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TEAMSTERS LOCAL 830 WELFARE PLAN 401k Plan overview

Plan NameTEAMSTERS LOCAL 830 WELFARE PLAN
Plan identification number 501

TEAMSTERS LOCAL 830 WELFARE PLAN Benefits

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

401k Sponsoring company profile

BOARD OF TRUSTEES OF TEAMSTERS LOCAL 830 WELFARE FUND has sponsored the creation of one or more 401k plans.

Company Name:BOARD OF TRUSTEES OF TEAMSTERS LOCAL 830 WELFARE FUND
Employer identification number (EIN):231415471
NAIC Classification:484120
NAIC Description: General Freight Trucking, Long-Distance

Form 5500 Filing Information

Submission information for form 5500 for 401k plan TEAMSTERS LOCAL 830 WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-09-01DANIEL GRACE - UNION TRUSTEE2024-05-20 DOMINIC ORIGLIO - EMPLOYER TRUSTEE2024-06-03
5012021-09-01DANIEL GRACE - UNION TRUSTEE2023-06-07 DOMINIC ORIGLIO - EMPLOYER TRUSTEE2023-06-07
5012020-09-01DANIEL GRACE - UNION TRUSTEE2022-06-06 DOMINIC ORIGLIO - EMPLOYER TRUSTEE2022-06-08
5012019-09-01DANIEL GRACE - UNION TRUSTEE2021-06-03 DOMINIC ORIGLIO - EMPLOYER TRUSTEE2021-06-03
5012018-09-01DANIEL GRACE - UNION TRUSTEE2020-07-08 DOMINIC ORIGLIO - EMPLOYER TRUSTEE2020-07-08
5012017-09-01
5012016-09-01UNION TRUSTEE
5012015-09-01UNION TRUSTEE
5012014-09-01UNION TRUSTEE
5012013-09-01UNION TRUSTEE
5012012-09-01UNION TRUSTEE
5012011-09-01UNION TRUSTEE
5012010-09-01UNION TRUSTEE
5012009-09-01UNION TRUSTEE

Plan Statistics for TEAMSTERS LOCAL 830 WELFARE PLAN

401k plan membership statisitcs for TEAMSTERS LOCAL 830 WELFARE PLAN

Measure Date Value
2022: TEAMSTERS LOCAL 830 WELFARE PLAN 2022 401k membership
Total participants, beginning-of-year2022-09-012,101
Total number of active participants reported on line 7a of the Form 55002022-09-012,013
Number of retired or separated participants receiving benefits2022-09-01184
Total of all active and inactive participants2022-09-012,197
Number of employers contributing to the scheme2022-09-0134
2021: TEAMSTERS LOCAL 830 WELFARE PLAN 2021 401k membership
Total participants, beginning-of-year2021-09-012,145
Total number of active participants reported on line 7a of the Form 55002021-09-011,946
Number of retired or separated participants receiving benefits2021-09-01155
Total of all active and inactive participants2021-09-012,101
Number of employers contributing to the scheme2021-09-0136
2020: TEAMSTERS LOCAL 830 WELFARE PLAN 2020 401k membership
Total participants, beginning-of-year2020-09-012,143
Total number of active participants reported on line 7a of the Form 55002020-09-011,959
Number of retired or separated participants receiving benefits2020-09-01186
Total of all active and inactive participants2020-09-012,145
Number of employers contributing to the scheme2020-09-0136
2019: TEAMSTERS LOCAL 830 WELFARE PLAN 2019 401k membership
Total participants, beginning-of-year2019-09-012,277
Total number of active participants reported on line 7a of the Form 55002019-09-012,117
Number of retired or separated participants receiving benefits2019-09-0126
Number of other retired or separated participants entitled to future benefits2019-09-010
Total of all active and inactive participants2019-09-012,143
Number of employers contributing to the scheme2019-09-0134
2018: TEAMSTERS LOCAL 830 WELFARE PLAN 2018 401k membership
Total participants, beginning-of-year2018-09-012,201
Total number of active participants reported on line 7a of the Form 55002018-09-012,252
Number of retired or separated participants receiving benefits2018-09-0125
Total of all active and inactive participants2018-09-012,277
Number of employers contributing to the scheme2018-09-0134
2017: TEAMSTERS LOCAL 830 WELFARE PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-011,904
Total number of active participants reported on line 7a of the Form 55002017-09-012,201
Total of all active and inactive participants2017-09-012,201
Total participants2017-09-012,201
Number of employers contributing to the scheme2017-09-0161
2016: TEAMSTERS LOCAL 830 WELFARE PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-011,953
Total number of active participants reported on line 7a of the Form 55002016-09-011,904
Total of all active and inactive participants2016-09-011,904
Total participants2016-09-011,904
Number of employers contributing to the scheme2016-09-0160
2015: TEAMSTERS LOCAL 830 WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-09-010
Total number of active participants reported on line 7a of the Form 55002015-09-011,953
Total of all active and inactive participants2015-09-011,953
Total participants2015-09-010
Number of employers contributing to the scheme2015-09-0160
2014: TEAMSTERS LOCAL 830 WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-09-011,792
Total number of active participants reported on line 7a of the Form 55002014-09-011,763
Total of all active and inactive participants2014-09-011,763
Total participants2014-09-010
Number of employers contributing to the scheme2014-09-0160
2013: TEAMSTERS LOCAL 830 WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-09-011,783
Total number of active participants reported on line 7a of the Form 55002013-09-011,792
Total of all active and inactive participants2013-09-011,792
Total participants2013-09-010
Number of employers contributing to the scheme2013-09-010
2012: TEAMSTERS LOCAL 830 WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-09-011,734
Total number of active participants reported on line 7a of the Form 55002012-09-011,783
Total of all active and inactive participants2012-09-011,783
Total participants2012-09-010
2011: TEAMSTERS LOCAL 830 WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-09-011,824
Total number of active participants reported on line 7a of the Form 55002011-09-011,734
Total of all active and inactive participants2011-09-011,734
Total participants2011-09-011,734
2010: TEAMSTERS LOCAL 830 WELFARE PLAN 2010 401k membership
Total participants, beginning-of-year2010-09-012,013
Total number of active participants reported on line 7a of the Form 55002010-09-011,824
Total of all active and inactive participants2010-09-011,824
Total participants2010-09-011,824
2009: TEAMSTERS LOCAL 830 WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-09-012,647
Total number of active participants reported on line 7a of the Form 55002009-09-012,013
Total of all active and inactive participants2009-09-012,013
Total participants2009-09-012,013

