CONSOLIDATED BUILDERS BENEFITS TRUST has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN
401k plan membership statisitcs for CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2022 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $124,473 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-06-30 | $155,338 |
| Total income from all sources (including contributions) | 2022-06-30 | $1,550,212 |
| Total of all expenses incurred | 2022-06-30 | $1,566,988 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-06-30 | $1,516,992 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-06-30 | $1,550,212 |
| Value of total assets at end of year | 2022-06-30 | $196,866 |
| Value of total assets at beginning of year | 2022-06-30 | $244,507 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-06-30 | $49,996 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-06-30 | No |
| Administrative expenses professional fees incurred | 2022-06-30 | $21,571 |
| Was this plan covered by a fidelity bond | 2022-06-30 | Yes |
| Value of fidelity bond cover | 2022-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-06-30 | $2,814 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-06-30 | $4,379 |
| Administrative expenses (other) incurred | 2022-06-30 | $10,975 |
| Liabilities. Value of operating payables at end of year | 2022-06-30 | $124,473 |
| Liabilities. Value of operating payables at beginning of year | 2022-06-30 | $155,338 |
| Total non interest bearing cash at end of year | 2022-06-30 | $194,052 |
| Total non interest bearing cash at beginning of year | 2022-06-30 | $240,128 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-06-30 | No |
| Value of net income/loss | 2022-06-30 | $-16,776 |
| Value of net assets at end of year (total assets less liabilities) | 2022-06-30 | $72,393 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-06-30 | $89,169 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-06-30 | $1,516,992 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-06-30 | No |
| Contributions received in cash from employer | 2022-06-30 | $1,550,212 |
| Contract administrator fees | 2022-06-30 | $17,450 |
| Did the plan have assets held for investment | 2022-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-06-30 | Unqualified |
| Accountancy firm name | 2022-06-30 | GROSSMAN YANAK & FORD LLP |
| Accountancy firm EIN | 2022-06-30 | 251638525 |
| 2021 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $155,338 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-06-30 | $171,676 |
| Total income from all sources (including contributions) | 2021-06-30 | $1,788,518 |
| Total of all expenses incurred | 2021-06-30 | $1,802,704 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-06-30 | $1,750,111 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-06-30 | $1,788,518 |
| Value of total assets at end of year | 2021-06-30 | $244,507 |
| Value of total assets at beginning of year | 2021-06-30 | $275,031 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-06-30 | $52,593 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-06-30 | No |
| Administrative expenses professional fees incurred | 2021-06-30 | $21,307 |
| Was this plan covered by a fidelity bond | 2021-06-30 | Yes |
| Value of fidelity bond cover | 2021-06-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-06-30 | $4,379 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-06-30 | $2,144 |
| Administrative expenses (other) incurred | 2021-06-30 | $13,206 |
| Liabilities. Value of operating payables at end of year | 2021-06-30 | $155,338 |
| Liabilities. Value of operating payables at beginning of year | 2021-06-30 | $171,676 |
| Total non interest bearing cash at end of year | 2021-06-30 | $240,128 |
| Total non interest bearing cash at beginning of year | 2021-06-30 | $272,887 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-06-30 | No |
| Value of net income/loss | 2021-06-30 | $-14,186 |
| Value of net assets at end of year (total assets less liabilities) | 2021-06-30 | $89,169 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-06-30 | $103,355 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-06-30 | $1,750,111 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-06-30 | No |
| Contributions received in cash from employer | 2021-06-30 | $1,788,518 |
| Contract administrator fees | 2021-06-30 | $18,080 |
| Did the plan have assets held for investment | 2021-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-06-30 | Unqualified |
| Accountancy firm name | 2021-06-30 | GROSSMAN YANAK AND FORD LLP |
| Accountancy firm EIN | 2021-06-30 | 251638525 |
| 2020 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $171,676 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-06-30 | $206,919 |
| Total income from all sources (including contributions) | 2020-06-30 | $2,091,800 |
| Total of all expenses incurred | 2020-06-30 | $2,101,188 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-06-30 | $2,047,667 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-06-30 | $2,091,800 |
