end of year2021-12-31$80,841
Liabilities. Value of operating payables at beginning of year2021-12-31$134,726
Total non interest bearing cash at end of year2021-12-31$1,024,202
Total non interest bearing cash at beginning of year2021-12-31$1,340,485
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-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)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-12-31$4,270,739
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-12-31$4,026,324
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$187,094
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$109,544
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$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 benefits2021-12-31$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 assets2021-12-31No
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Contributions received in cash from employer2021-12-31$1,761,526
Employer contributions (assets) at end of year2021-12-31$80,000
Employer contributions (assets) at beginning of year2021-12-31$177,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$2,816,747
Contract administrator fees2021-12-31$65,676
Liabilities. Value of benefit claims payable at end of year2021-12-31$430,992
Liabilities. Value of benefit claims payable at beginning of year2021-12-31$595,846
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2021-12-31131577780
2020 : DERRICKMENS WELFARE FUND, LOCAL 197 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-12-31$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 assets2020-12-31$0
Total of all expenses incurred2020-12-31$5,187,366
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$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 year2020-12-31$6,337,256
Value of total assets at beginning of year2020-12-31$6,915,844
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$250,563
Total interest from all sources2020-12-31$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 year2020-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2020-12-31$86,230
Administrative expenses professional fees incurred2020-12-31$147,636
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Contributions received from participants2020-12-31$2,522,398
Participant contributions at end of year2020-12-31$232,000
Participant contributions at beginning of year2020-12-31$284,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-12-31$451,903
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-12-31$118,885
Other income not declared elsewhere2020-12-31$36,593
Administrative expenses (other) incurred2020-12-31$31,689
Liabilities. Value of operating payables at end of year2020-12-31$134,726
Liabilities. Value of operating payables at beginning of year2020-12-31$97,904
Total non interest bearing cash at end of year2020-12-31$1,340,485
Total non interest bearing cash at beginning of year2020-12-31$2,477,326
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-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)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-12-31$4,026,324
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-12-31$3,786,330
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$109,544
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$23,303
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$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 benefits2020-12-31$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 assets2020-12-31No
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Contributions received in cash from employer2020-12-31$1,820,208
Employer contributions (assets) at end of year2020-12-31$177,000
Employer contributions (assets) at beginning of year2020-12-31$226,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$2,753,565
Contract administrator fees2020-12-31$65,238
Liabilities. Value of benefit claims payable at end of year2020-12-31$595,846
Liabilities. Value of benefit claims payable at beginning of year2020-12-31$730,331
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Opinion of an independent qualified public accountant for this plan2020-12-31Unqualified
Accountancy firm name2020-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2020-12-31131577780
2019 : DERRICKMENS WELFARE FUND, LOCAL 197 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-12-31$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 assets2019-12-31$0
Total of all expenses incurred2019-12-31$6,210,259
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$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 year2019-12-31$6,915,844
Value of total assets at beginning of year2019-12-31$5,950,340
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$235,452
Total interest from all sources2019-12-31$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 year2019-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-12-31$97,538
Administrative expenses professional fees incurred2019-12-31$128,289
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Contributions received from participants2019-12-31$3,923,722
Participant contributions at end of year2019-12-31$284,000
Participant contributions at beginning of year2019-12-31$360,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-12-31$118,885
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-12-31$947,879
Administrative expenses (other) incurred2019-12-31$40,905
Liabilities. Value of operating payables at end of year2019-12-31$97,904
Liabilities. Value of operating payables at beginning of year2019-12-31$95,653
Total non interest bearing cash at end of year2019-12-31$2,477,326
Total non interest bearing cash at beginning of year2019-12-31$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 appraiser2019-12-31No
Value of net income/loss2019-12-31$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)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-12-31$3,786,330
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-12-31$3,376,597
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$23,303
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$45,845
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$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 benefits2019-12-31$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 assets2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Contributions received in cash from employer2019-12-31$2,942,674