Financial Data on TEAMSTERS LOCAL 830 WELFARE PLAN

Measure Date Value
2023 : TEAMSTERS LOCAL 830 WELFARE PLAN 2023 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2023-08-31$-184,247
Total unrealized appreciation/depreciation of assets2023-08-31$-184,247
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-08-31$4,946,093
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-08-31$6,323,770
Total income from all sources (including contributions)2023-08-31$35,419,949
Total loss/gain on sale of assets2023-08-31$-173,641
Total of all expenses incurred2023-08-31$33,528,904
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-08-31$32,415,108
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-08-31$34,009,201
Value of total assets at end of year2023-08-31$44,242,697
Value of total assets at beginning of year2023-08-31$43,729,329
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-08-31$1,113,796
Total interest from all sources2023-08-31$1,524,857
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-08-31No
Administrative expenses professional fees incurred2023-08-31$157,283
Was this plan covered by a fidelity bond2023-08-31Yes
Value of fidelity bond cover2023-08-31$500,000
Were there any nonexempt tranactions with any party-in-interest2023-08-31No
Contributions received from participants2023-08-31$635,252
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2023-08-31$348,000
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-08-31$1,446,001
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-08-31$1,316,986
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-08-31$440,268
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-08-31$590,223
Administrative expenses (other) incurred2023-08-31$827,584
Liabilities. Value of operating payables at end of year2023-08-31$84,337
Liabilities. Value of operating payables at beginning of year2023-08-31$83,890
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-08-31No
Value of net income/loss2023-08-31$1,891,045
Value of net assets at end of year (total assets less liabilities)2023-08-31$39,296,604
Value of net assets at beginning of year (total assets less liabilities)2023-08-31$37,405,559
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2023-08-31No
Were any leases to which the plan was party in default or uncollectible2023-08-31No
Assets. partnership/joint venture interests at end of year2023-08-31$5,518,554
Assets. partnership/joint venture interests at beginning of year2023-08-31$5,445,884
Investment advisory and management fees2023-08-31$128,929
Interest earned on other investments2023-08-31$316,921
Income. Interest from US Government securities2023-08-31$111,087
Income. Interest from corporate debt instruments2023-08-31$993,361
Value of interest in common/collective trusts at end of year2023-08-31$1,973,898
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-08-31$8,327,882
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-08-31$8,445,359
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-08-31$8,445,359
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-08-31$103,488
Expenses. Payments to insurance carriers foe the provision of benefits2023-08-31$1,694,227
Asset value of US Government securities at end of year2023-08-31$6,356,224
Asset value of US Government securities at beginning of year2023-08-31$6,653,368
Net investment gain or loss from common/collective trusts2023-08-31$243,779
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-08-31Yes
Was there a failure to transmit to the plan any participant contributions2023-08-31No
Has the plan failed to provide any benefit when due under the plan2023-08-31No
Contributions received in cash from employer2023-08-31$33,373,949
Employer contributions (assets) at end of year2023-08-31$720,426
Employer contributions (assets) at beginning of year2023-08-31$1,679,894
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-08-31$30,372,881
Asset. Corporate debt instrument debt (other) at end of year2023-08-31$19,899,712
Asset. Corporate debt instrument debt (other) at beginning of year2023-08-31$20,187,838
Liabilities. Value of benefit claims payable at end of year2023-08-31$4,421,488
Liabilities. Value of benefit claims payable at beginning of year2023-08-31$5,649,657
Did the plan have assets held for investment2023-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-08-31Yes
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-08-31No
Aggregate proceeds on sale of assets2023-08-31$32,094,448
Aggregate carrying amount (costs) on sale of assets2023-08-31$32,268,089
Opinion of an independent qualified public accountant for this plan2023-08-31Unqualified
Accountancy firm name2023-08-31NOVAK FRANCELLA, LLC
Accountancy firm EIN2023-08-31611436956
2022 : TEAMSTERS LOCAL 830 WELFARE PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-08-31$-2,088,505
Total unrealized appreciation/depreciation of assets2022-08-31$-2,088,505
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-08-31$6,323,770
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-08-31$5,660,126
Total income from all sources (including contributions)2022-08-31$32,690,514
Total loss/gain on sale of assets2022-08-31$-695,085
Total of all expenses incurred2022-08-31$33,717,296
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-08-31$32,565,090
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-08-31$34,192,922
Value of total assets at end of year2022-08-31$43,729,329
Value of total assets at beginning of year2022-08-31$44,092,467
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-08-31$1,152,206
Total interest from all sources2022-08-31$1,281,182
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-08-31No
Administrative expenses professional fees incurred2022-08-31$164,028
Was this plan covered by a fidelity bond2022-08-31Yes
Value of fidelity bond cover2022-08-31$500,000
Were there any nonexempt tranactions with any party-in-interest2022-08-31No
Contributions received from participants2022-08-31$723,107
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-08-31$373,800
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-08-31$1,316,986
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-08-31$1,413,117
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-08-31$590,223
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-08-31$100,091
Administrative expenses (other) incurred2022-08-31$858,459
Liabilities. Value of operating payables at end of year2022-08-31$83,890
Liabilities. Value of operating payables at beginning of year2022-08-31$81,394
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-08-31No
Value of net income/loss2022-08-31$-1,026,782
Value of net assets at end of year (total assets less liabilities)2022-08-31$37,405,559
Value of net assets at beginning of year (total assets less liabilities)2022-08-31$38,432,341
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-08-31No
Were any leases to which the plan was party in default or uncollectible2022-08-31No
Assets. partnership/joint venture interests at end of year2022-08-31$5,445,884
Assets. partnership/joint venture interests at beginning of year2022-08-31$5,157,835
Investment advisory and management fees2022-08-31$129,719
Interest earned on other investments2022-08-31$276,609
Income. Interest from US Government securities2022-08-31$55,741
Income. Interest from corporate debt instruments2022-08-31$929,224
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-08-31$8,445,359
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-08-31$10,341,612
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-08-31$10,341,612
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-08-31$19,608
Expenses. Payments to insurance carriers foe the provision of benefits2022-08-31$1,418,179
Asset value of US Government securities at end of year2022-08-31$6,653,368
Asset value of US Government securities at beginning of year2022-08-31$5,660,681
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-08-31Yes
Was there a failure to transmit to the plan any participant contributions2022-08-31No
Has the plan failed to provide any benefit when due under the plan2022-08-31No
Contributions received in cash from employer2022-08-31$33,469,815
Employer contributions (assets) at end of year2022-08-31$1,679,894
Employer contributions (assets) at beginning of year2022-08-31$1,057,796
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-08-31$30,773,111
Asset. Corporate debt instrument debt (other) at end of year2022-08-31$20,187,838
Asset. Corporate debt instrument debt (other) at beginning of year2022-08-31$20,461,426
Liabilities. Value of benefit claims payable at end of year2022-08-31$5,649,657
Liabilities. Value of benefit claims payable at beginning of year2022-08-31$5,478,641
Did the plan have assets held for investment2022-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-08-31Yes
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-08-31No
Aggregate proceeds on sale of assets2022-08-31$32,951,585
Aggregate carrying amount (costs) on sale of assets2022-08-31$33,646,670
Opinion of an independent qualified public accountant for this plan2022-08-31Unqualified
Accountancy firm name2022-08-31NOVAK FRANCELLA, LLC
Accountancy firm EIN2022-08-31611436956
2021 : TEAMSTERS LOCAL 830 WELFARE PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-08-31$273,664
Total unrealized appreciation/depreciation of assets2021-08-31$273,664
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-08-31$5,660,126
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-08-31$4,973,380
Total income from all sources (including contributions)2021-08-31$36,304,281
Total loss/gain on sale of assets2021-08-31$-116,746
