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MID PENN BANK GROUP HEALTH PLAN 401k Plan overview

Plan NameMID PENN BANK GROUP HEALTH PLAN
Plan identification number 502

MID PENN BANK GROUP HEALTH PLAN Benefits

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

401k Sponsoring company profile

MID PENN BANK has sponsored the creation of one or more 401k plans.

Company Name:MID PENN BANK
Employer identification number (EIN):230880270
NAIC Classification:522120
NAIC Description:Savings Institutions

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MID PENN BANK GROUP HEALTH PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022021-10-01
5022020-10-01
5022019-10-01
5022018-10-01
5022017-10-01
5022016-10-01ROBERTA HOFFMAN
5022015-10-01ROBERTA HOFFMAN
5022014-10-01ROBERTA HOFFMAN
5022013-10-01ROBERTA HOFFMAN
5022012-10-01ROBERTA HOFFMAN
5022011-10-01ROBERTA HOFFMAN
5022009-10-01ROBERTA HOFFMAN
5022009-10-01ROBERTA A. HOFFMAN

Plan Statistics for MID PENN BANK GROUP HEALTH PLAN

401k plan membership statisitcs for MID PENN BANK GROUP HEALTH PLAN

Measure Date Value
2021: MID PENN BANK GROUP HEALTH PLAN 2021 401k membership
Total participants, beginning-of-year2021-10-01322
Total number of active participants reported on line 7a of the Form 55002021-10-01353
Number of retired or separated participants receiving benefits2021-10-012
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-01355
2020: MID PENN BANK GROUP HEALTH PLAN 2020 401k membership
Total participants, beginning-of-year2020-10-01331
Total number of active participants reported on line 7a of the Form 55002020-10-01335
Number of retired or separated participants receiving benefits2020-10-011
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-01336
2019: MID PENN BANK GROUP HEALTH PLAN 2019 401k membership
Total participants, beginning-of-year2019-10-01255
Total number of active participants reported on line 7a of the Form 55002019-10-01328
Number of retired or separated participants receiving benefits2019-10-013
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-01331
2018: MID PENN BANK GROUP HEALTH PLAN 2018 401k membership
Total participants, beginning-of-year2018-10-01274
Total number of active participants reported on line 7a of the Form 55002018-10-01252
Number of retired or separated participants receiving benefits2018-10-013
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-01255
2017: MID PENN BANK GROUP HEALTH PLAN 2017 401k membership
Total participants, beginning-of-year2017-10-01179
Total number of active participants reported on line 7a of the Form 55002017-10-01271
Number of retired or separated participants receiving benefits2017-10-013
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-01274
2016: MID PENN BANK GROUP HEALTH PLAN 2016 401k membership
Total participants, beginning-of-year2016-10-01174
Total number of active participants reported on line 7a of the Form 55002016-10-01174
Number of retired or separated participants receiving benefits2016-10-015
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-01179
2015: MID PENN BANK GROUP HEALTH PLAN 2015 401k membership
Total participants, beginning-of-year2015-10-01145
Total number of active participants reported on line 7a of the Form 55002015-10-01169
Number of retired or separated participants receiving benefits2015-10-015
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-01174
2014: MID PENN BANK GROUP HEALTH PLAN 2014 401k membership
Total participants, beginning-of-year2014-10-01132
Total number of active participants reported on line 7a of the Form 55002014-10-01140
Number of retired or separated participants receiving benefits2014-10-015
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-01145
2013: MID PENN BANK GROUP HEALTH PLAN 2013 401k membership
Total participants, beginning-of-year2013-10-01142
Total number of active participants reported on line 7a of the Form 55002013-10-01127
Number of retired or separated participants receiving benefits2013-10-015
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-01132
2012: MID PENN BANK GROUP HEALTH PLAN 2012 401k membership
Total participants, beginning-of-year2012-10-01144
Total number of active participants reported on line 7a of the Form 55002012-10-01137
Number of retired or separated participants receiving benefits2012-10-015
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-01142
2011: MID PENN BANK GROUP HEALTH PLAN 2011 401k membership
Total participants, beginning-of-year2011-10-01135
Total number of active participants reported on line 7a of the Form 55002011-10-01139
Number of retired or separated participants receiving benefits2011-10-015
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-01144
2009: MID PENN BANK GROUP HEALTH PLAN 2009 401k membership
Total participants, beginning-of-year2009-10-01125
Total number of active participants reported on line 7a of the Form 55002009-10-01128
Number of retired or separated participants receiving benefits2009-10-014
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-01132

Financial Data on MID PENN BANK GROUP HEALTH PLAN

Measure Date Value
2022 : MID PENN BANK GROUP HEALTH PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$160,855
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$351,113
Total income from all sources (including contributions)2022-09-30$3,445,461
Total loss/gain on sale of assets2022-09-30$0
Total of all expenses incurred2022-09-30$3,728,281
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-09-30$2,674,819
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-09-30$3,443,075
Value of total assets at end of year2022-09-30$936,004
Value of total assets at beginning of year2022-09-30$1,409,082
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-09-30$1,053,462
Total interest from all sources2022-09-30$2,386
Total dividends received (eg from common stock, registered investment company shares)2022-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-09-30No
Was this plan covered by a fidelity bond2022-09-30No
If this is an individual account plan, was there a blackout period2022-09-30No
Were there any nonexempt tranactions with any party-in-interest2022-09-30No
Contributions received from participants2022-09-30$963,623
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-09-30$305,915
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-09-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-09-30$76,070
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-09-30$277,478
Administrative expenses (other) incurred2022-09-30$924,873
Liabilities. Value of operating payables at end of year2022-09-30$84,785