Employer contributions (assets) at end of year2019-12-31$226,000
Employer contributions (assets) at beginning of year2019-12-31$307,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$4,106,150
Contract administrator fees2019-12-31$60,258
Liabilities. Value of benefit claims payable at end of year2019-12-31$730,331
Liabilities. Value of benefit claims payable at beginning of year2019-12-31$811,351
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31No
Opinion of an independent qualified public accountant for this plan2019-12-31Unqualified
Accountancy firm name2019-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2019-12-31131577780
2018 : DERRICKMENS WELFARE FUND, LOCAL 197 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-12-31$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 assets2018-12-31$0
Total of all expenses incurred2018-12-31$4,941,209
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$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 year2018-12-31$5,950,340
Value of total assets at beginning of year2018-12-31$4,962,336
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$242,823
Total interest from all sources2018-12-31$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 year2018-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-12-31$83,840
Administrative expenses professional fees incurred2018-12-31$145,682
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Contributions received from participants2018-12-31$3,017,162
Participant contributions at end of year2018-12-31$360,000
Participant contributions at beginning of year2018-12-31$150,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-12-31$947,879
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-12-31$727,711
Administrative expenses (other) incurred2018-12-31$31,381
Liabilities. Value of operating payables at end of year2018-12-31$95,653
Liabilities. Value of operating payables at beginning of year2018-12-31$48,393
Total non interest bearing cash at end of year2018-12-31$913,019
Total non interest bearing cash at beginning of year2018-12-31$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 appraiser2018-12-31No
Value of net income/loss2018-12-31$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)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-12-31$3,376,597
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-12-31$3,289,926
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$45,845
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$144,811
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$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 benefits2018-12-31$1,434,527
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-12-31$-96,339
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31No
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Contributions received in cash from employer2018-12-31$2,458,701
Employer contributions (assets) at end of year2018-12-31$307,000
Employer contributions (assets) at beginning of year2018-12-31$134,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$3,263,859
Contract administrator fees2018-12-31$59,760
Liabilities. Value of benefit claims payable at end of year2018-12-31$811,351
Liabilities. Value of benefit claims payable at beginning of year2018-12-31$392,966
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31No
Opinion of an independent qualified public accountant for this plan2018-12-31Unqualified
Accountancy firm name2018-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2018-12-31131577780
2017 : DERRICKMENS WELFARE FUND, LOCAL 197 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$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 assets2017-12-31$0
Total of all expenses incurred2017-12-31$3,705,628
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$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 year2017-12-31$4,962,336
Value of total assets at beginning of year2017-12-31$5,057,024
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$260,711
Total interest from all sources2017-12-31$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 year2017-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$59,402
Administrative expenses professional fees incurred2017-12-31$111,316
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$1,977,413
Participant contributions at end of year2017-12-31$150,000
Participant contributions at beginning of year2017-12-31$165,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$727,711
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-12-31$113,699
Administrative expenses (other) incurred2017-12-31$80,525
Liabilities. Value of operating payables at end of year2017-12-31$48,393
Liabilities. Value of operating payables at beginning of year2017-12-31$65,823
Total non interest bearing cash at end of year2017-12-31$515,888
Total non interest bearing cash at beginning of year2017-12-31$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 appraiser2017-12-31No
Value of net income/loss2017-12-31$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)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-12-31$3,289,926
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$3,256,469
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$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 benefits2017-12-31$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 assets2017-12-31Yes
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Contributions received in cash from employer2017-12-31$1,654,666
Employer contributions (assets) at end of year2017-12-31$134,000
Employer contributions (assets) at beginning of year2017-12-31$157,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$2,254,262
Contract administrator fees2017-12-31$62,870
Liabilities. Value of benefit claims payable at end of year2017-12-31$392,966
Liabilities. Value of benefit claims payable at beginning of year2017-12-31$574,943
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31No
Opinion of an independent qualified public accountant for this plan2017-12-31Unqualified
Accountancy firm name2017-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2017-12-31131577780
2016 : DERRICKMENS WELFARE FUND, LOCAL 197 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$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 assets2016-12-31$0
Total of all expenses incurred2016-12-31$3,945,840