Total of all expenses incurred2021-08-31$32,697,892
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-08-31$31,720,366
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-08-31$35,073,539
Value of total assets at end of year2021-08-31$44,092,467
Value of total assets at beginning of year2021-08-31$39,799,332
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-08-31$977,526
Total interest from all sources2021-08-31$1,073,824
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-08-31No
Administrative expenses professional fees incurred2021-08-31$140,932
Was this plan covered by a fidelity bond2021-08-31Yes
Value of fidelity bond cover2021-08-31$500,000
Were there any nonexempt tranactions with any party-in-interest2021-08-31No
Contributions received from participants2021-08-31$691,075
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-08-31$373,311
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-08-31$1,413,117
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-08-31$1,073,184
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-08-31$100,091
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-08-31$131,797
Administrative expenses (other) incurred2021-08-31$715,680
Liabilities. Value of operating payables at end of year2021-08-31$81,394
Liabilities. Value of operating payables at beginning of year2021-08-31$89,515
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-08-31No
Value of net income/loss2021-08-31$3,606,389
Value of net assets at end of year (total assets less liabilities)2021-08-31$38,432,341
Value of net assets at beginning of year (total assets less liabilities)2021-08-31$34,825,952
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-08-31No
Were any leases to which the plan was party in default or uncollectible2021-08-31No
Assets. partnership/joint venture interests at end of year2021-08-31$5,157,835
Assets. partnership/joint venture interests at beginning of year2021-08-31$4,194,698
Investment advisory and management fees2021-08-31$120,914
Interest earned on other investments2021-08-31$191,949
Income. Interest from US Government securities2021-08-31$45,042
Income. Interest from corporate debt instruments2021-08-31$825,120
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-08-31$10,341,612
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-08-31$10,255,619
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-08-31$10,255,619
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-08-31$11,713
Expenses. Payments to insurance carriers foe the provision of benefits2021-08-31$1,481,370
Asset value of US Government securities at end of year2021-08-31$5,660,681
Asset value of US Government securities at beginning of year2021-08-31$4,045,064
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-08-31Yes
Was there a failure to transmit to the plan any participant contributions2021-08-31No
Has the plan failed to provide any benefit when due under the plan2021-08-31No
Contributions received in cash from employer2021-08-31$34,382,464
Employer contributions (assets) at end of year2021-08-31$1,057,796
Employer contributions (assets) at beginning of year2021-08-31$1,976,494
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-08-31$29,865,685
Asset. Corporate debt instrument debt (other) at end of year2021-08-31$20,461,426
Asset. Corporate debt instrument debt (other) at beginning of year2021-08-31$18,254,273
Liabilities. Value of benefit claims payable at end of year2021-08-31$5,478,641
Liabilities. Value of benefit claims payable at beginning of year2021-08-31$4,752,068
Did the plan have assets held for investment2021-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-08-31Yes
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-08-31No
Aggregate proceeds on sale of assets2021-08-31$41,739,366
Aggregate carrying amount (costs) on sale of assets2021-08-31$41,856,112
Opinion of an independent qualified public accountant for this plan2021-08-31Unqualified
Accountancy firm name2021-08-31NOVAK FRANCELLA, LLC
Accountancy firm EIN2021-08-31611436956
2020 : TEAMSTERS LOCAL 830 WELFARE PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-08-31$263,735
Total unrealized appreciation/depreciation of assets2020-08-31$263,735
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-08-31$4,973,380
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-08-31$5,199,267
Total income from all sources (including contributions)2020-08-31$37,691,708
Total loss/gain on sale of assets2020-08-31$-1,855
Total of all expenses incurred2020-08-31$32,594,104
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-08-31$31,642,021
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-08-31$36,360,368
Value of total assets at end of year2020-08-31$39,799,332
Value of total assets at beginning of year2020-08-31$34,927,615
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-08-31$952,083
Total interest from all sources2020-08-31$1,069,460
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-08-31No
Administrative expenses professional fees incurred2020-08-31$170,863
Was this plan covered by a fidelity bond2020-08-31Yes
Value of fidelity bond cover2020-08-31$500,000
Were there any nonexempt tranactions with any party-in-interest2020-08-31No
Contributions received from participants2020-08-31$615,261
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-08-31$372,461
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-08-31$1,073,184
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-08-31$519,249
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-08-31$131,797
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-08-31$508,906
Administrative expenses (other) incurred2020-08-31$675,912
Liabilities. Value of operating payables at end of year2020-08-31$89,515
Liabilities. Value of operating payables at beginning of year2020-08-31$97,998
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-08-31No
Value of net income/loss2020-08-31$5,097,604
Value of net assets at end of year (total assets less liabilities)2020-08-31$34,825,952
Value of net assets at beginning of year (total assets less liabilities)2020-08-31$29,728,348
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-08-31No
Were any leases to which the plan was party in default or uncollectible2020-08-31No
Assets. partnership/joint venture interests at end of year2020-08-31$4,194,698
Assets. partnership/joint venture interests at beginning of year2020-08-31$2,041,267
Investment advisory and management fees2020-08-31$105,308
Interest earned on other investments2020-08-31$193,448
Income. Interest from US Government securities2020-08-31$76,342
Income. Interest from corporate debt instruments2020-08-31$764,576
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-08-31$10,255,619
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-08-31$8,307,248
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-08-31$8,307,248
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-08-31$35,094
Expenses. Payments to insurance carriers foe the provision of benefits2020-08-31$1,483,117
Asset value of US Government securities at end of year2020-08-31$4,045,064
Asset value of US Government securities at beginning of year2020-08-31$6,350,572
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-08-31Yes
Was there a failure to transmit to the plan any participant contributions2020-08-31No
Has the plan failed to provide any benefit when due under the plan2020-08-31No
Contributions received in cash from employer2020-08-31$35,745,107
Employer contributions (assets) at end of year2020-08-31$1,976,494
Employer contributions (assets) at beginning of year2020-08-31$1,709,220
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-08-31$29,786,443
Asset. Corporate debt instrument debt (other) at end of year2020-08-31$18,254,273
Asset. Corporate debt instrument debt (other) at beginning of year2020-08-31$15,636,059
Liabilities. Value of benefit claims payable at end of year2020-08-31$4,752,068
Liabilities. Value of benefit claims payable at beginning of year2020-08-31$4,592,363
Assets. Value of buildings and other operty used in plan operation at beginning of year2020-08-31$364,000
Did the plan have assets held for investment2020-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-08-31Yes
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-08-31No
Aggregate proceeds on sale of assets2020-08-31$30,530,698
Aggregate carrying amount (costs) on sale of assets2020-08-31$30,532,553
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-08-31No
Opinion of an independent qualified public accountant for this plan2020-08-31Unqualified
Accountancy firm name2020-08-31NOVAK FRANCELLA, LLC
Accountancy firm EIN2020-08-31611436956
2019 : TEAMSTERS LOCAL 830 WELFARE PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-08-31$390,019
Total unrealized appreciation/depreciation of assets2019-08-31$390,019
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-08-31$5,199,267
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-08-31$2,531,107
Total income from all sources (including contributions)2019-08-31$38,141,556
Total loss/gain on sale of assets2019-08-31$46,375
Total of all expenses incurred2019-08-31$33,609,521
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-08-31$32,688,217
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-08-31$37,069,063
Value of total assets at end of year2019-08-31$34,927,615
Value of total assets at beginning of year2019-08-31$27,727,420
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-08-31$921,304
Total interest from all sources2019-08-31$524,135
Total dividends received (eg from common stock, registered investment company shares)2019-08-31$120,694