Liabilities. Value of operating payables at beginning of year2022-09-30$73,635
Total non interest bearing cash at end of year2022-09-30$160,856
Total non interest bearing cash at beginning of year2022-09-30$346,114
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Value of net income/loss2022-09-30$-282,820
Value of net assets at end of year (total assets less liabilities)2022-09-30$775,149
Value of net assets at beginning of year (total assets less liabilities)2022-09-30$1,057,969
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-09-30No
Were any leases to which the plan was party in default or uncollectible2022-09-30No
Investment advisory and management fees2022-09-30$96,977
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-09-30$469,233
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-09-30$1,062,968
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-09-30$1,062,968
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-09-30$2,386
Expenses. Payments to insurance carriers foe the provision of benefits2022-09-30$2,674,819
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-09-30No
Was there a failure to transmit to the plan any participant contributions2022-09-30No
Has the plan failed to provide any benefit when due under the plan2022-09-30No
Contributions received in cash from employer2022-09-30$2,479,452
Contract administrator fees2022-09-30$31,612
Liabilities. Value of benefit claims payable at end of year2022-09-30$0
Liabilities. Value of benefit claims payable at beginning of year2022-09-30$0
Did the plan have assets held for investment2022-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-09-30No
Opinion of an independent qualified public accountant for this plan2022-09-30Unqualified
Accountancy firm name2022-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2022-09-30251589048
2021 : MID PENN BANK GROUP HEALTH PLAN 2021 401k financial data
Total unrealized appreciation/depreciation of assets2021-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$351,113
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$324,935
Total income from all sources (including contributions)2021-09-30$3,223,164
Total loss/gain on sale of assets2021-09-30$0
Total of all expenses incurred2021-09-30$2,739,966
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-09-30$1,743,906
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-09-30$3,220,366
Value of total assets at end of year2021-09-30$1,409,082
Value of total assets at beginning of year2021-09-30$899,706
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-09-30$996,060
Total interest from all sources2021-09-30$2,798
Total dividends received (eg from common stock, registered investment company shares)2021-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-09-30No
Was this plan covered by a fidelity bond2021-09-30No
If this is an individual account plan, was there a blackout period2021-09-30No
Were there any nonexempt tranactions with any party-in-interest2021-09-30No
Contributions received from participants2021-09-30$877,142
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-09-30$277,478
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-09-30$258,360
Administrative expenses (other) incurred2021-09-30$846,087
Liabilities. Value of operating payables at end of year2021-09-30$73,635
Liabilities. Value of operating payables at beginning of year2021-09-30$0
Total non interest bearing cash at end of year2021-09-30$346,114
Total non interest bearing cash at beginning of year2021-09-30$324,935
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Value of net income/loss2021-09-30$483,198
Value of net assets at end of year (total assets less liabilities)2021-09-30$1,057,969
Value of net assets at beginning of year (total assets less liabilities)2021-09-30$574,771
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-09-30No
Were any leases to which the plan was party in default or uncollectible2021-09-30No
Investment advisory and management fees2021-09-30$91,744
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-09-30$1,062,968
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-09-30$574,771
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-09-30$574,771
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-09-30$2,798
Expenses. Payments to insurance carriers foe the provision of benefits2021-09-30$1,743,906
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-09-30No
Was there a failure to transmit to the plan any participant contributions2021-09-30No
Has the plan failed to provide any benefit when due under the plan2021-09-30No
Contributions received in cash from employer2021-09-30$2,343,224
Contract administrator fees2021-09-30$58,229
Liabilities. Value of benefit claims payable at end of year2021-09-30$0
Liabilities. Value of benefit claims payable at beginning of year2021-09-30$66,575
Did the plan have assets held for investment2021-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-09-30No
Opinion of an independent qualified public accountant for this plan2021-09-30Unqualified
Accountancy firm name2021-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2021-09-30251589048
2020 : MID PENN BANK GROUP HEALTH PLAN 2020 401k financial data
Total unrealized appreciation/depreciation of assets2020-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$324,935
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$294,276
Total income from all sources (including contributions)2020-09-30$2,720,684
Total loss/gain on sale of assets2020-09-30$0
Total of all expenses incurred2020-09-30$3,456,150
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-09-30$2,516,432
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-09-30$2,698,772
Value of total assets at end of year2020-09-30$899,706
Value of total assets at beginning of year2020-09-30$1,604,513
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-09-30$939,718
Total interest from all sources2020-09-30$21,912
Total dividends received (eg from common stock, registered investment company shares)2020-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-09-30No
Was this plan covered by a fidelity bond2020-09-30No
If this is an individual account plan, was there a blackout period2020-09-30No
Were there any nonexempt tranactions with any party-in-interest2020-09-30No
Contributions received from participants2020-09-30$789,039
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-09-30$258,360
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-09-30$226,993
Administrative expenses (other) incurred2020-09-30$788,707
Total non interest bearing cash at end of year2020-09-30$324,935
Total non interest bearing cash at beginning of year2020-09-30$77,684