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$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 year2016-12-31$5,057,024
Value of total assets at beginning of year2016-12-31$4,378,206
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$280,290
Total interest from all sources2016-12-31$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 year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$42,372
Administrative expenses professional fees incurred2016-12-31$108,623
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$2,151,461
Participant contributions at end of year2016-12-31$165,000
Participant contributions at beginning of year2016-12-31$139,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$113,699
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$481,294
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$0
Administrative expenses (other) incurred2016-12-31$110,887
Liabilities. Value of operating payables at end of year2016-12-31$65,823
Liabilities. Value of operating payables at beginning of year2016-12-31$56,620
Total non interest bearing cash at end of year2016-12-31$1,364,856
Total non interest bearing cash at beginning of year2016-12-31$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 appraiser2016-12-31No
Value of net income/loss2016-12-31$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)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$6,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$3,256,469
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$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 benefits2016-12-31$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 assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$2,205,561
Employer contributions (assets) at end of year2016-12-31$157,000
Employer contributions (assets) at beginning of year2016-12-31$197,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$2,506,627
Contract administrator fees2016-12-31$54,780
Liabilities. Value of benefit claims payable at end of year2016-12-31$574,943
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$405,695
Assets. Value of buildings and other operty used in plan operation at beginning of year2016-12-31$21,030
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31SHULTHEIS & PANETTIERI LLP
Accountancy firm EIN2016-12-31131577780
2015 : DERRICKMENS WELFARE FUND, LOCAL 197 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$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 assets2015-12-31$0
Total of all expenses incurred2015-12-31$3,230,632
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$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 year2015-12-31$4,378,206
Value of total assets at beginning of year2015-12-31$3,724,911
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$312,626
Total interest from all sources2015-12-31$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 year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$18,154
Administrative expenses professional fees incurred2015-12-31$123,918
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$1,541,659
Participant contributions at end of year2015-12-31$139,000
Participant contributions at beginning of year2015-12-31$92,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$481,294
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$308,846
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$8,290
Administrative expenses (other) incurred2015-12-31$123,109
Liabilities. Value of operating payables at end of year2015-12-31$56,620
Liabilities. Value of operating payables at beginning of year2015-12-31$47,328
Total non interest bearing cash at end of year2015-12-31$1,772,597
Total non interest bearing cash at beginning of year2015-12-31$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 appraiser2015-12-31No
Value of net income/loss2015-12-31$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)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$5,839
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$1,767,285
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$610,259
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$1,147,963
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$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 benefits2015-12-31$1,024,688
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-12,155
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$2,244,689
Employer contributions (assets) at end of year2015-12-31$197,000
Employer contributions (assets) at beginning of year2015-12-31$142,400
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$1,893,318
Contract administrator fees2015-12-31$59,760
Liabilities. Value of benefit claims payable at end of year2015-12-31$405,695
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$318,180
Assets. Value of buildings and other operty used in plan operation at end of year2015-12-31$21,030
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2015-12-31131577780
2014 : DERRICKMENS WELFARE FUND, LOCAL 197 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$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 assets2014-12-31$0
Total of all expenses incurred2014-12-31$2,892,640
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$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 year2014-12-31$3,724,911
Value of total assets at beginning of year2014-12-31$2,765,960
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$266,180
Total interest from all sources2014-12-31$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 year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$1,143
Administrative expenses professional fees incurred2014-12-31$103,300
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$1,470,988
Participant contributions at end of year2014-12-31$92,000
Participant contributions at beginning of year2014-12-31$102,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$308,846
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$69,555
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$8,290
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$8,290
Administrative expenses (other) incurred2014-12-31$97,270
Liabilities. Value of operating payables at end of year2014-12-31$47,328
Liabilities. Value of operating payables at beginning of year2014-12-31$53,266
Total non interest bearing cash at end of year2014-12-31$1,423,443