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-08-31No
Total dividends received from registered investment company shares (eg mutual funds)2019-08-31$120,694
Administrative expenses professional fees incurred2019-08-31$158,602
Was this plan covered by a fidelity bond2019-08-31Yes
Value of fidelity bond cover2019-08-31$500,000
If this is an individual account plan, was there a blackout period2019-08-31No
Were there any nonexempt tranactions with any party-in-interest2019-08-31No
Contributions received from participants2019-08-31$560,900
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-08-31$331,029
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-08-31$519,249
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-08-31$171,378
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-08-31$508,906
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-08-31$127,800
Administrative expenses (other) incurred2019-08-31$706,826
Liabilities. Value of operating payables at end of year2019-08-31$97,998
Liabilities. Value of operating payables at beginning of year2019-08-31$37,307
Total non interest bearing cash at beginning of year2019-08-31$20,694,980
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-08-31No
Value of net income/loss2019-08-31$4,532,035
Value of net assets at end of year (total assets less liabilities)2019-08-31$29,728,348
Value of net assets at beginning of year (total assets less liabilities)2019-08-31$25,196,313
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-08-31No
Were any leases to which the plan was party in default or uncollectible2019-08-31No
Assets. partnership/joint venture interests at end of year2019-08-31$2,041,267
Investment advisory and management fees2019-08-31$55,876
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-08-31$4,408,298
Interest earned on other investments2019-08-31$505
Income. Interest from US Government securities2019-08-31$66,888
Income. Interest from corporate debt instruments2019-08-31$295,896
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-08-31$8,307,248
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-08-31$160,846
Expenses. Payments to insurance carriers foe the provision of benefits2019-08-31$1,237,996
Asset value of US Government securities at end of year2019-08-31$6,350,572
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-08-31$-8,730
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-08-31Yes
Was there a failure to transmit to the plan any participant contributions2019-08-31No
Has the plan failed to provide any benefit when due under the plan2019-08-31No
Contributions received in cash from employer2019-08-31$36,508,163
Employer contributions (assets) at end of year2019-08-31$1,709,220
Employer contributions (assets) at beginning of year2019-08-31$2,452,764
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-08-31$31,119,192
Asset. Corporate debt instrument debt (other) at end of year2019-08-31$15,636,059
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-08-31No
Liabilities. Value of benefit claims payable at end of year2019-08-31$4,592,363
Liabilities. Value of benefit claims payable at beginning of year2019-08-31$2,366,000
Assets. Value of buildings and other operty used in plan operation at end of year2019-08-31$364,000
Did the plan have assets held for investment2019-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-08-31No
Aggregate proceeds on sale of assets2019-08-31$35,305,369
Aggregate carrying amount (costs) on sale of assets2019-08-31$35,258,994
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-08-31No
Opinion of an independent qualified public accountant for this plan2019-08-31Unqualified
Accountancy firm name2019-08-31NOVAK FRANCELLA LLC
Accountancy firm EIN2019-08-31611436956
2018 : TEAMSTERS LOCAL 830 WELFARE PLAN 2018 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-08-31$2,531,107
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-08-31$2,573,346
Total income from all sources (including contributions)2018-08-31$33,426,996
Total of all expenses incurred2018-08-31$28,367,640
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-08-31$27,551,960
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-08-31$33,346,242
Value of total assets at end of year2018-08-31$27,727,420
Value of total assets at beginning of year2018-08-31$22,710,303
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-08-31$815,680
Total interest from all sources2018-08-31$29,768
Total dividends received (eg from common stock, registered investment company shares)2018-08-31$50,986
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-08-31No
Total dividends received from registered investment company shares (eg mutual funds)2018-08-31$50,986
Administrative expenses professional fees incurred2018-08-31$167,512
Was this plan covered by a fidelity bond2018-08-31Yes
Value of fidelity bond cover2018-08-31$500,000
If this is an individual account plan, was there a blackout period2018-08-31No
Were there any nonexempt tranactions with any party-in-interest2018-08-31No
Contributions received from participants2018-08-31$412,522
Income. Received or receivable in cash from other sources (including rollovers)2018-08-31$120,957
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-08-31$171,378
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-08-31$159,655
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-08-31$127,800
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-08-31$120,297
Administrative expenses (other) incurred2018-08-31$648,168
Liabilities. Value of operating payables at end of year2018-08-31$37,307
Liabilities. Value of operating payables at beginning of year2018-08-31$37,049
Total non interest bearing cash at end of year2018-08-31$20,694,980
Total non interest bearing cash at beginning of year2018-08-31$15,473,634
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-08-31No
Value of net income/loss2018-08-31$5,059,356
Value of net assets at end of year (total assets less liabilities)2018-08-31$25,196,313
Value of net assets at beginning of year (total assets less liabilities)2018-08-31$20,136,957
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-08-31No
Were any leases to which the plan was party in default or uncollectible2018-08-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-08-31$4,408,298
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-08-31$4,357,312
Value of interest in common/collective trusts at end of year2018-08-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-08-31$29,768
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-08-31No
Was there a failure to transmit to the plan any participant contributions2018-08-31No
Has the plan failed to provide any benefit when due under the plan2018-08-31No
Contributions received in cash from employer2018-08-31$32,812,763
Employer contributions (assets) at end of year2018-08-31$2,452,764
Employer contributions (assets) at beginning of year2018-08-31$2,719,702
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-08-31$27,551,960
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-08-31No
Liabilities. Value of benefit claims payable at end of year2018-08-31$2,366,000
Liabilities. Value of benefit claims payable at beginning of year2018-08-31$2,416,000
Did the plan have assets held for investment2018-08-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-08-31No
Opinion of an independent qualified public accountant for this plan2018-08-31Unqualified
Accountancy firm name2018-08-31E. TEN BROECK LLC
Accountancy firm EIN2018-08-31202017396
2017 : TEAMSTERS LOCAL 830 WELFARE PLAN 2017 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-08-31$2,573,346
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-08-31$2,530,598
Total income from all sources (including contributions)2017-08-31$31,436,239
Total of all expenses incurred2017-08-31$29,020,802
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-08-31$28,260,691
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-08-31$31,134,334
Value of total assets at end of year2017-08-31$22,710,303
Value of total assets at beginning of year2017-08-31$20,252,118
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-08-31$760,111
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-08-31No
Administrative expenses professional fees incurred2017-08-31$155,609
Was this plan covered by a fidelity bond2017-08-31Yes
Value of fidelity bond cover2017-08-31$500,000
If this is an individual account plan, was there a blackout period2017-08-31No
Were there any nonexempt tranactions with any party-in-interest2017-08-31No
Contributions received from participants2017-08-31$379,678
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-08-31$159,655
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-08-31$181,762
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-08-31$120,297
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-08-31$120,071
Other income not declared elsewhere2017-08-31$29,599
Administrative expenses (other) incurred2017-08-31$604,502
Liabilities. Value of operating payables at end of year2017-08-31$37,049
Liabilities. Value of operating payables at beginning of year2017-08-31$71,527
Total non interest bearing cash at end of year2017-08-31$15,473,634
Total non interest bearing cash at beginning of year2017-08-31$14,293,536
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-08-31No
Value of net income/loss2017-08-31$2,415,437
Value of net assets at end of year (total assets less liabilities)2017-08-31$20,136,957
Value of net assets at beginning of year (total assets less liabilities)2017-08-31$17,721,520
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-08-31No