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Value of net income/loss2020-09-30$-735,466
Value of net assets at end of year (total assets less liabilities)2020-09-30$574,771
Value of net assets at beginning of year (total assets less liabilities)2020-09-30$1,310,237
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-09-30No
Were any leases to which the plan was party in default or uncollectible2020-09-30No
Investment advisory and management fees2020-09-30$85,425
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-09-30$574,771
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-09-30$1,526,829
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-09-30$1,526,829
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-09-30$21,912
Expenses. Payments to insurance carriers foe the provision of benefits2020-09-30$2,516,432
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-09-30No
Was there a failure to transmit to the plan any participant contributions2020-09-30No
Has the plan failed to provide any benefit when due under the plan2020-09-30No
Contributions received in cash from employer2020-09-30$1,909,733
Contract administrator fees2020-09-30$65,586
Liabilities. Value of benefit claims payable at end of year2020-09-30$66,575
Liabilities. Value of benefit claims payable at beginning of year2020-09-30$67,283
Did the plan have assets held for investment2020-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-09-30No
Opinion of an independent qualified public accountant for this plan2020-09-30Unqualified
Accountancy firm name2020-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2020-09-30251589048
2019 : MID PENN BANK GROUP HEALTH PLAN 2019 401k financial data
Total unrealized appreciation/depreciation of assets2019-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$294,276
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$221,420
Total income from all sources (including contributions)2019-09-30$2,878,724
Total loss/gain on sale of assets2019-09-30$0
Total of all expenses incurred2019-09-30$2,708,261
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-09-30$1,753,617
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-09-30$2,853,622
Value of total assets at end of year2019-09-30$1,604,513
Value of total assets at beginning of year2019-09-30$1,361,194
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-09-30$954,644
Total interest from all sources2019-09-30$25,102
Total dividends received (eg from common stock, registered investment company shares)2019-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-09-30No
Was this plan covered by a fidelity bond2019-09-30No
If this is an individual account plan, was there a blackout period2019-09-30No
Were there any nonexempt tranactions with any party-in-interest2019-09-30No
Contributions received from participants2019-09-30$706,096
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-09-30$226,993
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-09-30$202,216
Administrative expenses (other) incurred2019-09-30$777,978
Liabilities. Value of operating payables at end of year2019-09-30$0
Liabilities. Value of operating payables at beginning of year2019-09-30$4,595
Total non interest bearing cash at end of year2019-09-30$77,684
Total non interest bearing cash at beginning of year2019-09-30$68,738
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Value of net income/loss2019-09-30$170,463
Value of net assets at end of year (total assets less liabilities)2019-09-30$1,310,237
Value of net assets at beginning of year (total assets less liabilities)2019-09-30$1,139,774
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-09-30No
Were any leases to which the plan was party in default or uncollectible2019-09-30No
Investment advisory and management fees2019-09-30$91,294
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-09-30$1,526,829
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-09-30$1,292,456
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-09-30$1,292,456
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-09-30$25,102
Expenses. Payments to insurance carriers foe the provision of benefits2019-09-30$1,753,617
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-09-30No
Was there a failure to transmit to the plan any participant contributions2019-09-30No
Has the plan failed to provide any benefit when due under the plan2019-09-30No
Contributions received in cash from employer2019-09-30$2,147,526
Contract administrator fees2019-09-30$85,372
Liabilities. Value of benefit claims payable at end of year2019-09-30$67,283
Liabilities. Value of benefit claims payable at beginning of year2019-09-30$14,609
Did the plan have assets held for investment2019-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-09-30No
Opinion of an independent qualified public accountant for this plan2019-09-30Unqualified
Accountancy firm name2019-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2019-09-30251589048
2018 : MID PENN BANK GROUP HEALTH PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$221,420
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$123,866
Total income from all sources (including contributions)2018-09-30$2,208,528
Total loss/gain on sale of assets2018-09-30$0
Total of all expenses incurred2018-09-30$1,664,215
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-09-30$964,374
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-09-30$2,192,579
Value of total assets at end of year2018-09-30$1,361,194
Value of total assets at beginning of year2018-09-30$719,327
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-09-30$699,841
Total interest from all sources2018-09-30$15,949
Total dividends received (eg from common stock, registered investment company shares)2018-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-09-30No
Was this plan covered by a fidelity bond2018-09-30Yes
Value of fidelity bond cover2018-09-30$500,000
If this is an individual account plan, was there a blackout period2018-09-30No
Were there any nonexempt tranactions with any party-in-interest2018-09-30No
Contributions received from participants2018-09-30$548,585
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-09-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-09-30$110,879
Administrative expenses (other) incurred2018-09-30$555,211
Liabilities. Value of operating payables at end of year2018-09-30$206,811
Liabilities. Value of operating payables at beginning of year2018-09-30$0
Total non interest bearing cash at end of year2018-09-30$68,738
Total non interest bearing cash at beginning of year2018-09-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Value of net income/loss2018-09-30$544,313