| Value of total assets at end of year | 2020-06-30 | $275,031 |
| Value of total assets at beginning of year | 2020-06-30 | $319,662 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-06-30 | $53,521 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-06-30 | No |
| Administrative expenses professional fees incurred | 2020-06-30 | $21,982 |
| Was this plan covered by a fidelity bond | 2020-06-30 | Yes |
| Value of fidelity bond cover | 2020-06-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2020-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-06-30 | $2,144 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-06-30 | $2,144 |
| Administrative expenses (other) incurred | 2020-06-30 | $11,124 |
| Liabilities. Value of operating payables at end of year | 2020-06-30 | $171,676 |
| Liabilities. Value of operating payables at beginning of year | 2020-06-30 | $206,919 |
| Total non interest bearing cash at end of year | 2020-06-30 | $272,887 |
| Total non interest bearing cash at beginning of year | 2020-06-30 | $317,518 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-06-30 | No |
| Value of net income/loss | 2020-06-30 | $-9,388 |
| Value of net assets at end of year (total assets less liabilities) | 2020-06-30 | $103,355 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-06-30 | $112,743 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-06-30 | $2,047,667 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-06-30 | No |
| Contributions received in cash from employer | 2020-06-30 | $2,091,800 |
| Contract administrator fees | 2020-06-30 | $20,415 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-06-30 | No |
| Did the plan have assets held for investment | 2020-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-06-30 | Unqualified |
| Accountancy firm name | 2020-06-30 | GROSSMAN YANAK AND FORD LLP |
| Accountancy firm EIN | 2020-06-30 | 251638525 |
| 2019 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $206,919 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-06-30 | $179,428 |
| Total income from all sources (including contributions) | 2019-06-30 | $2,164,179 |
| Total of all expenses incurred | 2019-06-30 | $2,166,162 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-06-30 | $2,115,834 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-06-30 | $2,158,679 |
| Value of total assets at end of year | 2019-06-30 | $319,662 |
| Value of total assets at beginning of year | 2019-06-30 | $294,154 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-06-30 | $50,328 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-06-30 | No |
| Administrative expenses professional fees incurred | 2019-06-30 | $20,822 |
| Was this plan covered by a fidelity bond | 2019-06-30 | Yes |
| Value of fidelity bond cover | 2019-06-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-06-30 | $2,144 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-06-30 | $2,189 |
| Other income not declared elsewhere | 2019-06-30 | $5,500 |
| Administrative expenses (other) incurred | 2019-06-30 | $7,646 |
| Liabilities. Value of operating payables at end of year | 2019-06-30 | $206,919 |
| Liabilities. Value of operating payables at beginning of year | 2019-06-30 | $179,428 |
| Total non interest bearing cash at end of year | 2019-06-30 | $317,518 |
| Total non interest bearing cash at beginning of year | 2019-06-30 | $291,965 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-06-30 | No |
| Value of net income/loss | 2019-06-30 | $-1,983 |
| Value of net assets at end of year (total assets less liabilities) | 2019-06-30 | $112,743 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-06-30 | $114,726 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-06-30 | $2,115,834 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-06-30 | No |
| Contributions received in cash from employer | 2019-06-30 | $2,158,679 |
| Contract administrator fees | 2019-06-30 | $21,860 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-06-30 | No |
| Did the plan have assets held for investment | 2019-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-06-30 | Unqualified |
| Accountancy firm name | 2019-06-30 | GROSSMAN YANAK AND FORD LLP |
| Accountancy firm EIN | 2019-06-30 | 251638525 |
| 2018 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $179,428 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-06-30 | $144,305 |
| Total income from all sources (including contributions) | 2018-06-30 | $1,795,910 |
| Total of all expenses incurred | 2018-06-30 | $1,807,355 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-06-30 | $1,756,276 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-06-30 | $1,790,320 |
| Value of total assets at end of year | 2018-06-30 | $294,154 |
| Value of total assets at beginning of year | 2018-06-30 | $270,476 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-06-30 | $51,079 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-06-30 | No |