Were any leases to which the plan was party in default or uncollectible2017-08-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-08-31$4,357,312
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-08-31$4,085,006
Value of interest in common/collective trusts at end of year2017-08-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-08-31$272,306
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-08-31Yes
Was there a failure to transmit to the plan any participant contributions2017-08-31No
Has the plan failed to provide any benefit when due under the plan2017-08-31No
Contributions received in cash from employer2017-08-31$30,754,656
Employer contributions (assets) at end of year2017-08-31$2,719,702
Employer contributions (assets) at beginning of year2017-08-31$1,691,814
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-08-31$28,260,691
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-08-31No
Liabilities. Value of benefit claims payable at end of year2017-08-31$2,416,000
Liabilities. Value of benefit claims payable at beginning of year2017-08-31$2,339,000
Did the plan have assets held for investment2017-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-08-31No
Opinion of an independent qualified public accountant for this plan2017-08-31Unqualified
Accountancy firm name2017-08-31E. TEN BROECK LLC
Accountancy firm EIN2017-08-31202017396
2016 : TEAMSTERS LOCAL 830 WELFARE PLAN 2016 401k financial data
Total plan liabilities at end of year2016-08-31$2,530,598
Total plan liabilities at beginning of year2016-08-31$2,093,403
Total income from all sources2016-08-31$31,593,364
Expenses. Total of all expenses incurred2016-08-31$28,754,136
Benefits paid (including direct rollovers)2016-08-31$27,941,642
Total plan assets at end of year2016-08-31$20,252,118
Total plan assets at beginning of year2016-08-31$16,975,695
Value of fidelity bond covering the plan2016-08-31$500,000
Total contributions received or receivable from participants2016-08-31$314,949
Expenses. Other expenses not covered elsewhere2016-08-31$812,494
Other income received2016-08-31$250,598
Net income (gross income less expenses)2016-08-31$2,839,228
Net plan assets at end of year (total assets less liabilities)2016-08-31$17,721,520
Net plan assets at beginning of year (total assets less liabilities)2016-08-31$14,882,292
Total contributions received or receivable from employer(s)2016-08-31$31,027,817
2015 : TEAMSTERS LOCAL 830 WELFARE PLAN 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-08-31$2,093,403
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-08-31$966,351
Total income from all sources (including contributions)2015-08-31$28,722,190
Total of all expenses incurred2015-08-31$23,219,292
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-08-31$22,394,507
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-08-31$28,737,091
Value of total assets at end of year2015-08-31$16,975,695
Value of total assets at beginning of year2015-08-31$10,345,745
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-08-31$824,785
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-08-31No
Administrative expenses professional fees incurred2015-08-31$191,156
Was this plan covered by a fidelity bond2015-08-31Yes
Value of fidelity bond cover2015-08-31$500,000
If this is an individual account plan, was there a blackout period2015-08-31No
Were there any nonexempt tranactions with any party-in-interest2015-08-31No
Contributions received from participants2015-08-31$296,148
Income. Received or receivable in cash from other sources (including rollovers)2015-08-31$57,482
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-08-31$326,629
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-08-31$199,904
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-08-31$201,976
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-08-31$287,595
Administrative expenses (other) incurred2015-08-31$633,629
Liabilities. Value of operating payables at end of year2015-08-31$72,727
Liabilities. Value of operating payables at beginning of year2015-08-31$72,145
Total non interest bearing cash at end of year2015-08-31$11,238,589
Total non interest bearing cash at beginning of year2015-08-31$6,747,642
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-08-31No
Value of net income/loss2015-08-31$5,502,898
Value of net assets at end of year (total assets less liabilities)2015-08-31$14,882,292
Value of net assets at beginning of year (total assets less liabilities)2015-08-31$9,379,394
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-08-31No
Were any leases to which the plan was party in default or uncollectible2015-08-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-08-31$4,018,643
Value of interest in common/collective trusts at end of year2015-08-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-08-31$1,833,544
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-08-31$1,833,544
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-08-31$-14,901
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-08-31No
Was there a failure to transmit to the plan any participant contributions2015-08-31No
Has the plan failed to provide any benefit when due under the plan2015-08-31No
Contributions received in cash from employer2015-08-31$28,383,461
Employer contributions (assets) at end of year2015-08-31$1,391,834
Employer contributions (assets) at beginning of year2015-08-31$1,564,655
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-08-31$22,394,507
Liabilities. Value of benefit claims payable at end of year2015-08-31$1,818,700
Liabilities. Value of benefit claims payable at beginning of year2015-08-31$606,611
Did the plan have assets held for investment2015-08-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-08-31No
Opinion of an independent qualified public accountant for this plan2015-08-31Unqualified
Accountancy firm name2015-08-31E. TEN BROECK LLC
Accountancy firm EIN2015-08-31202017396
2014 : TEAMSTERS LOCAL 830 WELFARE PLAN 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-08-31$969,351
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-08-31$1,083,063
Total income from all sources (including contributions)2014-08-31$26,505,459
Total of all expenses incurred2014-08-31$21,967,029
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-08-31$21,166,564
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-08-31$26,230,029
Value of total assets at end of year2014-08-31$10,355,745
Value of total assets at beginning of year2014-08-31$5,931,027
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-08-31$800,465
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-08-31No
Was this plan covered by a fidelity bond2014-08-31Yes
Value of fidelity bond cover2014-08-31$500,000
If this is an individual account plan, was there a blackout period2014-08-31No
Were there any nonexempt tranactions with any party-in-interest2014-08-31No
Contributions received from participants2014-08-31$196,621
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-08-31$200,291
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-08-31$19,060
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-08-31$290,595
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-08-31$404,918
Other income not declared elsewhere2014-08-31$219,654
Administrative expenses (other) incurred2014-08-31$800,465
Liabilities. Value of operating payables at end of year2014-08-31$72,145
Liabilities. Value of operating payables at beginning of year2014-08-31$72,145
Total non interest bearing cash at end of year2014-08-31$6,757,642
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-08-31No
Value of net income/loss2014-08-31$4,538,430
Value of net assets at end of year (total assets less liabilities)2014-08-31$9,386,394
Value of net assets at beginning of year (total assets less liabilities)2014-08-31$4,847,964
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-08-31No
Were any leases to which the plan was party in default or uncollectible2014-08-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-08-31$1,833,157
Value of interest in common/collective trusts at end of year2014-08-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-08-31$4,726,180
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-08-31$4,726,180
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-08-31$55,776
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-08-31No
Was there a failure to transmit to the plan any participant contributions2014-08-31No
Has the plan failed to provide any benefit when due under the plan2014-08-31No
Contributions received in cash from employer2014-08-31$26,033,408
Employer contributions (assets) at end of year2014-08-31$1,564,655
Employer contributions (assets) at beginning of year2014-08-31$1,185,787
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-08-31$21,166,564
Liabilities. Value of benefit claims payable at end of year2014-08-31$606,611
Liabilities. Value of benefit claims payable at beginning of year2014-08-31$606,000
Did the plan have assets held for investment2014-08-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-08-31No
Opinion of an independent qualified public accountant for this plan2014-08-31Unqualified
Accountancy firm name2014-08-31E. TEN BROECK LLC
Accountancy firm EIN2014-08-31202017396
2013 : TEAMSTERS LOCAL 830 WELFARE PLAN 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-08-31$1,083,063
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-08-31$720,896
Total income from all sources (including contributions)2013-08-31$26,545,430
Total of all expenses incurred2013-08-31$26,196,525
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-08-31$25,416,276
