STAUFFER BISCUIT COMPANY has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan STAUFFER BISCUIT CO. GROUP INSURANCE PLAN
| Measure | Date | Value |
|---|
| 2023 : STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2023 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2023-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $717,226 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $1,212,532 |
| Total income from all sources (including contributions) | 2023-12-31 | $8,014,158 |
| Total loss/gain on sale of assets | 2023-12-31 | $0 |
| Total of all expenses incurred | 2023-12-31 | $6,742,961 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-12-31 | $6,597,480 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-12-31 | $7,993,207 |
| Value of total assets at end of year | 2023-12-31 | $1,330,975 |
| Value of total assets at beginning of year | 2023-12-31 | $555,084 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-12-31 | $145,481 |
| Total interest from all sources | 2023-12-31 | $20,951 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-12-31 | $0 |
| 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 | $1,700,778 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-12-31 | $73,275 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-12-31 | $300,653 |
| Administrative expenses (other) incurred | 2023-12-31 | $145,481 |
| 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 | $1,271,197 |
| Value of net assets at end of year (total assets less liabilities) | 2023-12-31 | $613,749 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-12-31 | $-657,448 |
| 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 bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-12-31 | $1,257,700 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-12-31 | $254,431 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-12-31 | $254,431 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-12-31 | $20,951 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-12-31 | $1,956,514 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2023-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-12-31 | No |
| Contributions received in cash from employer | 2023-12-31 | $6,292,429 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-12-31 | $4,640,966 |
| Liabilities. Value of benefit claims payable at end of year | 2023-12-31 | $717,226 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-12-31 | $1,212,532 |
| Did the plan have assets held for investment | 2023-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-12-31 | Unqualified |
| Accountancy firm name | 2023-12-31 | RKL LLP |
| Accountancy firm EIN | 2023-12-31 | 232108173 |
| Total unrealized appreciation/depreciation of assets | 2023-01-01 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-01-01 | $717,226 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-01-01 | $1,212,532 |
| Total income from all sources (including contributions) | 2023-01-01 | $8,014,158 |
| Total loss/gain on sale of assets | 2023-01-01 | $0 |
| Total of all expenses incurred | 2023-01-01 | $6,742,961 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-01-01 | $6,597,480 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-01-01 | $7,993,207 |
| Value of total assets at end of year | 2023-01-01 | $1,330,975 |
| Value of total assets at beginning of year | 2023-01-01 | $555,084 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-01-01 | $145,481 |
| Total interest from all sources | 2023-01-01 | $20,951 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-01-01 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-01-01 | No |
| Was this plan covered by a fidelity bond | 2023-01-01 | Yes |
| Value of fidelity bond cover | 2023-01-01 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2023-01-01 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-01-01 | No |
| Contributions received from participants | 2023-01-01 | $1,700,778 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-01-01 | $73,275 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-01-01 | $300,653 |
| Administrative expenses (other) incurred | 2023-01-01 | $145,481 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-01-01 | No |
| Value of net income/loss | 2023-01-01 | $1,271,197 |
| Value of net assets at end of year (total assets less liabilities) | 2023-01-01 | $613,749 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-01-01 | $-657,448 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-01-01 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-01-01 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-01-01 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-01-01 | $1,257,700 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-01-01 | $20,951 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-01-01 | $1,956,514 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-01-01 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2023-01-01 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-01-01 | No |
| Contributions received in cash from employer | 2023-01-01 | $6,292,429 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-01-01 | $4,640,966 |
| Liabilities. Value of benefit claims payable at end of year | 2023-01-01 | $717,226 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-01-01 | $1,212,532 |
| Did the plan have assets held for investment | 2023-01-01 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-01-01 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-01-01 | No |
| Opinion of an independent qualified public accountant for this plan | 2023-01-01 | 1 |
| Accountancy firm name | 2023-01-01 | RKL LLP |
| Accountancy firm EIN | 2023-01-01 | 232108173 |
| 2022 : STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $1,212,532 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $631,205 |
| Total income from all sources (including contributions) | 2022-12-31 | $6,615,328 |
| Total loss/gain on sale of assets | 2022-12-31 | $0 |
| Total of all expenses incurred | 2022-12-31 | $7,225,498 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $7,078,877 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $6,614,237 |
| Value of total assets at end of year | 2022-12-31 | $555,084 |
| Value of total assets at beginning of year | 2022-12-31 | $583,927 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $146,621 |