| Administrative expenses professional fees incurred | 2018-06-30 | $23,832 |
| Was this plan covered by a fidelity bond | 2018-06-30 | Yes |
| Value of fidelity bond cover | 2018-06-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2018-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-06-30 | $2,189 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-06-30 | $2,245 |
| Other income not declared elsewhere | 2018-06-30 | $5,590 |
| Administrative expenses (other) incurred | 2018-06-30 | $7,947 |
| Liabilities. Value of operating payables at end of year | 2018-06-30 | $179,428 |
| Liabilities. Value of operating payables at beginning of year | 2018-06-30 | $144,305 |
| Total non interest bearing cash at end of year | 2018-06-30 | $291,965 |
| Total non interest bearing cash at beginning of year | 2018-06-30 | $268,231 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Value of net income/loss | 2018-06-30 | $-11,445 |
| Value of net assets at end of year (total assets less liabilities) | 2018-06-30 | $114,726 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-06-30 | $126,171 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-06-30 | $1,756,276 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-06-30 | No |
| Contributions received in cash from employer | 2018-06-30 | $1,790,320 |
| Contract administrator fees | 2018-06-30 | $19,300 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-06-30 | No |
| Did the plan have assets held for investment | 2018-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-06-30 | Unqualified |
| Accountancy firm name | 2018-06-30 | GROSSMAN YANAK AND FORD LLP |
| Accountancy firm EIN | 2018-06-30 | 251638525 |
| 2017 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $144,305 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-06-30 | $154,900 |
| Total income from all sources (including contributions) | 2017-06-30 | $683,841 |
| Total of all expenses incurred | 2017-06-30 | $677,839 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-06-30 | $630,219 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-06-30 | $670,708 |
| Value of total assets at end of year | 2017-06-30 | $270,476 |
| Value of total assets at beginning of year | 2017-06-30 | $275,069 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-06-30 | $47,620 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-06-30 | No |
| Administrative expenses professional fees incurred | 2017-06-30 | $21,554 |
| Was this plan covered by a fidelity bond | 2017-06-30 | Yes |
| Value of fidelity bond cover | 2017-06-30 | $20,000 |
| If this is an individual account plan, was there a blackout period | 2017-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-06-30 | $2,245 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-06-30 | $2,103 |
| Other income not declared elsewhere | 2017-06-30 | $13,133 |
| Administrative expenses (other) incurred | 2017-06-30 | $7,803 |
| Liabilities. Value of operating payables at end of year | 2017-06-30 | $144,305 |
| Liabilities. Value of operating payables at beginning of year | 2017-06-30 | $154,900 |
| Total non interest bearing cash at end of year | 2017-06-30 | $268,231 |
| Total non interest bearing cash at beginning of year | 2017-06-30 | $272,966 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-06-30 | No |
| Value of net income/loss | 2017-06-30 | $6,002 |
| Value of net assets at end of year (total assets less liabilities) | 2017-06-30 | $126,171 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-06-30 | $120,169 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-06-30 | $630,219 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-06-30 | No |
| Contributions received in cash from employer | 2017-06-30 | $670,708 |
| Contract administrator fees | 2017-06-30 | $18,263 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-06-30 | No |
| Did the plan have assets held for investment | 2017-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-06-30 | Unqualified |
| Accountancy firm name | 2017-06-30 | GROSSMAN YANAK AND FORD LLP |
| Accountancy firm EIN | 2017-06-30 | 251638525 |
| 2016 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $153,669 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-06-30 | $139,658 |
| Total income from all sources (including contributions) | 2016-06-30 | $138,435 |
| Total of all expenses incurred | 2016-06-30 | $138,969 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-06-30 | $88,808 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-06-30 | $138,435 |
| Value of total assets at end of year | 2016-06-30 | $275,069 |
| Value of total assets at beginning of year | 2016-06-30 | $261,592 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-06-30 | $50,161 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-06-30 | No |
| Administrative expenses professional fees incurred | 2016-06-30 | $23,000 |