Value of net assets at end of year (total assets less liabilities)2018-09-30$1,139,774
Value of net assets at beginning of year (total assets less liabilities)2018-09-30$595,461
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-09-30No
Were any leases to which the plan was party in default or uncollectible2018-09-30No
Investment advisory and management fees2018-09-30$66,946
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-09-30$1,292,456
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-09-30$719,327
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-09-30$719,327
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-09-30$15,949
Expenses. Payments to insurance carriers foe the provision of benefits2018-09-30$964,374
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-09-30No
Was there a failure to transmit to the plan any participant contributions2018-09-30No
Has the plan failed to provide any benefit when due under the plan2018-09-30No
Contributions received in cash from employer2018-09-30$1,643,994
Contract administrator fees2018-09-30$77,684
Liabilities. Value of benefit claims payable at end of year2018-09-30$14,609
Liabilities. Value of benefit claims payable at beginning of year2018-09-30$12,987
Did the plan have assets held for investment2018-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-09-30No
Opinion of an independent qualified public accountant for this plan2018-09-30Unqualified
Accountancy firm name2018-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2018-09-30251589048
2017 : MID PENN BANK GROUP HEALTH PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$123,866
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$154,890
Total income from all sources (including contributions)2017-09-30$1,998,847
Total loss/gain on sale of assets2017-09-30$0
Total of all expenses incurred2017-09-30$1,916,239
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-09-30$1,282,149
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-09-30$1,996,233
Value of total assets at end of year2017-09-30$719,327
Value of total assets at beginning of year2017-09-30$667,743
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-09-30$634,090
Total interest from all sources2017-09-30$2,614
Total dividends received (eg from common stock, registered investment company shares)2017-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-09-30No
Was this plan covered by a fidelity bond2017-09-30Yes
Value of fidelity bond cover2017-09-30$500,000
If this is an individual account plan, was there a blackout period2017-09-30No
Were there any nonexempt tranactions with any party-in-interest2017-09-30No
Contributions received from participants2017-09-30$513,169
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-09-30$110,879
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-09-30$144,725
Administrative expenses (other) incurred2017-09-30$472,990
Total non interest bearing cash at end of year2017-09-30$0
Total non interest bearing cash at beginning of year2017-09-30$54,202
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Value of net income/loss2017-09-30$82,608
Value of net assets at end of year (total assets less liabilities)2017-09-30$595,461
Value of net assets at beginning of year (total assets less liabilities)2017-09-30$512,853
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-09-30No
Were any leases to which the plan was party in default or uncollectible2017-09-30No
Investment advisory and management fees2017-09-30$62,667
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-09-30$719,327
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-09-30$613,541
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-09-30$613,541
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-09-30$2,614
Expenses. Payments to insurance carriers foe the provision of benefits2017-09-30$1,282,149
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-09-30No
Was there a failure to transmit to the plan any participant contributions2017-09-30No
Has the plan failed to provide any benefit when due under the plan2017-09-30No
Contributions received in cash from employer2017-09-30$1,483,064
Contract administrator fees2017-09-30$98,433
Liabilities. Value of benefit claims payable at end of year2017-09-30$12,987
Liabilities. Value of benefit claims payable at beginning of year2017-09-30$10,165
Did the plan have assets held for investment2017-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-09-30No
Opinion of an independent qualified public accountant for this plan2017-09-30Unqualified
Accountancy firm name2017-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2017-09-30251589048
2016 : MID PENN BANK GROUP HEALTH PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$154,890
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$129,684
Total income from all sources (including contributions)2016-09-30$1,738,373
Total loss/gain on sale of assets2016-09-30$0
Total of all expenses incurred2016-09-30$1,605,317
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-09-30$1,042,058
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-09-30$1,736,779
Value of total assets at end of year2016-09-30$667,743
Value of total assets at beginning of year2016-09-30$509,481
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-09-30$563,259
Total interest from all sources2016-09-30$1,594
Total dividends received (eg from common stock, registered investment company shares)2016-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-09-30No
Was this plan covered by a fidelity bond2016-09-30Yes
Value of fidelity bond cover2016-09-30$500,000
If this is an individual account plan, was there a blackout period2016-09-30No
Were there any nonexempt tranactions with any party-in-interest2016-09-30No
Contributions received from participants2016-09-30$443,067
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-09-30$144,725
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-09-30$111,863
Administrative expenses (other) incurred2016-09-30$410,360
Total non interest bearing cash at end of year2016-09-30$54,202
Total non interest bearing cash at beginning of year2016-09-30$40,262
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Value of net income/loss2016-09-30$133,056
Value of net assets at end of year (total assets less liabilities)2016-09-30$512,853
Value of net assets at beginning of year (total assets less liabilities)2016-09-30$379,797
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-09-30No
Were any leases to which the plan was party in default or uncollectible2016-09-30No
Investment advisory and management fees2016-09-30$57,896
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-09-30$613,541