| Total interest from all sources | 2022-12-31 | $1,091 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Administrative expenses professional fees incurred | 2022-12-31 | $146,621 |
| 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 | $1,428,219 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $300,653 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $0 |
| 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 | $-610,170 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $-657,448 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $-47,278 |
| 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 bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $254,431 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $583,927 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $583,927 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $1,091 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $1,767,822 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $5,186,018 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $5,311,055 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $1,212,532 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $631,205 |
| Did the plan have assets held for investment | 2022-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | RKL LLP |
| Accountancy firm EIN | 2022-12-31 | 232108173 |
| Total unrealized appreciation/depreciation of assets | 2022-01-01 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-01-01 | $1,212,532 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-01-01 | $631,205 |
| Total income from all sources (including contributions) | 2022-01-01 | $6,615,328 |
| Total loss/gain on sale of assets | 2022-01-01 | $0 |
| Total of all expenses incurred | 2022-01-01 | $7,225,498 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-01-01 | $7,078,877 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-01-01 | $6,614,237 |
| Value of total assets at end of year | 2022-01-01 | $555,084 |
| Value of total assets at beginning of year | 2022-01-01 | $583,927 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-01-01 | $146,621 |
| Total interest from all sources | 2022-01-01 | $1,091 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-01-01 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-01-01 | No |
| Administrative expenses professional fees incurred | 2022-01-01 | $146,621 |
| Was this plan covered by a fidelity bond | 2022-01-01 | Yes |
| Value of fidelity bond cover | 2022-01-01 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2022-01-01 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-01-01 | No |
| Contributions received from participants | 2022-01-01 | $1,428,219 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-01-01 | $300,653 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-01-01 | $0 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-01-01 | No |
| Value of net income/loss | 2022-01-01 | $-610,170 |
| Value of net assets at end of year (total assets less liabilities) | 2022-01-01 | $-657,448 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-01-01 | $-47,278 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-01-01 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-01-01 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-01-01 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-01-01 | $254,431 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-01-01 | $1,091 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-01-01 | $1,767,822 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-01-01 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-01-01 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-01-01 | No |
| Contributions received in cash from employer | 2022-01-01 | $5,186,018 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-01-01 | $5,311,055 |
| Liabilities. Value of benefit claims payable at end of year | 2022-01-01 | $1,212,532 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-01-01 | $631,205 |
| Did the plan have assets held for investment | 2022-01-01 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-01-01 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-01-01 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-01-01 | 1 |
| Accountancy firm name | 2022-01-01 | RKL LLP |
| Accountancy firm EIN | 2022-01-01 | 232108173 |
| 2021 : STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2021 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2021-12-31 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $631,205 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $0 |
| Total income from all sources (including contributions) | 2021-12-31 | $6,266,837 |
| Total loss/gain on sale of assets | 2021-12-31 | $0 |
| Total of all expenses incurred | 2021-12-31 | $6,314,115 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $6,103,963 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $6,265,006 |
| Value of total assets at end of year | 2021-12-31 | $583,927 |
| Value of total assets at beginning of year | 2021-12-31 | $0 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $210,152 |
| Total interest from all sources | 2021-12-31 | $1,831 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Administrative expenses professional fees incurred | 2021-12-31 | $210,152 |
| 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 | $1,500,216 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $-47,278 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $-47,278 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $0 |
| 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 bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $583,927 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $0 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-12-31 | $1,831 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $1,629,216 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $4,764,790 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $4,474,747 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $631,205 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $0 |
| Did the plan have assets held for investment | 2021-12-31 | Yes |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | RKL LLP |
| Accountancy firm EIN | 2021-12-31 | 232108173 |
| 2023: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2023 form 5500 responses |
|---|