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-08-31$26,477,505
Value of total assets at end of year2013-08-31$5,931,027
Value of total assets at beginning of year2013-08-31$5,219,955
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-08-31$780,249
Total interest from all sources2013-08-31$67,925
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-08-31No
Was this plan covered by a fidelity bond2013-08-31Yes
Value of fidelity bond cover2013-08-31$500,000
Were there any nonexempt tranactions with any party-in-interest2013-08-31No
Contributions received from participants2013-08-31$85,944
Income. Received or receivable in cash from other sources (including rollovers)2013-08-31$130,450
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-08-31$1,292,716
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-08-31$19,060
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-08-31$13,473
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-08-31$404,918
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-08-31$55,085
Administrative expenses (other) incurred2013-08-31$780,249
Liabilities. Value of operating payables at end of year2013-08-31$72,145
Liabilities. Value of operating payables at beginning of year2013-08-31$55,111
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-08-31No
Value of net income/loss2013-08-31$348,905
Value of net assets at end of year (total assets less liabilities)2013-08-31$4,847,964
Value of net assets at beginning of year (total assets less liabilities)2013-08-31$4,499,059
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-08-31No
Were any leases to which the plan was party in default or uncollectible2013-08-31No
Value of interest in common/collective trusts at end of year2013-08-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-08-31$4,726,180
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-08-31$3,698,242
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-08-31$3,698,242
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-08-31$67,925
Expenses. Payments to insurance carriers foe the provision of benefits2013-08-31$19,324,902
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-08-31No
Was there a failure to transmit to the plan any participant contributions2013-08-31No
Has the plan failed to provide any benefit when due under the plan2013-08-31No
Contributions received in cash from employer2013-08-31$26,261,111
Employer contributions (assets) at end of year2013-08-31$1,185,787
Employer contributions (assets) at beginning of year2013-08-31$1,508,240
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-08-31$4,798,658
Liabilities. Value of benefit claims payable at end of year2013-08-31$606,000
Liabilities. Value of benefit claims payable at beginning of year2013-08-31$610,700
Did the plan have assets held for investment2013-08-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-08-31No
Opinion of an independent qualified public accountant for this plan2013-08-31Unqualified
Accountancy firm name2013-08-31E. TEN BROECK LLC
Accountancy firm EIN2013-08-31202017396
2012 : TEAMSTERS LOCAL 830 WELFARE PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-08-31$37,156
Total unrealized appreciation/depreciation of assets2012-08-31$37,156
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-08-31$720,896
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-08-31$705,997
Total income from all sources (including contributions)2012-08-31$25,255,015
Total of all expenses incurred2012-08-31$24,774,789
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-08-31$23,991,689
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-08-31$25,175,553
Value of total assets at end of year2012-08-31$5,219,955
Value of total assets at beginning of year2012-08-31$4,724,830
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-08-31$783,100
Total interest from all sources2012-08-31$42,306
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-08-31No
Was this plan covered by a fidelity bond2012-08-31Yes
Value of fidelity bond cover2012-08-31$500,000
Were there any nonexempt tranactions with any party-in-interest2012-08-31No
Income. Received or receivable in cash from other sources (including rollovers)2012-08-31$122,572
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-08-31$13,473
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-08-31$17,820
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-08-31$55,085
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-08-31$66,002
Administrative expenses (other) incurred2012-08-31$783,100
Liabilities. Value of operating payables at end of year2012-08-31$55,111
Liabilities. Value of operating payables at beginning of year2012-08-31$55,085
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-08-31No
Value of net income/loss2012-08-31$480,226
Value of net assets at end of year (total assets less liabilities)2012-08-31$4,499,059
Value of net assets at beginning of year (total assets less liabilities)2012-08-31$4,018,833
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-08-31No
Were any leases to which the plan was party in default or uncollectible2012-08-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-08-31$3,698,242
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-08-31$3,368,822
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-08-31$3,368,822
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-08-31$42,306
Expenses. Payments to insurance carriers foe the provision of benefits2012-08-31$17,555,735
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-08-31No
Was there a failure to transmit to the plan any participant contributions2012-08-31No
Has the plan failed to provide any benefit when due under the plan2012-08-31No
Contributions received in cash from employer2012-08-31$25,052,981
Employer contributions (assets) at end of year2012-08-31$1,508,240
Employer contributions (assets) at beginning of year2012-08-31$1,338,188
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-08-31$6,435,954
Liabilities. Value of benefit claims payable at end of year2012-08-31$610,700
Liabilities. Value of benefit claims payable at beginning of year2012-08-31$584,910
Did the plan have assets held for investment2012-08-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-08-31No
Opinion of an independent qualified public accountant for this plan2012-08-31Unqualified
Accountancy firm name2012-08-31E. TEN BROECK LLC
Accountancy firm EIN2012-08-31202017396
2011 : TEAMSTERS LOCAL 830 WELFARE PLAN 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-08-31$705,997
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-08-31$669,018
Total income from all sources (including contributions)2011-08-31$23,889,353
Total of all expenses incurred2011-08-31$24,306,502
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-08-31$23,524,174
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-08-31$23,855,142
Value of total assets at end of year2011-08-31$4,724,830
Value of total assets at beginning of year2011-08-31$5,105,000
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-08-31$782,328
Total interest from all sources2011-08-31$17,297
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-08-31No
Administrative expenses professional fees incurred2011-08-31$150,616
Was this plan covered by a fidelity bond2011-08-31Yes
Value of fidelity bond cover2011-08-31$500,000
Were there any nonexempt tranactions with any party-in-interest2011-08-31No
Contributions received from participants2011-08-31$475,814
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-08-31$17,820
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-08-31$42,298
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-08-31$66,002
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-08-31$52,113
Other income not declared elsewhere2011-08-31$16,914
Administrative expenses (other) incurred2011-08-31$631,712
Liabilities. Value of operating payables at end of year2011-08-31$55,085
Liabilities. Value of operating payables at beginning of year2011-08-31$57,205
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-08-31No
Value of net income/loss2011-08-31$-417,149
Value of net assets at end of year (total assets less liabilities)2011-08-31$4,018,833
Value of net assets at beginning of year (total assets less liabilities)2011-08-31$4,435,982
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-08-31No
Were any leases to which the plan was party in default or uncollectible2011-08-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-08-31$3,368,822
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-08-31$4,396,560
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-08-31$4,396,560
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-08-31$17,297
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-08-31No
Was there a failure to transmit to the plan any participant contributions2011-08-31No
Has the plan failed to provide any benefit when due under the plan2011-08-31No
Contributions received in cash from employer2011-08-31$23,379,328
Employer contributions (assets) at end of year2011-08-31$1,338,188
Employer contributions (assets) at beginning of year2011-08-31$666,142
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-08-31$23,524,174
Liabilities. Value of benefit claims payable at end of year2011-08-31$584,910
Liabilities. Value of benefit claims payable at beginning of year2011-08-31$559,700
Did the plan have assets held for investment2011-08-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-08-31No
Opinion of an independent qualified public accountant for this plan2011-08-31Unqualified
Accountancy firm name2011-08-31E. TEN BROECK LLC
Accountancy firm EIN2011-08-31202017396