| Was this plan covered by a fidelity bond | 2016-06-30 | Yes |
| Value of fidelity bond cover | 2016-06-30 | $20,000 |
| If this is an individual account plan, was there a blackout period | 2016-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-06-30 | $2,103 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-06-30 | $2,080 |
| Administrative expenses (other) incurred | 2016-06-30 | $8,833 |
| Liabilities. Value of operating payables at end of year | 2016-06-30 | $153,669 |
| Liabilities. Value of operating payables at beginning of year | 2016-06-30 | $139,658 |
| Total non interest bearing cash at end of year | 2016-06-30 | $272,966 |
| Total non interest bearing cash at beginning of year | 2016-06-30 | $259,512 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-06-30 | No |
| Value of net income/loss | 2016-06-30 | $-534 |
| Value of net assets at end of year (total assets less liabilities) | 2016-06-30 | $121,400 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-06-30 | $121,934 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-06-30 | $88,808 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-06-30 | No |
| Contributions received in cash from employer | 2016-06-30 | $138,435 |
| Contract administrator fees | 2016-06-30 | $18,328 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-06-30 | No |
| Did the plan have assets held for investment | 2016-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-06-30 | Unqualified |
| Accountancy firm name | 2016-06-30 | GROSSMAN YANAK & FORD, LLP |
| Accountancy firm EIN | 2016-06-30 | 251638525 |
| 2015 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-06-30 | $139,658 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-06-30 | $2,379,056 |
| Total income from all sources (including contributions) | 2015-06-30 | $4,482,272 |
| Total of all expenses incurred | 2015-06-30 | $2,320,771 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-06-30 | $2,256,761 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-06-30 | $2,320,716 |
| Value of total assets at end of year | 2015-06-30 | $261,592 |
| Value of total assets at beginning of year | 2015-06-30 | $339,489 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-06-30 | $64,010 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-06-30 | No |
| Administrative expenses professional fees incurred | 2015-06-30 | $21,000 |
| Was this plan covered by a fidelity bond | 2015-06-30 | No |
| If this is an individual account plan, was there a blackout period | 2015-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-06-30 | $2,080 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-06-30 | $40,327 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-06-30 | $2,161,556 |
| Other income not declared elsewhere | 2015-06-30 | $2,161,556 |
| Administrative expenses (other) incurred | 2015-06-30 | $7,280 |
| Liabilities. Value of operating payables at end of year | 2015-06-30 | $139,658 |
| Liabilities. Value of operating payables at beginning of year | 2015-06-30 | $217,500 |
| Total non interest bearing cash at end of year | 2015-06-30 | $259,512 |
| Total non interest bearing cash at beginning of year | 2015-06-30 | $299,162 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-06-30 | No |
| Value of net income/loss | 2015-06-30 | $2,161,501 |
| Value of net assets at end of year (total assets less liabilities) | 2015-06-30 | $121,934 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-06-30 | $-2,039,567 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-06-30 | $2,256,761 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-06-30 | No |
| Contributions received in cash from employer | 2015-06-30 | $2,320,716 |
| Contract administrator fees | 2015-06-30 | $35,730 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-06-30 | No |
| Did the plan have assets held for investment | 2015-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-06-30 | Unqualified |
| Accountancy firm name | 2015-06-30 | GROSSMAN YANAK AND FORD, LLP |
| Accountancy firm EIN | 2015-06-30 | 251638525 |
| 2014 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-06-30 | $2,379,056 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-06-30 | $2,487,772 |
| Total income from all sources (including contributions) | 2014-06-30 | $2,954,528 |
| Total of all expenses incurred | 2014-06-30 | $2,941,844 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-06-30 | $2,853,985 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-06-30 | $2,954,528 |
| Value of total assets at end of year | 2014-06-30 | $339,489 |
| Value of total assets at beginning of year | 2014-06-30 | $435,521 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-06-30 | $87,859 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-06-30 | No |
| Administrative expenses professional fees incurred | 2014-06-30 | $21,000 |
| Was this plan covered by a fidelity bond | 2014-06-30 | No |
