NEW JERSEY B.A.C. HEALTH FUND has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN
401k plan membership statisitcs for NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN
| Measure | Date | Value |
|---|
| 2023 : NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN 2023 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $246,855 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $293,354 |
| Total income from all sources (including contributions) | 2023-12-31 | $1,717,574 |
| Total of all expenses incurred | 2023-12-31 | $1,709,725 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-12-31 | $1,550,545 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-12-31 | $1,320,998 |
| Value of total assets at end of year | 2023-12-31 | $206,189 |
| Value of total assets at beginning of year | 2023-12-31 | $244,839 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-12-31 | $159,180 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-12-31 | No |
| Was this plan covered by a fidelity bond | 2023-12-31 | Yes |
| Value of fidelity bond cover | 2023-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2023-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-12-31 | No |
| Contributions received from participants | 2023-12-31 | $1,320,998 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-12-31 | $206,189 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-12-31 | $244,839 |
| Other income not declared elsewhere | 2023-12-31 | $396,576 |
| Total non interest bearing cash at end of year | 2023-12-31 | $206,189 |
| Total non interest bearing cash at beginning of year | 2023-12-31 | $244,839 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Value of net income/loss | 2023-12-31 | $7,849 |
| Value of net assets at end of year (total assets less liabilities) | 2023-12-31 | $-40,666 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-12-31 | $-48,515 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2023-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-12-31 | $489,069 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2023-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-12-31 | $1,061,476 |
| Contract administrator fees | 2023-12-31 | $159,180 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2023-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2023-12-31 | $40,666 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-12-31 | $48,515 |
| Did the plan have assets held for investment | 2023-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-12-31 | Unqualified |
| Accountancy firm name | 2023-12-31 | RICHARD J. CUMMINGS, CPA |
| Accountancy firm EIN | 2023-12-31 | 223346148 |
| 2022 : NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $293,354 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $343,509 |
| Total income from all sources (including contributions) | 2022-12-31 | $1,874,591 |
| Total of all expenses incurred | 2022-12-31 | $1,861,750 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $1,693,928 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $1,415,154 |
| Value of total assets at end of year | 2022-12-31 | $244,839 |
| Value of total assets at beginning of year | 2022-12-31 | $282,153 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $167,822 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $1,415,154 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-12-31 | $244,839 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-12-31 | $282,153 |
| Other income not declared elsewhere | 2022-12-31 | $459,437 |
| Total non interest bearing cash at end of year | 2022-12-31 | $244,839 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $282,153 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $12,841 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $-48,515 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $-61,356 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2022-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $445,365 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $1,248,563 |
| Contract administrator fees | 2022-12-31 | $167,822 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $48,515 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $61,356 |
| Did the plan have assets held for investment | 2022-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | RICHARD J. CUMMINGS, CPA |
| Accountancy firm EIN | 2022-12-31 | 223346148 |
| 2021 : NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $343,509 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $346,194 |
| Total income from all sources (including contributions) | 2021-12-31 | $2,217,836 |
| Total of all expenses incurred | 2021-12-31 | $2,236,856 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $2,058,339 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $1,519,362 |
| Value of total assets at end of year | 2021-12-31 | $282,153 |
| Value of total assets at beginning of year | 2021-12-31 | $303,858 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $178,517 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $1,519,362 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-12-31 | $282,153 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-12-31 | $303,858 |
| Other income not declared elsewhere | 2021-12-31 | $698,474 |
| Total non interest bearing cash at end of year | 2021-12-31 | $282,153 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $303,858 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $-19,020 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $-61,356 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $-42,336 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2021-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $430,072 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $1,628,267 |
| Contract administrator fees | 2021-12-31 | $178,517 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $61,356 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $42,336 |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | RICHARD J. CUMMINGS, CPA |
| Accountancy firm EIN | 2021-12-31 | 223346148 |
| 2020 : NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $346,194 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $339,742 |
| Total income from all sources (including contributions) | 2020-12-31 | $1,751,112 |
| Total of all expenses incurred | 2020-12-31 | $1,743,922 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $1,558,177 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $1,598,718 |
| Value of total assets at end of year | 2020-12-31 | $303,858 |
| Value of total assets at beginning of year | 2020-12-31 | $290,216 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $185,745 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $1,598,718 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-12-31 | $303,858 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-12-31 | $290,216 |
| Other income not declared elsewhere | 2020-12-31 | $152,394 |
| Total non interest bearing cash at end of year | 2020-12-31 | $303,858 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $290,216 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $7,190 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $-42,336 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $-49,526 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2020-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $458,654 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $1,099,523 |