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-09-30$469,219
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-09-30$469,219
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-09-30$1,594
Expenses. Payments to insurance carriers foe the provision of benefits2016-09-30$1,042,058
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-09-30No
Was there a failure to transmit to the plan any participant contributions2016-09-30No
Has the plan failed to provide any benefit when due under the plan2016-09-30No
Contributions received in cash from employer2016-09-30$1,293,712
Contract administrator fees2016-09-30$95,003
Liabilities. Value of benefit claims payable at end of year2016-09-30$10,165
Liabilities. Value of benefit claims payable at beginning of year2016-09-30$17,821
Did the plan have assets held for investment2016-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-09-30No
Opinion of an independent qualified public accountant for this plan2016-09-30Unqualified
Accountancy firm name2016-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2016-09-30251589048
2015 : MID PENN BANK GROUP HEALTH PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$129,684
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$140,970
Total income from all sources (including contributions)2015-09-30$1,325,542
Total loss/gain on sale of assets2015-09-30$0
Total of all expenses incurred2015-09-30$1,282,652
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-09-30$888,356
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-09-30$1,324,210
Value of total assets at end of year2015-09-30$509,481
Value of total assets at beginning of year2015-09-30$477,877
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-09-30$394,296
Total interest from all sources2015-09-30$1,332
Total dividends received (eg from common stock, registered investment company shares)2015-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-09-30No
Was this plan covered by a fidelity bond2015-09-30Yes
Value of fidelity bond cover2015-09-30$500,000
If this is an individual account plan, was there a blackout period2015-09-30No
Were there any nonexempt tranactions with any party-in-interest2015-09-30No
Contributions received from participants2015-09-30$358,660
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-09-30$111,863
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-09-30$113,460
Administrative expenses (other) incurred2015-09-30$268,398
Total non interest bearing cash at end of year2015-09-30$40,262
Total non interest bearing cash at beginning of year2015-09-30$32,839
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Value of net income/loss2015-09-30$42,890
Value of net assets at end of year (total assets less liabilities)2015-09-30$379,797
Value of net assets at beginning of year (total assets less liabilities)2015-09-30$336,907
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-09-30No
Were any leases to which the plan was party in default or uncollectible2015-09-30No
Investment advisory and management fees2015-09-30$48,531
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-09-30$469,219
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-09-30$445,038
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-09-30$445,038
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-09-30$1,332
Expenses. Payments to insurance carriers foe the provision of benefits2015-09-30$888,356
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-09-30No
Was there a failure to transmit to the plan any participant contributions2015-09-30No
Has the plan failed to provide any benefit when due under the plan2015-09-30No
Contributions received in cash from employer2015-09-30$965,550
Contract administrator fees2015-09-30$77,367
Liabilities. Value of benefit claims payable at end of year2015-09-30$17,821
Liabilities. Value of benefit claims payable at beginning of year2015-09-30$27,510
Did the plan have assets held for investment2015-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-09-30No
Opinion of an independent qualified public accountant for this plan2015-09-30Unqualified
Accountancy firm name2015-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2015-09-30251589048
2014 : MID PENN BANK GROUP HEALTH PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$140,970
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$185,021
Total income from all sources (including contributions)2014-09-30$1,384,069
Total loss/gain on sale of assets2014-09-30$0
Total of all expenses incurred2014-09-30$1,158,424
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-09-30$742,580
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-09-30$1,383,150
Value of total assets at end of year2014-09-30$477,877
Value of total assets at beginning of year2014-09-30$296,283
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-09-30$415,844
Total interest from all sources2014-09-30$919
Total dividends received (eg from common stock, registered investment company shares)2014-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-09-30No
Was this plan covered by a fidelity bond2014-09-30Yes
Value of fidelity bond cover2014-09-30$500,000
If this is an individual account plan, was there a blackout period2014-09-30No
Were there any nonexempt tranactions with any party-in-interest2014-09-30No
Contributions received from participants2014-09-30$306,601
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-09-30$113,460
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-09-30$163,217
Administrative expenses (other) incurred2014-09-30$296,809
Total non interest bearing cash at end of year2014-09-30$32,839
Total non interest bearing cash at beginning of year2014-09-30$39,715
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Value of net income/loss2014-09-30$225,645
Value of net assets at end of year (total assets less liabilities)2014-09-30$336,907
Value of net assets at beginning of year (total assets less liabilities)2014-09-30$111,262
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-09-30No
Were any leases to which the plan was party in default or uncollectible2014-09-30No
Investment advisory and management fees2014-09-30$44,922
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-09-30$445,038
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-09-30$256,568
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-09-30$256,568
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-09-30$919
Expenses. Payments to insurance carriers foe the provision of benefits2014-09-30$742,580
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-09-30No
Was there a failure to transmit to the plan any participant contributions2014-09-30No