| Value of fidelity bond cover | 2014-06-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2014-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-06-30 | No |
| Participant contributions at end of year | 2014-06-30 | $38,267 |
| Participant contributions at beginning of year | 2014-06-30 | $0 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-06-30 | $2,060 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-06-30 | $1,861 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-06-30 | $2,161,556 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-06-30 | $2,175,677 |
| Administrative expenses (other) incurred | 2014-06-30 | $7,585 |
| Liabilities. Value of operating payables at end of year | 2014-06-30 | $217,500 |
| Liabilities. Value of operating payables at beginning of year | 2014-06-30 | $312,095 |
| Total non interest bearing cash at end of year | 2014-06-30 | $299,162 |
| Total non interest bearing cash at beginning of year | 2014-06-30 | $425,076 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-06-30 | No |
| Value of net income/loss | 2014-06-30 | $12,684 |
| Value of net assets at end of year (total assets less liabilities) | 2014-06-30 | $-2,039,567 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-06-30 | $-2,052,251 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-06-30 | $2,853,985 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-06-30 | No |
| Contributions received in cash from employer | 2014-06-30 | $2,954,528 |
| Employer contributions (assets) at end of year | 2014-06-30 | $0 |
| Employer contributions (assets) at beginning of year | 2014-06-30 | $8,584 |
| Contract administrator fees | 2014-06-30 | $59,274 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-06-30 | No |
| Did the plan have assets held for investment | 2014-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-06-30 | Unqualified |
| Accountancy firm name | 2014-06-30 | GROSSMAN YANAK & FORD, LLP |
| Accountancy firm EIN | 2014-06-30 | 251638525 |
| 2013 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $2,487,772 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-06-30 | $2,471,259 |
| Total income from all sources (including contributions) | 2013-06-30 | $3,566,138 |
| Total of all expenses incurred | 2013-06-30 | $3,577,470 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-06-30 | $3,439,354 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-06-30 | $3,566,138 |
| Value of total assets at end of year | 2013-06-30 | $435,521 |
| Value of total assets at beginning of year | 2013-06-30 | $430,340 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-06-30 | $138,116 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-06-30 | No |
| Administrative expenses professional fees incurred | 2013-06-30 | $22,767 |
| Was this plan covered by a fidelity bond | 2013-06-30 | Yes |
| Value of fidelity bond cover | 2013-06-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2013-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-06-30 | $1,861 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-06-30 | $1,648 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-06-30 | $2,175,677 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-06-30 | $2,192,358 |
| Administrative expenses (other) incurred | 2013-06-30 | $8,263 |
| Liabilities. Value of operating payables at end of year | 2013-06-30 | $312,095 |
| Liabilities. Value of operating payables at beginning of year | 2013-06-30 | $278,901 |
| Total non interest bearing cash at end of year | 2013-06-30 | $425,076 |
| Total non interest bearing cash at beginning of year | 2013-06-30 | $417,255 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Value of net income/loss | 2013-06-30 | $-11,332 |
| Value of net assets at end of year (total assets less liabilities) | 2013-06-30 | $-2,052,251 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-06-30 | $-2,040,919 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-06-30 | $3,439,354 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-06-30 | No |
| Contributions received in cash from employer | 2013-06-30 | $3,566,138 |
| Employer contributions (assets) at end of year | 2013-06-30 | $8,584 |
| Employer contributions (assets) at beginning of year | 2013-06-30 | $11,437 |
| Contract administrator fees | 2013-06-30 | $107,086 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2013-06-30 | No |
| Did the plan have assets held for investment | 2013-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-06-30 | Unqualified |
| Accountancy firm name | 2013-06-30 | GROSSMAN YANAK & FORD, LLP |
| Accountancy firm EIN | 2013-06-30 | 251638525 |
| 2012 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $2,471,259 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-06-30 | $2,619,211 |
| Total income from all sources (including contributions) | 2012-06-30 | $4,202,999 |
| Total of all expenses incurred | 2012-06-30 | $4,364,684 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-06-30 | $4,051,951 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-06-30 | $4,202,999 |