| Contract administrator fees | 2020-12-31 | $185,745 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $42,336 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $49,526 |
| Did the plan have assets held for investment | 2020-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | RICHARD J. CUMMINGS, CPA |
| Accountancy firm EIN | 2020-12-31 | 223346148 |
| 2019 : NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $339,742 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $339,742 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $445,629 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $445,629 |
| Total income from all sources (including contributions) | 2019-12-31 | $1,965,426 |
| Total income from all sources (including contributions) | 2019-12-31 | $1,965,426 |
| Total of all expenses incurred | 2019-12-31 | $1,951,490 |
| Total of all expenses incurred | 2019-12-31 | $1,951,490 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $1,766,591 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $1,766,591 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $1,749,608 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $1,749,608 |
| Value of total assets at end of year | 2019-12-31 | $290,216 |
| Value of total assets at end of year | 2019-12-31 | $290,216 |
| Value of total assets at beginning of year | 2019-12-31 | $382,167 |
| Value of total assets at beginning of year | 2019-12-31 | $382,167 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $184,899 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $184,899 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| Value of fidelity bond cover | 2019-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $1,749,608 |
| Contributions received from participants | 2019-12-31 | $1,749,608 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $290,216 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $290,216 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $382,167 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $382,167 |
| Other income not declared elsewhere | 2019-12-31 | $215,818 |
| Other income not declared elsewhere | 2019-12-31 | $215,818 |
| Total non interest bearing cash at end of year | 2019-12-31 | $290,216 |
| Total non interest bearing cash at end of year | 2019-12-31 | $290,216 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $382,167 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $382,167 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $13,936 |
| Value of net income/loss | 2019-12-31 | $13,936 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $-49,526 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $-49,526 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $-63,462 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $-63,462 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2019-12-31 | $0 |
| Value of interest in pooled separate accounts at end of year | 2019-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $468,854 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $468,854 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $1,297,737 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $1,297,737 |
| Contract administrator fees | 2019-12-31 | $184,899 |
| Contract administrator fees | 2019-12-31 | $184,899 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $49,526 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $49,526 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $63,462 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $63,462 |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | RICHARD J. CUMMINGS, CPA |
| Accountancy firm name | 2019-12-31 | RICHARD J. CUMMINGS, CPA |
| Accountancy firm EIN | 2019-12-31 | 223346148 |
| Accountancy firm EIN | 2019-12-31 | 223346148 |
| 2018 : NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $445,629 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $442,364 |
| Total income from all sources (including contributions) | 2018-12-31 | $2,468,397 |
| Total of all expenses incurred | 2018-12-31 | $2,480,902 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $2,280,275 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $1,816,674 |
| Value of total assets at end of year | 2018-12-31 | $382,167 |
| Value of total assets at beginning of year | 2018-12-31 | $391,407 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $200,627 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | No |
| Contributions received from participants | 2018-12-31 | $1,816,674 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-12-31 | $382,167 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-12-31 | $391,407 |
| Other income not declared elsewhere | 2018-12-31 | $651,723 |
| Total non interest bearing cash at end of year | 2018-12-31 | $382,167 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $391,407 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $-12,505 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $-63,462 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $-50,957 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Value of interest in pooled separate accounts at end of year | 2018-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $688,755 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $1,591,520 |
| Contract administrator fees | 2018-12-31 | $200,627 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $63,462 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $50,957 |
| Did the plan have assets held for investment | 2018-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | RICHARD J. CUMMINGS, CPA |
| Accountancy firm EIN | 2018-12-31 | 223346148 |
| 2017 : NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $442,364 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $474,390 |
| Total income from all sources (including contributions) | 2017-12-31 | $2,015,625 |
| Total of all expenses incurred | 2017-12-31 | $2,019,679 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $1,813,791 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $1,862,583 |
| Value of total assets at end of year | 2017-12-31 | $391,407 |
| Value of total assets at beginning of year | 2017-12-31 | $427,487 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $205,888 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $1,862,583 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-12-31 | $391,407 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-12-31 | $427,487 |
| Other income not declared elsewhere | 2017-12-31 | $153,042 |
| Total non interest bearing cash at end of year | 2017-12-31 | $391,407 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $427,487 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $-4,054 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $-50,957 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $-46,903 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Value of interest in common/collective trusts at end of year | 2017-12-31 | $0 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $610,864 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $1,202,927 |
| Contract administrator fees | 2017-12-31 | $205,888 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $50,957 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $46,903 |