| 2023-01-01 | Type of plan entity | Single employer plan |
| 2023-01-01 | Submission has been amended | No |
| 2023-01-01 | This submission is the final filing | No |
| 2023-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2023-01-01 | Plan is a collectively bargained plan | No |
| 2023-01-01 | Plan funding arrangement – Insurance | Yes |
| 2023-01-01 | Plan funding arrangement – Trust | Yes |
| 2023-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2023-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2023-01-01 | Plan benefit arrangement - Trust | Yes |
| 2023-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2022: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2022 form 5500 responses |
|---|
| 2022-01-01 | Type of plan entity | Single employer plan |
| 2022-01-01 | Submission has been amended | No |
| 2022-01-01 | This submission is the final filing | No |
| 2022-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2022-01-01 | Plan is a collectively bargained plan | No |
| 2022-01-01 | Plan funding arrangement – Insurance | Yes |
| 2022-01-01 | Plan funding arrangement – Trust | Yes |
| 2022-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2022-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2022-01-01 | Plan benefit arrangement - Trust | Yes |
| 2022-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2021: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2021 form 5500 responses |
|---|
| 2021-01-01 | Type of plan entity | Single employer plan |
| 2021-01-01 | Submission has been amended | No |
| 2021-01-01 | This submission is the final filing | No |
| 2021-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2021-01-01 | Plan is a collectively bargained plan | No |
| 2021-01-01 | Plan funding arrangement – Insurance | Yes |
| 2021-01-01 | Plan funding arrangement – Trust | Yes |
| 2021-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2021-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2021-01-01 | Plan benefit arrangement - Trust | Yes |
| 2021-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2020: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2020 form 5500 responses |
|---|
| 2020-07-01 | Type of plan entity | Single employer plan |
| 2020-07-01 | Submission has been amended | No |
| 2020-07-01 | This submission is the final filing | No |
| 2020-07-01 | This return/report is a short plan year return/report (less than 12 months) | Yes |
| 2020-07-01 | Plan is a collectively bargained plan | No |
| 2020-07-01 | Plan funding arrangement – Insurance | Yes |
| 2020-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2019 form 5500 responses |
|---|
| 2019-07-01 | Type of plan entity | Single employer plan |
| 2019-07-01 | Submission has been amended | No |
| 2019-07-01 | This submission is the final filing | No |
| 2019-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2019-07-01 | Plan is a collectively bargained plan | No |
| 2019-07-01 | Plan funding arrangement – Insurance | Yes |
| 2019-07-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-07-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2018 form 5500 responses |
|---|
| 2018-07-01 | Type of plan entity | Single employer plan |
| 2018-07-01 | Submission has been amended | No |
| 2018-07-01 | This submission is the final filing | No |
| 2018-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2018-07-01 | Plan is a collectively bargained plan | No |
| 2018-07-01 | Plan funding arrangement – Insurance | Yes |
| 2018-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2017: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2017 form 5500 responses |
|---|
| 2017-07-01 | Type of plan entity | Single employer plan |
| 2017-07-01 | Submission has been amended | No |
| 2017-07-01 | This submission is the final filing | No |
| 2017-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-07-01 | Plan is a collectively bargained plan | No |
| 2017-07-01 | Plan funding arrangement – Insurance | Yes |
| 2017-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2016: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2016 form 5500 responses |
|---|
| 2016-07-01 | Type of plan entity | Single employer plan |
| 2016-07-01 | Submission has been amended | No |
| 2016-07-01 | This submission is the final filing | No |
| 2016-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-07-01 | Plan is a collectively bargained plan | No |
| 2016-07-01 | Plan funding arrangement – Insurance | Yes |
| 2016-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2015: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2015 form 5500 responses |
|---|
| 2015-07-01 | Type of plan entity | Single employer plan |
| 2015-07-01 | Submission has been amended | No |
| 2015-07-01 | This submission is the final filing | No |
| 2015-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-07-01 | Plan is a collectively bargained plan | No |
| 2015-07-01 | Plan funding arrangement – Insurance | Yes |
| 2015-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2014: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2014 form 5500 responses |
|---|
| 2014-07-01 | Type of plan entity | Single employer plan |
| 2014-07-01 | Submission has been amended | No |
| 2014-07-01 | This submission is the final filing | No |
| 2014-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-07-01 | Plan is a collectively bargained plan | No |
| 2014-07-01 | Plan funding arrangement – Insurance | Yes |
| 2014-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2013: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2013 form 5500 responses |
|---|
| 2013-07-01 | Type of plan entity | Single employer plan |
| 2013-07-01 | Submission has been amended | No |
| 2013-07-01 | This submission is the final filing | No |
| 2013-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-07-01 | Plan is a collectively bargained plan | No |
| 2013-07-01 | Plan funding arrangement – Insurance | Yes |
| 2013-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2012: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2012 form 5500 responses |
|---|
| 2012-07-01 | Type of plan entity | Single employer plan |
| 2012-07-01 | Submission has been amended | No |
| 2012-07-01 | This submission is the final filing | No |
| 2012-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-07-01 | Plan is a collectively bargained plan | No |