Has the plan failed to provide any benefit when due under the plan2014-09-30No
Contributions received in cash from employer2014-09-30$1,076,549
Contract administrator fees2014-09-30$74,113
Liabilities. Value of benefit claims payable at end of year2014-09-30$27,510
Liabilities. Value of benefit claims payable at beginning of year2014-09-30$21,804
Did the plan have assets held for investment2014-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-09-30No
Opinion of an independent qualified public accountant for this plan2014-09-30Unqualified
Accountancy firm name2014-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2014-09-30251589048
2013 : MID PENN BANK GROUP HEALTH PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$185,021
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$148,434
Total income from all sources (including contributions)2013-09-30$1,614,617
Total loss/gain on sale of assets2013-09-30$0
Total of all expenses incurred2013-09-30$1,693,376
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-09-30$1,284,014
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-09-30$1,251,938
Value of total assets at end of year2013-09-30$296,283
Value of total assets at beginning of year2013-09-30$338,455
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-09-30$409,362
Total interest from all sources2013-09-30$435
Total dividends received (eg from common stock, registered investment company shares)2013-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-09-30No
Was this plan covered by a fidelity bond2013-09-30Yes
Value of fidelity bond cover2013-09-30$500,000
If this is an individual account plan, was there a blackout period2013-09-30No
Were there any nonexempt tranactions with any party-in-interest2013-09-30No
Contributions received from participants2013-09-30$320,402
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-09-30$163,217
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-09-30$123,491
Other income not declared elsewhere2013-09-30$362,244
Administrative expenses (other) incurred2013-09-30$280,779
Total non interest bearing cash at end of year2013-09-30$39,715
Total non interest bearing cash at beginning of year2013-09-30$42,024
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Value of net income/loss2013-09-30$-78,759
Value of net assets at end of year (total assets less liabilities)2013-09-30$111,262
Value of net assets at beginning of year (total assets less liabilities)2013-09-30$190,021
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-09-30No
Were any leases to which the plan was party in default or uncollectible2013-09-30No
Investment advisory and management fees2013-09-30$47,202
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-09-30$256,568
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-09-30$296,431
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-09-30$296,431
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-09-30$435
Expenses. Payments to insurance carriers foe the provision of benefits2013-09-30$1,284,014
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-09-30No
Was there a failure to transmit to the plan any participant contributions2013-09-30No
Has the plan failed to provide any benefit when due under the plan2013-09-30No
Contributions received in cash from employer2013-09-30$931,536
Contract administrator fees2013-09-30$81,381
Liabilities. Value of benefit claims payable at end of year2013-09-30$21,804
Liabilities. Value of benefit claims payable at beginning of year2013-09-30$24,943
Did the plan have assets held for investment2013-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-09-30No
Opinion of an independent qualified public accountant for this plan2013-09-30Unqualified
Accountancy firm name2013-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2013-09-30251589048
2012 : MID PENN BANK GROUP HEALTH PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$148,434
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$113,516
Total income from all sources (including contributions)2012-09-30$1,295,222
Total loss/gain on sale of assets2012-09-30$0
Total of all expenses incurred2012-09-30$1,402,996
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-09-30$1,018,661
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-09-30$1,178,793
Value of total assets at end of year2012-09-30$338,455
Value of total assets at beginning of year2012-09-30$411,311
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-09-30$384,335
Total interest from all sources2012-09-30$3,172
Total dividends received (eg from common stock, registered investment company shares)2012-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-09-30No
Was this plan covered by a fidelity bond2012-09-30Yes
Value of fidelity bond cover2012-09-30$500,000
If this is an individual account plan, was there a blackout period2012-09-30No
Were there any nonexempt tranactions with any party-in-interest2012-09-30No
Contributions received from participants2012-09-30$268,884
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-09-30$123,491
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-09-30$113,516
Other income not declared elsewhere2012-09-30$113,257
Administrative expenses (other) incurred2012-09-30$260,902
Total non interest bearing cash at end of year2012-09-30$42,024
Total non interest bearing cash at beginning of year2012-09-30$30,290
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Value of net income/loss2012-09-30$-107,774
Value of net assets at end of year (total assets less liabilities)2012-09-30$190,021
Value of net assets at beginning of year (total assets less liabilities)2012-09-30$297,795
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-09-30No
Were any leases to which the plan was party in default or uncollectible2012-09-30No
Investment advisory and management fees2012-09-30$45,026
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-09-30$296,431
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-09-30$381,021
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-09-30$381,021
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-09-30$3,172
Expenses. Payments to insurance carriers foe the provision of benefits2012-09-30$1,018,661
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-09-30No
Was there a failure to transmit to the plan any participant contributions2012-09-30No
Has the plan failed to provide any benefit when due under the plan2012-09-30No
Contributions received in cash from employer2012-09-30$909,909
Contract administrator fees2012-09-30$78,407
Liabilities. Value of benefit claims payable at end of year2012-09-30$24,943