| Did the plan have assets held for investment | 2017-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | RICHARD J. CUMMINGS, CPA |
| Accountancy firm EIN | 2017-12-31 | 223346148 |
| 2016 : NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $474,390 |
| Total plan liabilities at beginning of year | 2016-12-31 | $437,366 |
| Total income from all sources | 2016-12-31 | $2,155,825 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $2,146,121 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $1,932,051 |
| Total plan assets at end of year | 2016-12-31 | $427,487 |
| Total plan assets at beginning of year | 2016-12-31 | $380,759 |
| Value of fidelity bond covering the plan | 2016-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $1,831,564 |
| Other income received | 2016-12-31 | $324,261 |
| Net income (gross income less expenses) | 2016-12-31 | $9,704 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $-46,903 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $-56,607 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $214,070 |
| 2015 : NEW JERSEY B.A.C. HEALTH FUND RETIREE PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $437,366 |
| Total income from all sources | 2015-12-31 | $2,330,456 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $2,387,063 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $2,166,882 |
| Total plan assets at end of year | 2015-12-31 | $380,759 |
| Value of fidelity bond covering the plan | 2015-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $2,136,676 |
| Other income received | 2015-12-31 | $193,780 |
| Net income (gross income less expenses) | 2015-12-31 | $-56,607 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $-56,607 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $220,181 |
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 65-85642 |
| Policy instance | 3 |
| Insurance contract or identification number | 65-85642 | | Number of Individuals Covered | 172 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $205,060 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 64-85642 |
| Policy instance | 2 |
| Insurance contract or identification number | 64-85642 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $258,052 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 62-85642 |
| Policy instance | 1 |
| Insurance contract or identification number | 62-85642 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $23,922 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 65-85642 |
| Policy instance | 3 |
| Insurance contract or identification number | 65-85642 | | Number of Individuals Covered | 183 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $184,451 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 64-85642 |
| Policy instance | 2 |
| Insurance contract or identification number | 64-85642 | | Number of Individuals Covered | 229 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $235,429 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 62-85642 |
| Policy instance | 1 |
| Insurance contract or identification number | 62-85642 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $23,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 62-85642 |
| Policy instance | 1 |
| Insurance contract or identification number | 62-85642 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $21,031 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 64-85642 |
| Policy instance | 2 |
| Insurance contract or identification number | 64-85642 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $230,844 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 65-85642 |
| Policy instance | 3 |
| Insurance contract or identification number | 65-85642 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $177,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 65-85642 |
| Policy instance | 3 |
| Insurance contract or identification number | 65-85642 | | Number of Individuals Covered | 199 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $188,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 64-85642 |
| Policy instance | 2 |
| Insurance contract or identification number | 64-85642 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $248,468 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 62-85642 |
| Policy instance | 1 |
| Insurance contract or identification number | 62-85642 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $20,843 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 65-85642 |
| Policy instance | 3 |
| Insurance contract or identification number | 65-85642 | | Number of Individuals Covered | 209 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $187,964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 64-85642 |
| Policy instance | 2 |
| Insurance contract or identification number | 64-85642 | | Number of Individuals Covered | 284 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $260,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 62-85642 |
| Policy instance | 1 |
| Insurance contract or identification number | 62-85642 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $19,829 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 65-85642 |
| Policy instance | 3 |
| Insurance contract or identification number | 65-85642 | | Number of Individuals Covered | 225 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $276,171 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 64-85642 |
| Policy instance | 2 |
| Insurance contract or identification number | 64-85642 | | Number of Individuals Covered | 308 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $382,303 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 62-85642 |
| Policy instance | 1 |
| Insurance contract or identification number | 62-85642 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $28,916 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 62-85642 |
| Policy instance | 1 |
| Insurance contract or identification number | 62-85642 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $26,121 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 64-85642 |
| Policy instance | 2 |
| Insurance contract or identification number | 64-85642 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $339,233 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 65-85642 |
| Policy instance | 3 |
| Insurance contract or identification number | 65-85642 | | Number of Individuals Covered | 235 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $247,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 65-85642 |
| Policy instance | 3 |
| Insurance contract or identification number | 65-85642 | | Number of Individuals Covered | 255 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $279,062 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 64-85642 |
| Policy instance | 2 |
| Insurance contract or identification number | 64-85642 | | Number of Individuals Covered | 346 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $279,062 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HORIZON HEALTHCARE SERVICES, INC. (National Association of Insurance Commissioners NAIC id number: 95529 ) |
| Policy contract number | 62-85642 |
| Policy instance | 1 |
| Insurance contract or identification number | 62-85642 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $23,633 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