Total non interest bearing cash at beginning of year2014-12-31$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 appraiser2014-12-31No
Value of net income/loss2014-12-31$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)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$5,850
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$610,259
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$1,147,963
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$845,352
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$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 benefits2014-12-31$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 assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$2,376,823
Employer contributions (assets) at end of year2014-12-31$142,400
Employer contributions (assets) at beginning of year2014-12-31$182,400
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$1,706,325
Contract administrator fees2014-12-31$59,760
Liabilities. Value of benefit claims payable at end of year2014-12-31$318,180
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$321,342
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2014-12-31131577780
2013 : DERRICKMENS WELFARE FUND, LOCAL 197 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$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 assets2013-12-31$0
Total of all expenses incurred2013-12-31$2,380,108
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$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 year2013-12-31$2,765,960
Value of total assets at beginning of year2013-12-31$1,910,721
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$276,235
Total interest from all sources2013-12-31$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 year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$105,090
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$1,093,787
Participant contributions at end of year2013-12-31$102,000
Participant contributions at beginning of year2013-12-31$81,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$69,555
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-12-31$48,994
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$8,290
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-12-31$7,717
Administrative expenses (other) incurred2013-12-31$106,769
Liabilities. Value of operating payables at end of year2013-12-31$53,266
Liabilities. Value of operating payables at beginning of year2013-12-31$45,880
Total non interest bearing cash at end of year2013-12-31$1,566,653
Total non interest bearing cash at beginning of year2013-12-31$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 appraiser2013-12-31No
Value of net income/loss2013-12-31$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)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$5,616
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$845,352
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$843,437
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$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 benefits2013-12-31$832,257
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$2,086,661
Employer contributions (assets) at end of year2013-12-31$182,400
Employer contributions (assets) at beginning of year2013-12-31$163,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$1,271,616
Contract administrator fees2013-12-31$58,760
Liabilities. Value of benefit claims payable at end of year2013-12-31$321,342
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$276,317
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2013-12-31131577780
2012 : DERRICKMENS WELFARE FUND, LOCAL 197 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$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 assets2012-12-31$0
Total of all expenses incurred2012-12-31$2,184,944
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$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 year2012-12-31$1,910,721
Value of total assets at beginning of year2012-12-31$1,486,192
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$260,838
Total interest from all sources2012-12-31$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 year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$85,858
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Contributions received from participants2012-12-31$1,005,593
Participant contributions at end of year2012-12-31$81,000
Participant contributions at beginning of year2012-12-31$32,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-12-31$48,994
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-12-31$32,258
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-12-31$7,717
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-12-31$5,531
Administrative expenses (other) incurred2012-12-31$116,138
Liabilities. Value of operating payables at end of year2012-12-31$45,880
Liabilities. Value of operating payables at beginning of year2012-12-31$50,360
Total non interest bearing cash at end of year2012-12-31$774,290
Total non interest bearing cash at beginning of year2012-12-31$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 appraiser2012-12-31No
Value of net income/loss2012-12-31$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)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Investment advisory and management fees2012-12-31$4,717
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$843,437
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$1,177,170
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$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 benefits2012-12-31$606,087
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$1,827,681
Employer contributions (assets) at end of year2012-12-31$163,000
Employer contributions (assets) at beginning of year2012-12-31$45,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$1,318,019
Contract administrator fees2012-12-31$54,125
Liabilities. Value of benefit claims payable at end of year2012-12-31$276,317
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$498,925
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2012-12-31131577780
2011 : DERRICKMENS WELFARE FUND, LOCAL 197 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$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 assets2011-12-31$0
Total of all expenses incurred2011-12-31$3,171,078
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$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 year2011-12-31$1,486,192