Did the plan have assets held for investment2012-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-09-30No
Opinion of an independent qualified public accountant for this plan2012-09-30Unqualified
Accountancy firm name2012-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2012-09-30251589048
2011 : MID PENN BANK GROUP HEALTH PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-09-30$113,516
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-09-30$99,739
Total income from all sources (including contributions)2011-09-30$1,032,688
Total loss/gain on sale of assets2011-09-30$0
Total of all expenses incurred2011-09-30$1,010,980
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-09-30$687,305
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-09-30$1,010,211
Value of total assets at end of year2011-09-30$411,311
Value of total assets at beginning of year2011-09-30$375,826
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-09-30$323,675
Total interest from all sources2011-09-30$5,274
Total dividends received (eg from common stock, registered investment company shares)2011-09-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-09-30No
Was this plan covered by a fidelity bond2011-09-30Yes
Value of fidelity bond cover2011-09-30$1,555,810
If this is an individual account plan, was there a blackout period2011-09-30No
Were there any nonexempt tranactions with any party-in-interest2011-09-30No
Contributions received from participants2011-09-30$248,746
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-09-30$687,305
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-09-30$113,516
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-09-30$99,739
Other income not declared elsewhere2011-09-30$17,203
Administrative expenses (other) incurred2011-09-30$215,829
Total non interest bearing cash at end of year2011-09-30$30,290
Total non interest bearing cash at beginning of year2011-09-30$26,308
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Value of net income/loss2011-09-30$21,708
Value of net assets at end of year (total assets less liabilities)2011-09-30$297,795
Value of net assets at beginning of year (total assets less liabilities)2011-09-30$276,087
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-09-30No
Were any leases to which the plan was party in default or uncollectible2011-09-30No
Investment advisory and management fees2011-09-30$39,917
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-09-30$381,021
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-09-30$349,518
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-09-30$349,518
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-09-30$5,274
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-09-30No
Was there a failure to transmit to the plan any participant contributions2011-09-30No
Has the plan failed to provide any benefit when due under the plan2011-09-30No
Contributions received in cash from employer2011-09-30$761,465
Contract administrator fees2011-09-30$67,929
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-09-30No
Did the plan have assets held for investment2011-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-09-30No
Opinion of an independent qualified public accountant for this plan2011-09-30Unqualified
Accountancy firm name2011-09-30YOUNG, OAKES, BROWN & CO. P.C.
Accountancy firm EIN2011-09-30251589048

Form 5500 Responses for MID PENN BANK GROUP HEALTH PLAN

2021: MID PENN BANK GROUP HEALTH PLAN 2021 form 5500 responses
2021-10-01Type of plan entitySingle employer plan
2021-10-01Submission has been amendedNo
2021-10-01This submission is the final filingNo
2021-10-01This return/report is a short plan year return/report (less than 12 months)No
2021-10-01Plan is a collectively bargained planNo
2021-10-01Plan funding arrangement – TrustYes
2021-10-01Plan funding arrangement – General assets of the sponsorYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement - TrustYes
2021-10-01Plan benefit arrangement – General assets of the sponsorYes
2020: MID PENN BANK GROUP HEALTH PLAN 2020 form 5500 responses
2020-10-01Type of plan entitySingle employer plan
2020-10-01Submission has been amendedNo
2020-10-01This submission is the final filingNo
2020-10-01This return/report is a short plan year return/report (less than 12 months)No
2020-10-01Plan is a collectively bargained planNo
2020-10-01Plan funding arrangement – InsuranceYes
2020-10-01Plan funding arrangement – TrustYes
2020-10-01Plan funding arrangement – General assets of the sponsorYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement - TrustYes
2020-10-01Plan benefit arrangement – General assets of the sponsorYes
2019: MID PENN BANK GROUP HEALTH PLAN 2019 form 5500 responses
2019-10-01Type of plan entitySingle employer plan
2019-10-01Submission has been amendedNo
2019-10-01This submission is the final filingNo
2019-10-01This return/report is a short plan year return/report (less than 12 months)No
2019-10-01Plan is a collectively bargained planNo
2019-10-01Plan funding arrangement – InsuranceYes
2019-10-01Plan funding arrangement – TrustYes
2019-10-01Plan funding arrangement – General assets of the sponsorYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement - TrustYes
2019-10-01Plan benefit arrangement – General assets of the sponsorYes
2018: MID PENN BANK GROUP HEALTH PLAN 2018 form 5500 responses
2018-10-01Type of plan entitySingle employer plan
2018-10-01Submission has been amendedNo
2018-10-01This submission is the final filingNo
2018-10-01This return/report is a short plan year return/report (less than 12 months)No
2018-10-01Plan is a collectively bargained planNo
2018-10-01Plan funding arrangement – InsuranceYes
2018-10-01Plan funding arrangement – TrustYes
2018-10-01Plan funding arrangement – General assets of the sponsorYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement - TrustYes
2018-10-01Plan benefit arrangement – General assets of the sponsorYes
2017: MID PENN BANK GROUP HEALTH PLAN 2017 form 5500 responses
2017-10-01Type of plan entitySingle employer plan
2017-10-01Submission has been amendedNo
2017-10-01This submission is the final filingNo
2017-10-01This return/report is a short plan year return/report (less than 12 months)No
2017-10-01Plan is a collectively bargained planNo
2017-10-01Plan funding arrangement – InsuranceYes
2017-10-01Plan funding arrangement – TrustYes
2017-10-01Plan funding arrangement – General assets of the sponsorYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement - TrustYes
2017-10-01Plan benefit arrangement – General assets of the sponsorYes
2016: MID PENN BANK GROUP HEALTH PLAN 2016 form 5500 responses