| 2012-07-01 | Plan funding arrangement – Insurance | Yes |
| 2012-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2011: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2011 form 5500 responses |
|---|
| 2011-07-01 | Type of plan entity | Single employer plan |
| 2011-07-01 | Submission has been amended | No |
| 2011-07-01 | This submission is the final filing | No |
| 2011-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-07-01 | Plan is a collectively bargained plan | No |
| 2011-07-01 | Plan funding arrangement – Insurance | Yes |
| 2011-07-01 | Plan benefit arrangement – Insurance | Yes |
| 2009: STAUFFER BISCUIT CO. GROUP INSURANCE PLAN 2009 form 5500 responses |
|---|
| 2009-07-01 | Type of plan entity | Single employer plan |
| 2009-07-01 | Submission has been amended | No |
| 2009-07-01 | This submission is the final filing | No |
| 2009-07-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2009-07-01 | Plan is a collectively bargained plan | No |
| 2009-07-01 | Plan funding arrangement – Insurance | Yes |
| 2009-07-01 | Plan benefit arrangement – Insurance | Yes |
| UNIMERICA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 91529 ) |
| Policy contract number | UNI-203401 |
| Policy instance | 4 |
| Insurance contract or identification number | UNI-203401 | | Number of Individuals Covered | 422 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $1,478,997 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 013244 |
| Policy instance | 3 |
| Insurance contract or identification number | 013244 | | Number of Individuals Covered | 587 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $21,197 | | Total amount of fees paid to insurance company | USD $10,598 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $252,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18390 |
| Policy instance | 2 |
| Insurance contract or identification number | 18390 | | Number of Individuals Covered | 488 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $6,813 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $227,088 | | 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 number | 4882 |
| Policy instance | 1 |
| Insurance contract or identification number | 4882 | | Number of Individuals Covered | 485 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $1,876 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $37,525 | | 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 number | 4882 |
| Policy instance | 1 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18390 |
| Policy instance | 2 |
| MONY (National Association of Insurance Commissioners NAIC id number: 78077 ) |
| Policy contract number | 013244 |
| Policy instance | 3 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500691 |
| Policy instance | 4 |
| VISION BENEFITS OF AMERICA (National Association of Insurance Commissioners NAIC id number: 53953 ) |
| Policy contract number | 4882 |
| Policy instance | 1 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18390 |
| Policy instance | 2 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010259739 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010259737 |
| Policy instance | 4 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010259738 |
| Policy instance | 5 |
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | 30500691 |
| Policy instance | 6 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 1 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18390 |
| Policy instance | 2 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 3 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010259739 |
| Policy instance | 4 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010259737 |
| Policy instance | 5 |
| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010259738 |
| Policy instance | 6 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 1 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18390 |
| Policy instance | 2 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 3 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AVHR |
| Policy instance | 4 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AVHR |
| Policy instance | 5 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AHVR |
| Policy instance | 6 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 1 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 6 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 2 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 3 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AVHR |
| Policy instance | 8 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18390 |
| Policy instance | 4 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 02534940 |
| Policy instance | 5 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AVHR |
| Policy instance | 9 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AVHR |
| Policy instance | 7 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | 7507S18 |
| Policy instance | 10 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AVHR |
| Policy instance | 8 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AVHR |
| Policy instance | 7 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 02534940 |
| Policy instance | 5 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 3 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 18390 |
| Policy instance | 4 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 2 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 1 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 6 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AVHR |
| Policy instance | 9 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 3 |
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: 55204 ) |
| Policy contract number | 00315100 |
| Policy instance | 1 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 2 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 10723 |
| Policy instance | 5 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 4 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 259246 |
| Policy instance | 12 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 71412 ) |
| Policy contract number | 7507S18 |
| Policy instance | 11 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GUG0AVHR |
| Policy instance | 10 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLTD0AVHR |
| Policy instance | 9 |
| MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 ) |
| Policy contract number | GLUG0AVHR |
| Policy instance | 8 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 7 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 02534940 |
| Policy instance | 6 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 02534940 |
| Policy instance | 6 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 10723 |
| Policy instance | 5 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 4 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 2 |
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: 55204 ) |
| Policy contract number | 00315100 |
| Policy instance | 1 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 143218 |
| Policy instance | 8 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 117116 |
| Policy instance | 9 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 159153 |
| Policy instance | 10 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
| Policy contract number | DBL 251438 |
| Policy instance | 11 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 259246 |
| Policy instance | 12 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 7 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 3 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 3 |
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: 55204 ) |
| Policy contract number | 00315100 |
| Policy instance | 1 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 5 |
| CAPITAL BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 54720 ) |
| Policy contract number | 00502630 |
| Policy instance | 6 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 2 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | 10723 |
| Policy instance | 7 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 9 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 143218 |
| Policy instance | 10 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 02534940 |
| Policy instance | 8 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 117116 |
| Policy instance | 11 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 159153 |
| Policy instance | 12 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
| Policy contract number | DBL 251438 |
| Policy instance | 13 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 259246 |
| Policy instance | 14 |
| CAPITAL ADVANTAGE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 14411 ) |
| Policy contract number | 00502630 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 143218 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 117116 |
| Policy instance | 3 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 159153 |
| Policy instance | 4 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
| Policy contract number | DBL 251438 |
| Policy instance | 5 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 259246 |
| Policy instance | 6 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 7 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 8 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 10 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | PA10723 |
| Policy instance | 12 |
| CAPITAL BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 54720 ) |
| Policy contract number | 00502630 |
| Policy instance | 11 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 02534940 |
| Policy instance | 13 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 14 |
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: 55204 ) |
| Policy contract number | 00315100 |
| Policy instance | 1 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 9 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 159153 |
| Policy instance | 4 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 143218 |
| Policy instance | 2 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 117116 |
| Policy instance | 3 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 14 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 02534940 |
| Policy instance | 13 |
| CAPITAL BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 54720 ) |
| Policy contract number | 00502630 |
| Policy instance | 11 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 10 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 9 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 8 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 7 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | 259246 |
| Policy instance | 6 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
| Policy contract number | DBL 251438 |
| Policy instance | 5 |
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: 55204 ) |
| Policy contract number | 00315100 |
| Policy instance | 1 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | PA10723 |
| Policy instance | 12 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 2 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 3 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 4 |
| CAPITAL ADVANTAGE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 41203 ) |
| Policy contract number | 00502630 |
| Policy instance | 5 |
| CAPITAL BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 54720 ) |
| Policy contract number | 00502630 |
| Policy instance | 6 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 02534940 |
| Policy instance | 8 |
| KEYSTONE HEALTH PLAN CENTRAL (National Association of Insurance Commissioners NAIC id number: 95199 ) |
| Policy contract number | 00502630 |
| Policy instance | 9 |
| DELTA DENTAL OF PENNSYLVANIA (National Association of Insurance Commissioners NAIC id number: 54798 ) |
| Policy contract number | PA10723 |
| Policy instance | 7 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | LTD 117116 |
| Policy instance | 11 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 143218 |
| Policy instance | 10 |
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | G 159153 |
| Policy instance | 12 |
| FIRST RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71005 ) |
| Policy contract number | DBL 251438 |
| Policy instance | 13 |
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | SEE FOOTNOTE |
| Policy instance | 14 |
| HEALTHNOW NEW YORK, INC. DBA BLUESHIELD OF NORTHEASTERN NEW YORK (National Association of Insurance Commissioners NAIC id number: 55204 ) |
| Policy contract number | 00315100 |
| Policy instance | 1 |