Value of total assets at beginning of year2011-12-31$2,047,026
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$307,037
Total interest from all sources2011-12-31$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 year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$85,828
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Contributions received from participants2011-12-31$1,086,853
Participant contributions at end of year2011-12-31$32,000
Participant contributions at beginning of year2011-12-31$42,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-12-31$32,258
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-12-31$5,531
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-12-31$232,716
Administrative expenses (other) incurred2011-12-31$167,700
Liabilities. Value of operating payables at end of year2011-12-31$50,360
Liabilities. Value of operating payables at beginning of year2011-12-31$47,904
Total non interest bearing cash at end of year2011-12-31$199,764
Total non interest bearing cash at beginning of year2011-12-31$202,616
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-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)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$1,177,170
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$1,743,410
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$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 benefits2011-12-31$1,435,041
Asset value of US Government securities at beginning of year2011-12-31$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$1,470,019
Employer contributions (assets) at end of year2011-12-31$45,000
Employer contributions (assets) at beginning of year2011-12-31$59,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$1,429,000
Contract administrator fees2011-12-31$53,509
Liabilities. Value of benefit claims payable at end of year2011-12-31$498,925
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$224,294
Assets. Value of buildings and other operty used in plan operation at beginning of year2011-12-31$0
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2011-12-31131577780
2010 : DERRICKMENS WELFARE FUND, LOCAL 197 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$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 assets2010-12-31$0
Total of all expenses incurred2010-12-31$3,469,826
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$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 year2010-12-31$2,047,026
Value of total assets at beginning of year2010-12-31$3,158,026
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$286,564
Total interest from all sources2010-12-31$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 year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$86,608
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$1,210,043
Participant contributions at end of year2010-12-31$42,000
Participant contributions at beginning of year2010-12-31$78,000
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2010-12-31$232,716
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2010-12-31$303,885
Administrative expenses (other) incurred2010-12-31$140,215
Liabilities. Value of operating payables at end of year2010-12-31$47,904
Liabilities. Value of operating payables at beginning of year2010-12-31$68,119
Total non interest bearing cash at end of year2010-12-31$202,616
Total non interest bearing cash at beginning of year2010-12-31$239,064
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-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)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Income. Interest from US Government securities2010-12-31$597
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$1,743,410
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$1,897,850
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$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 benefits2010-12-31$1,851,549
Asset value of US Government securities at end of year2010-12-31$0
Asset value of US Government securities at beginning of year2010-12-31$829,402
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$1,552,339
Employer contributions (assets) at end of year2010-12-31$59,000
Employer contributions (assets) at beginning of year2010-12-31$104,120
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$1,331,713
Contract administrator fees2010-12-31$59,741
Liabilities. Value of benefit claims payable at end of year2010-12-31$224,294
Liabilities. Value of benefit claims payable at beginning of year2010-12-31$540,163
Assets. Value of buildings and other operty used in plan operation at end of year2010-12-31$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2010-12-31$9,590
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31SCHULTHEIS & PANETTIERI, LLP
Accountancy firm EIN2010-12-31131577780

Form 5500 Responses for DERRICKMENS WELFARE FUND, LOCAL 197

2022: DERRICKMENS WELFARE FUND, LOCAL 197 2022 form 5500 responses
2022-01-01Type of plan entityMulti-employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: DERRICKMENS WELFARE FUND, LOCAL 197 2021 form 5500 responses
2021-01-01Type of plan entityMulti-employer plan
2021-01-01Submission has been amendedNo
2021-01-01This submission is the final filingNo
2021-01-01This return/report is a short plan year return/report (less than 12 months)No
2021-01-01Plan is a collectively bargained planYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: DERRICKMENS WELFARE FUND, LOCAL 197 2020 form 5500 responses
2020-01-01Type of plan entityMulti-employer plan
2020-01-01Submission has been amendedNo
2020-01-01This submission is the final filingNo
2020-01-01This return/report is a short plan year return/report (less than 12 months)No
2020-01-01Plan is a collectively bargained planYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: DERRICKMENS WELFARE FUND, LOCAL 197 2019 form 5500 responses
2019-01-01Type of plan entityMulti-employer plan
2019-01-01Submission has been amendedNo
2019-01-01This submission is the final filingNo
2019-01-01This return/report is a short plan year return/report (less than 12 months)No
2019-01-01Plan is a collectively bargained planYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: DERRICKMENS WELFARE FUND, LOCAL 197 2018 form 5500 responses
2018-01-01Type of plan entityMulti-employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: DERRICKMENS WELFARE FUND, LOCAL 197 2017 form 5500 responses