2016-10-01Type of plan entitySingle employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planNo
2016-10-01Plan funding arrangement – InsuranceYes
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan funding arrangement – General assets of the sponsorYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement - TrustYes
2016-10-01Plan benefit arrangement – General assets of the sponsorYes
2015: MID PENN BANK GROUP HEALTH PLAN 2015 form 5500 responses
2015-10-01Type of plan entitySingle employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planNo
2015-10-01Plan funding arrangement – InsuranceYes
2015-10-01Plan funding arrangement – TrustYes
2015-10-01Plan funding arrangement – General assets of the sponsorYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement - TrustYes
2015-10-01Plan benefit arrangement – General assets of the sponsorYes
2014: MID PENN BANK GROUP HEALTH PLAN 2014 form 5500 responses
2014-10-01Type of plan entitySingle employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planNo
2014-10-01Plan funding arrangement – InsuranceYes
2014-10-01Plan funding arrangement – TrustYes
2014-10-01Plan funding arrangement – General assets of the sponsorYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement - TrustYes
2014-10-01Plan benefit arrangement – General assets of the sponsorYes
2013: MID PENN BANK GROUP HEALTH PLAN 2013 form 5500 responses
2013-10-01Type of plan entitySingle employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planNo
2013-10-01Plan funding arrangement – InsuranceYes
2013-10-01Plan funding arrangement – TrustYes
2013-10-01Plan funding arrangement – General assets of the sponsorYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement - TrustYes
2013-10-01Plan benefit arrangement – General assets of the sponsorYes
2012: MID PENN BANK GROUP HEALTH PLAN 2012 form 5500 responses
2012-10-01Type of plan entitySingle employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planNo
2012-10-01Plan funding arrangement – InsuranceYes
2012-10-01Plan funding arrangement – TrustYes
2012-10-01Plan funding arrangement – General assets of the sponsorYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement - TrustYes
2012-10-01Plan benefit arrangement – General assets of the sponsorYes
2011: MID PENN BANK GROUP HEALTH PLAN 2011 form 5500 responses
2011-10-01Type of plan entitySingle employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planNo
2011-10-01Plan funding arrangement – InsuranceYes
2011-10-01Plan funding arrangement – TrustYes
2011-10-01Plan funding arrangement – General assets of the sponsorYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement - TrustYes
2011-10-01Plan benefit arrangement – General assets of the sponsorYes
2009: MID PENN BANK GROUP HEALTH PLAN 2009 form 5500 responses
2009-10-01Type of plan entitySingle employer plan
2009-10-01Submission has been amendedYes
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planNo
2009-10-01Plan funding arrangement – InsuranceYes
2009-10-01Plan funding arrangement – TrustYes
2009-10-01Plan funding arrangement – General assets of the sponsorYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan benefit arrangement - TrustYes
2009-10-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number2926
Policy instance 1
Insurance contract or identification number2926
Number of Individuals Covered335
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Total amount of commissions paid to insurance brokerUSD $730
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 BenefitYes
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 $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $730
Insurance broker organization code?3
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number2926
Policy instance 1
Insurance contract or identification number2926
Number of Individuals Covered328
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Total amount of commissions paid to insurance brokerUSD $1,577
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,577
Insurance broker organization code?3
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number2926
Policy instance 1
Insurance contract or identification number2926
Number of Individuals Covered287
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $707
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $707
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number017668303
Policy instance 2
Insurance contract or identification number017668303
Number of Individuals Covered3
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $1,428
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 $19,699
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,428
Insurance broker organization code?3
UPMC HEALTH SOLUTION (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number017668903
Policy instance 4
Insurance contract or identification number017668903
Number of Individuals Covered3
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $567
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 $19,444
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $567
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number017668801
Policy instance 3
Insurance contract or identification number017668801
Number of Individuals Covered40
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Total amount of commissions paid to insurance brokerUSD $10,807
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 $219,249
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,807
Insurance broker organization code?3
UPMC HEALTH OPTIONS (National Association of Insurance Commissioners NAIC id number: 15345 )
Policy contract number017668302
Policy instance 2
Insurance contract or identification number017668302
Number of Individuals Covered0
Insurance policy start date2018-01-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $2,112
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 $143,124
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 )
Policy contract number2926
Policy instance 1
Insurance contract or identification number2926
Number of Individuals Covered271
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $1,299
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 BenefitYes
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number81962728
Policy instance 3
Insurance contract or identification number81962728
Number of Individuals Covered52
Insurance policy start date2018-01-01
Insurance policy end date2018-09-30
Total amount of commissions paid to insurance brokerUSD $22,798
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 $491,556
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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