Form 5500 Responses for TEAMSTERS LOCAL 830 WELFARE PLAN

2022: TEAMSTERS LOCAL 830 WELFARE PLAN 2022 form 5500 responses
2022-09-01Type of plan entityMulti-employer plan
2022-09-01Plan is a collectively bargained planYes
2022-09-01Plan funding arrangement – TrustYes
2022-09-01Plan benefit arrangement – InsuranceYes
2022-09-01Plan benefit arrangement - TrustYes
2021: TEAMSTERS LOCAL 830 WELFARE PLAN 2021 form 5500 responses
2021-09-01Type of plan entityMulti-employer plan
2021-09-01Plan is a collectively bargained planYes
2021-09-01Plan funding arrangement – TrustYes
2021-09-01Plan benefit arrangement – InsuranceYes
2021-09-01Plan benefit arrangement - TrustYes
2020: TEAMSTERS LOCAL 830 WELFARE PLAN 2020 form 5500 responses
2020-09-01Type of plan entityMulti-employer plan
2020-09-01Plan is a collectively bargained planYes
2020-09-01Plan funding arrangement – TrustYes
2020-09-01Plan benefit arrangement – InsuranceYes
2020-09-01Plan benefit arrangement - TrustYes
2019: TEAMSTERS LOCAL 830 WELFARE PLAN 2019 form 5500 responses
2019-09-01Type of plan entityMulti-employer plan
2019-09-01Plan is a collectively bargained planYes
2019-09-01Plan funding arrangement – TrustYes
2019-09-01Plan benefit arrangement – InsuranceYes
2019-09-01Plan benefit arrangement - TrustYes
2018: TEAMSTERS LOCAL 830 WELFARE PLAN 2018 form 5500 responses
2018-09-01Type of plan entityMulti-employer plan
2018-09-01Plan is a collectively bargained planYes
2018-09-01Plan funding arrangement – TrustYes
2018-09-01Plan benefit arrangement – InsuranceYes
2018-09-01Plan benefit arrangement - TrustYes
2017: TEAMSTERS LOCAL 830 WELFARE PLAN 2017 form 5500 responses
2017-09-01Type of plan entityMulti-employer plan
2017-09-01Plan is a collectively bargained planYes
2017-09-01Plan funding arrangement – TrustYes
2017-09-01Plan benefit arrangement – InsuranceYes
2017-09-01Plan benefit arrangement - TrustYes
2016: TEAMSTERS LOCAL 830 WELFARE PLAN 2016 form 5500 responses
2016-09-01Type of plan entityMulti-employer plan
2016-09-01Plan is a collectively bargained planYes
2016-09-01Plan funding arrangement – TrustYes
2016-09-01Plan benefit arrangement – InsuranceYes
2016-09-01Plan benefit arrangement - TrustYes
2015: TEAMSTERS LOCAL 830 WELFARE PLAN 2015 form 5500 responses
2015-09-01Type of plan entityMulti-employer plan
2015-09-01Plan is a collectively bargained planYes
2015-09-01Plan funding arrangement – TrustYes
2015-09-01Plan benefit arrangement – InsuranceYes
2015-09-01Plan benefit arrangement - TrustYes
2014: TEAMSTERS LOCAL 830 WELFARE PLAN 2014 form 5500 responses
2014-09-01Type of plan entityMulti-employer plan
2014-09-01Plan is a collectively bargained planYes
2014-09-01Plan funding arrangement – TrustYes
2014-09-01Plan benefit arrangement – InsuranceYes
2014-09-01Plan benefit arrangement - TrustYes
2013: TEAMSTERS LOCAL 830 WELFARE PLAN 2013 form 5500 responses
2013-09-01Type of plan entityMulti-employer plan
2013-09-01Plan is a collectively bargained planYes
2013-09-01Plan funding arrangement – TrustYes
2013-09-01Plan benefit arrangement – InsuranceYes
2013-09-01Plan benefit arrangement - TrustYes
2012: TEAMSTERS LOCAL 830 WELFARE PLAN 2012 form 5500 responses
2012-09-01Type of plan entityMulti-employer plan
2012-09-01Plan is a collectively bargained planYes
2012-09-01Plan funding arrangement – TrustYes
2012-09-01Plan benefit arrangement – InsuranceYes
2012-09-01Plan benefit arrangement - TrustYes
2011: TEAMSTERS LOCAL 830 WELFARE PLAN 2011 form 5500 responses
2011-09-01Type of plan entityMulti-employer plan
2011-09-01Plan is a collectively bargained planYes
2011-09-01Plan funding arrangement – TrustYes
2011-09-01Plan benefit arrangement – InsuranceYes
2011-09-01Plan benefit arrangement - TrustYes
2010: TEAMSTERS LOCAL 830 WELFARE PLAN 2010 form 5500 responses
2010-09-01Type of plan entityMulti-employer plan
2010-09-01Submission has been amendedYes
2010-09-01Plan is a collectively bargained planYes
2010-09-01Plan funding arrangement – TrustYes
2010-09-01Plan benefit arrangement – InsuranceYes
2010-09-01Plan benefit arrangement - TrustYes
2009: TEAMSTERS LOCAL 830 WELFARE PLAN 2009 form 5500 responses
2009-09-01Type of plan entityMulti-employer plan
2009-09-01Plan is a collectively bargained planYes
2009-09-01Plan funding arrangement – TrustYes
2009-09-01Plan benefit arrangement – InsuranceYes
2009-09-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number404829-0010SSLS
Policy instance 3
Insurance contract or identification number404829-0010SSLS
Number of Individuals Covered1970
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $26,084
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $869,451
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $26,084
Insurance broker organization code?3
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number856683-000/099
Policy instance 2
Insurance contract or identification number856683-000/099
Number of Individuals Covered35
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5343805/806
Policy instance 1
Insurance contract or identification number5343805/806
Number of Individuals Covered1786
Insurance policy start date2022-09-01
Insurance policy end date2023-08-31
Total amount of commissions paid to insurance brokerUSD $56,708
Total amount of fees paid to insurance companyUSD $25
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $807,414
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $56,708
Amount paid for insurance broker fees25
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5343805/806
Policy instance 1
Insurance contract or identification number5343805/806
Number of Individuals Covered1786
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $67,074
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $740,705
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $67,074
Insurance broker organization code?3
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number856683-000/099
Policy instance 2
Insurance contract or identification number856683-000/099
Number of Individuals Covered46
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,009
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number404829-0010SSLS
Policy instance 3
Insurance contract or identification number404829-0010SSLS
Number of Individuals Covered1953
Insurance policy start date2021-09-01
Insurance policy end date2022-08-31
Total amount of commissions paid to insurance brokerUSD $19,966
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $723,366
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $19,966
Insurance broker organization code?3
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number856683-000/099
Policy instance 2
Insurance contract or identification number856683-000/099
Number of Individuals Covered37
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $7,020
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number5343805
Policy instance 1
Insurance contract or identification number5343805
Number of Individuals Covered1750
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $68,679
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $779,103
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $68,679
Insurance broker organization code?3
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number404829-0010SSLS
Policy instance 3
Insurance contract or identification number404829-0010SSLS
Number of Individuals Covered1994
Insurance policy start date2020-09-01
Insurance policy end date2021-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $720,724
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05343805
Policy instance 1
Insurance contract or identification numberTS05343805
Number of Individuals Covered1866
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $51,527
Total amount of fees paid to insurance companyUSD $0
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $780,687
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $51,527
Insurance broker organization code?3
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number856683-009
Policy instance 2
Insurance contract or identification number856683-009
Number of Individuals Covered52
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 )
Policy contract number404829-0010SSLS
Policy instance 3
Insurance contract or identification number404829-0010SSLS
Number of Individuals Covered2070
Insurance policy start date2019-09-01
Insurance policy end date2020-08-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $730,849
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )
Policy contract number159858
Policy instance 2
Insurance contract or identification number159858
Number of Individuals Covered545
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $74,899
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number159858
Policy instance 3
Insurance contract or identification number159858
Number of Individuals Covered4267
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $626,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number856683-009
Policy instance 4
Insurance contract or identification number856683-009
Number of Individuals Covered52
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $8,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05343805
Policy instance 1
Insurance contract or identification numberTS05343805
Number of Individuals Covered1895
Insurance policy start date2018-09-01
Insurance policy end date2019-08-31
Total amount of commissions paid to insurance brokerUSD $51,135
Total amount of fees paid to insurance companyUSD $10
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedAD & D
Welfare Benefit Premiums Paid to CarrierUSD $576,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $30,954
Insurance broker organization code?3
Amount paid for insurance broker fees10
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )
Policy contract number33810
Policy instance 1
Insurance contract or identification number33810
Number of Individuals Covered402
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )
Policy contract number
Policy instance 2
Number of Individuals Covered125
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number
Policy instance 3
Number of Individuals Covered98
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $111,214
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 )
Policy contract number856683
Policy instance 6
Insurance contract or identification number856683
Number of Individuals Covered52
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $10,079
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number33810
Policy instance 5
Insurance contract or identification number33810
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract numberTS05343805
Policy instance 4
Insurance contract or identification numberTS05343805
Number of Individuals Covered1966
Total amount of commissions paid to insurance brokerUSD $67,081
Total amount of fees paid to insurance companyUSD $85
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Other welfare benefits providedACCIDENTAL DEATH AND DISABILITY
Welfare Benefit Premiums Paid to CarrierUSD $725,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 2
Insurance contract or identification numberG000337J
Number of Individuals Covered45
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $1,852
Total amount of fees paid to insurance companyUSD $1,295
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $18,517
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $1,852
Amount paid for insurance broker fees1295
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMERSON REID LLC
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number33810
Policy instance 8
Insurance contract or identification number33810
Number of Individuals Covered4254
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4169991
Policy instance 7
Insurance contract or identification numberE4169991
Number of Individuals Covered1678
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $441
Total amount of fees paid to insurance companyUSD $175
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $407
Amount paid for insurance broker fees130
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?4
Insurance broker nameFRANKLIN BENEFIT CONSULTING
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 6
Insurance contract or identification numberG000337J