2017-01-01Type of plan entityMulti-employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: DERRICKMENS WELFARE FUND, LOCAL 197 2016 form 5500 responses
2016-01-01Type of plan entityMulti-employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: DERRICKMENS WELFARE FUND, LOCAL 197 2015 form 5500 responses
2015-01-01Type of plan entityMulti-employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: DERRICKMENS WELFARE FUND, LOCAL 197 2014 form 5500 responses
2014-01-01Type of plan entityMulti-employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: DERRICKMENS WELFARE FUND, LOCAL 197 2013 form 5500 responses
2013-01-01Type of plan entityMulti-employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: DERRICKMENS WELFARE FUND, LOCAL 197 2012 form 5500 responses
2012-01-01Type of plan entityMulti-employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: DERRICKMENS WELFARE FUND, LOCAL 197 2011 form 5500 responses
2011-01-01Type of plan entityMulti-employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: DERRICKMENS WELFARE FUND, LOCAL 197 2009 form 5500 responses
2009-01-01Type of plan entityMulti-employer plan
2009-01-01Submission has been amendedYes
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberCP4423
Policy instance 4
Insurance contract or identification numberCP4423
Number of Individuals Covered67
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPAID 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 CarrierUSD $23,442
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: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 3
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered80
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $17,876
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 numberG1921
Policy instance 2
Insurance contract or identification numberG1921
Number of Individuals Covered75
Insurance policy start date2021-11-01
Insurance policy end date2022-10-31
Total amount of commissions paid to insurance brokerUSD $58,932
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $29,466
Insurance broker organization code?3
Amount paid for insurance broker fees18615
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 )
Policy contract numberG0458
Policy instance 1
Insurance contract or identification numberG0458
Number of Individuals Covered84
Insurance policy start date2021-02-01
Insurance policy end date2022-01-31
Total amount of commissions paid to insurance brokerUSD $902
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,712
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $902
Amount paid for insurance broker fees0
Insurance broker organization code?3
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION & TRAINING
ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 )
Policy contract numberG0458
Policy instance 1
Insurance contract or identification numberG0458
Number of Individuals Covered120
Insurance policy start date2020-02-01
Insurance policy end date2021-01-31
Total amount of commissions paid to insurance brokerUSD $1,229
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $14,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,035
Insurance broker organization code?3
Amount paid for insurance broker fees615
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract numberG1921
Policy instance 2
Insurance contract or identification numberG1921
Number of Individuals Covered118
Insurance policy start date2020-11-01
Insurance policy end date2021-10-31
Total amount of commissions paid to insurance brokerUSD $67,464
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $33,732
Insurance broker organization code?3
Amount paid for insurance broker fees21945
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 3
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered179
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $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: 52414 )
Policy contract numberCP4423
Policy instance 4
Insurance contract or identification numberCP4423
Number of Individuals Covered54
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPAID 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 CarrierUSD $29,466
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: 52414 )
Policy contract numberCP4423
Policy instance 4
Insurance contract or identification numberCP4423
Number of Individuals Covered90
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPAID 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 CarrierUSD $17,115
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: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 3
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered240
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $27,385
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 numberG1921
Policy instance 2
Insurance contract or identification numberG1921
Number of Individuals Covered133
Insurance policy start date2019-11-01
Insurance policy end date2020-10-31
Total amount of commissions paid to insurance brokerUSD $76,545
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $2,105,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $38,272
Insurance broker organization code?3
Amount paid for insurance broker fees25635
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 )
Policy contract numberG0458
Policy instance 1
Insurance contract or identification numberG0458
Number of Individuals Covered139
Insurance policy start date2019-02-01
Insurance policy end date2020-01-31
Total amount of commissions paid to insurance brokerUSD $1,145
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $10,991
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $596
Insurance broker organization code?3
Amount paid for insurance broker fees596
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberCP4423
Policy instance 4
Insurance contract or identification numberCP4423
Number of Individuals Covered105
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPAID 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 CarrierUSD $11,339
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: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 3
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered250
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $24,986
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 numberG1921