Number of Individuals Covered116
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $18,933
Total amount of fees paid to insurance companyUSD $10,396
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $126,223
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $18,933
Amount paid for insurance broker fees10396
Insurance broker organization code?3
Insurance broker nameEMERSON REID LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 5
Insurance contract or identification numberG000337J
Number of Individuals Covered1372
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $6,049
Total amount of fees paid to insurance companyUSD $15,813
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $195,133
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $6,049
Amount paid for insurance broker fees15813
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMERSON REID LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 4
Insurance contract or identification numberG000337J
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $11,010
Total amount of fees paid to insurance companyUSD $6,258
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $73,042
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $11,010
Amount paid for insurance broker fees6258
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMERSON REID LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 3
Insurance contract or identification numberG000337J
Number of Individuals Covered1185
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Total amount of commissions paid to insurance brokerUSD $10,619
Total amount of fees paid to insurance companyUSD $29,619
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $424,768
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $10,619
Amount paid for insurance broker fees29619
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMERSON REID LLC
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )
Policy contract number33810
Policy instance 1
Insurance contract or identification number33810
Number of Individuals Covered43
Insurance policy start date2014-09-01
Insurance policy end date2015-08-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number33810
Policy instance 2
Insurance contract or identification number33810
Number of Individuals Covered73
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,831
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
COLONIAL LIFE & ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62049 )
Policy contract numberE4169991
Policy instance 9
Insurance contract or identification numberE4169991
Number of Individuals Covered1678
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $549,098
Total amount of fees paid to insurance companyUSD $65,301
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $291,550
Amount paid for insurance broker fees27068
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?4
Insurance broker nameSHEALY BENEFITS SERVICES INC
AMERIHEALTH HMO, INC. (National Association of Insurance Commissioners NAIC id number: 95044 )
Policy contract number33810
Policy instance 10
Insurance contract or identification number33810
Number of Individuals Covered126
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95109 )
Policy contract number08661130HNO
Policy instance 8
Insurance contract or identification number08661130HNO
Number of Individuals Covered63
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $10,771
Welfare Benefit Premiums Paid to CarrierUSD $223,270
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,771
Insurance broker nameFRANKLIN EMPLOYEE BENEFITS
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 7
Insurance contract or identification numberG000337J
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $11,482
Total amount of fees paid to insurance companyUSD $8,308
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $76,547
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $11,482
Amount paid for insurance broker fees8308
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMERSON REID LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 6
Insurance contract or identification numberG000337J
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $5,939
Total amount of fees paid to insurance companyUSD $22,132
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $191,566
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $5,939
Amount paid for insurance broker fees22132
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMERSON REID LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 5
Insurance contract or identification numberG000337J
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $18,970
Total amount of fees paid to insurance companyUSD $14,486
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $126,471
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $18,970
Amount paid for insurance broker fees14486
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMERSON REID LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 4
Insurance contract or identification numberG000337J
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Total amount of commissions paid to insurance brokerUSD $10,988
Total amount of fees paid to insurance companyUSD $41,823
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $435,533
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $10,988
Amount paid for insurance broker fees41823
Additional information about fees paid to insurance brokerOTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMERSON REID LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 3
Insurance contract or identification numberG000337J
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $19,837
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )
Policy contract number33810
Policy instance 1
Insurance contract or identification number33810
Number of Individuals Covered39
Insurance policy start date2013-09-01
Insurance policy end date2014-08-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KEYSTONE HEALTH PLAN EAST (National Association of Insurance Commissioners NAIC id number: 95056 )
Policy contract number33810
Policy instance 11
Insurance contract or identification number33810
Number of Individuals Covered4113
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 2
Insurance contract or identification numberG000337J
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $440,945
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 5
Insurance contract or identification numberG000337J
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $127,799
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 6
Insurance contract or identification numberG000337J
Number of Individuals Covered52
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,508
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 4
Insurance contract or identification numberG000337J
Number of Individuals Covered115
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $75,428
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 3
Insurance contract or identification numberG000337J
Number of Individuals Covered1415
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Total amount of commissions paid to insurance brokerUSD $49,603
Total amount of fees paid to insurance companyUSD $61,152
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $195,004
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
Commission paid to Insurance BrokerUSD $49,603
Amount paid for insurance broker fees61152
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameEMERSON REID
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract numberUS450497
Policy instance 1
Insurance contract or identification numberUS450497
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $203,146
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number33810
Policy instance 7
Insurance contract or identification number33810
Number of Individuals Covered45
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,519
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )
Policy contract number33810
Policy instance 8
Insurance contract or identification number33810
Number of Individuals Covered4354
Insurance policy start date2012-09-01
Insurance policy end date2013-08-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number
Policy instance 2
Number of Individuals Covered60
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 3
Insurance contract or identification numberG000337J
Number of Individuals Covered1121
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $127,400
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 4
Insurance contract or identification numberG000337J
Number of Individuals Covered1452
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Total amount of commissions paid to insurance brokerUSD $89,567
Total amount of fees paid to insurance companyUSD $43,744
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $208,030
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: 00000 )
Policy contract numberUS450497
Policy instance 1
Insurance contract or identification numberUS450497
Number of Individuals Covered84
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $105,997
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 5
Insurance contract or identification numberG000337J
Number of Individuals Covered115
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $70,605
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 6
Insurance contract or identification numberG000337J
Number of Individuals Covered1355
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $448,801
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )
Policy contract number33810
Policy instance 9
Insurance contract or identification number33810
Number of Individuals Covered4345
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number33810
Policy instance 8
Insurance contract or identification number33810
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $58,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 7
Insurance contract or identification numberG000337J
Number of Individuals Covered54
Insurance policy start date2011-09-01
Insurance policy end date2012-08-31
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,070
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 6
Insurance contract or identification numberG000337J
Number of Individuals Covered130
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 4
Insurance contract or identification numberG000337J
Number of Individuals Covered54
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $20,041
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 93688 )
Policy contract number33810
Policy instance 8
Insurance contract or identification number33810
Number of Individuals Covered4363
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $50,036
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
INDEPENDENCE BLUE CROSS (National Association of Insurance Commissioners NAIC id number: 52411 )
Policy contract number33810
Policy instance 7
Insurance contract or identification number33810
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 1
Insurance contract or identification numberG000337J
Number of Individuals Covered130
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Total amount of fees paid to insurance companyUSD $37,017
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $12,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 2
Insurance contract or identification numberG000337J
Number of Individuals Covered1337
Insurance policy start date2009-09-01
Insurance policy end date2010-08-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $456,601
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 3
Insurance contract or identification numberG000337J
Number of Individuals Covered118
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Life Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000337J
Policy instance 5
Insurance contract or identification numberG000337J
Number of Individuals Covered979
Insurance policy start date2010-09-01
Insurance policy end date2011-08-31
Long Term Disability Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $113,787
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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