Policy instance 2
Insurance contract or identification numberG1921
Number of Individuals Covered126
Insurance policy start date2018-11-01
Insurance policy end date2019-10-31
Total amount of commissions paid to insurance brokerUSD $60,950
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $30,475
Insurance broker organization code?3
Amount paid for insurance broker fees26862
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
ANTHEM LIFE & DISABILITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 13573 )
Policy contract numberG0458
Policy instance 1
Insurance contract or identification numberG0458
Number of Individuals Covered121
Insurance policy start date2018-02-01
Insurance policy end date2019-01-31
Total amount of commissions paid to insurance brokerUSD $356
Total amount of fees paid to insurance companyUSD $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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $9,538
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $356
Insurance broker organization code?3
Amount paid for insurance broker fees431
Additional information about fees paid to insurance brokerINCENTIVES, EDUCATION, COMMUNICATION AND TRAINING
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract numberG1921
Policy instance 1
Insurance contract or identification numberG1921
Number of Individuals Covered103
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $46,366
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $20,917
Insurance broker organization code?3
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 2
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered219
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $20,845
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: 52414 )
Policy contract numberCP4423
Policy instance 3
Insurance contract or identification numberCP4423
Number of Individuals Covered108
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPAID 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 CarrierUSD $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: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 2
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered165
Insurance policy start date2016-07-01
Insurance policy end date2017-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $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 numberG1921
Policy instance 1
Insurance contract or identification numberG1921
Number of Individuals Covered80
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $51,352
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $20,850
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL S
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract numberG1921
Policy instance 1
Insurance contract or identification numberG1921
Number of Individuals Covered83
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $51,827
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $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 BrokerUSD $20,807
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL S
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 2
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered156
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $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: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 1
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered177
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $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 numberG1921
Policy instance 2
Insurance contract or identification numberG1921
Number of Individuals Covered79
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $38,148
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $983,331
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $16,029
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL S
EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )
Policy contract numberG1921
Policy instance 2
Insurance contract or identification numberG1921
Number of Individuals Covered74
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $36,751
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $735,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,390
Insurance broker organization code?3
Insurance broker nameCENTERSTONE INS & FINANCIAL S
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 1
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered151
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $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 numberG1921
Policy instance 2
Insurance contract or identification numberG1921
Number of Individuals Covered51
Insurance policy start date2011-11-01
Insurance policy end date2012-10-31
Total amount of commissions paid to insurance brokerUSD $34,861
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $647,253
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $12,492
Insurance broker organization code?3
Insurance broker nameTOM Z DUSI
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 1
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered155
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $12,772
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: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 1
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered87
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $15,485
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 number3330840
Policy instance 2
Insurance contract or identification number3330840
Number of Individuals Covered75
Insurance policy start date2011-01-01
Insurance policy end date2011-10-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,271,170
CONNECTICUT GENERAL LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 62308 )
Policy contract number3330840
Policy instance 2
Insurance contract or identification number3330840
Number of Individuals Covered119
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,730,817
THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 )
Policy contract numberG-3139 C-4423
Policy instance 1
Insurance contract or identification numberG-3139 C-4423
Number of Individuals Covered182
Insurance policy start date2009-07-01
Insurance policy end date2010-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL 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 CarrierUSD $20,087

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