| Value of total assets at end of year | 2012-06-30 | $430,340 |
| Value of total assets at beginning of year | 2012-06-30 | $739,977 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-06-30 | $312,733 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-06-30 | No |
| Administrative expenses professional fees incurred | 2012-06-30 | $23,875 |
| Was this plan covered by a fidelity bond | 2012-06-30 | Yes |
| Value of fidelity bond cover | 2012-06-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2012-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-06-30 | $1,648 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-06-30 | $1,656 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-06-30 | $2,192,358 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-06-30 | $2,218,156 |
| Administrative expenses (other) incurred | 2012-06-30 | $24,164 |
| Liabilities. Value of operating payables at end of year | 2012-06-30 | $278,901 |
| Liabilities. Value of operating payables at beginning of year | 2012-06-30 | $401,055 |
| Total non interest bearing cash at end of year | 2012-06-30 | $417,255 |
| Total non interest bearing cash at beginning of year | 2012-06-30 | $697,932 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Value of net income/loss | 2012-06-30 | $-161,685 |
| Value of net assets at end of year (total assets less liabilities) | 2012-06-30 | $-2,040,919 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-06-30 | $-1,879,234 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-06-30 | $4,051,951 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-06-30 | No |
| Contributions received in cash from employer | 2012-06-30 | $4,202,999 |
| Employer contributions (assets) at end of year | 2012-06-30 | $11,437 |
| Employer contributions (assets) at beginning of year | 2012-06-30 | $40,389 |
| Contract administrator fees | 2012-06-30 | $264,694 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2012-06-30 | No |
| Did the plan have assets held for investment | 2012-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-06-30 | Unqualified |
| Accountancy firm name | 2012-06-30 | GROSSMAN YANAK & FORD, LLP |
| Accountancy firm EIN | 2012-06-30 | 251638525 |
| 2011 : CONSOLIDATED BUILDERS BENEFITS TRUST HEALTH AND WELFARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $2,619,211 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-06-30 | $2,685,592 |
| Total income from all sources (including contributions) | 2011-06-30 | $4,774,610 |
| Total of all expenses incurred | 2011-06-30 | $4,744,570 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-06-30 | $4,602,392 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-06-30 | $4,774,610 |
| Value of total assets at end of year | 2011-06-30 | $739,977 |
| Value of total assets at beginning of year | 2011-06-30 | $776,318 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-06-30 | $142,178 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-06-30 | No |
| Administrative expenses professional fees incurred | 2011-06-30 | $26,150 |
| Was this plan covered by a fidelity bond | 2011-06-30 | Yes |
| Value of fidelity bond cover | 2011-06-30 | $1,000,000 |
| If this is an individual account plan, was there a blackout period | 2011-06-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-06-30 | No |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-06-30 | $1,656 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-06-30 | $1,656 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-06-30 | $2,218,156 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-06-30 | $2,240,308 |
| Administrative expenses (other) incurred | 2011-06-30 | $6,079 |
| Liabilities. Value of operating payables at end of year | 2011-06-30 | $401,055 |
| Liabilities. Value of operating payables at beginning of year | 2011-06-30 | $445,284 |
| Total non interest bearing cash at end of year | 2011-06-30 | $697,932 |
| Total non interest bearing cash at beginning of year | 2011-06-30 | $715,560 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Value of net income/loss | 2011-06-30 | $30,040 |
| Value of net assets at end of year (total assets less liabilities) | 2011-06-30 | $-1,879,234 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-06-30 | $-1,909,274 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-06-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-06-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-06-30 | No |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-06-30 | $4,602,392 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-06-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-06-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-06-30 | No |
| Contributions received in cash from employer | 2011-06-30 | $4,774,610 |
| Employer contributions (assets) at end of year | 2011-06-30 | $40,389 |
| Employer contributions (assets) at beginning of year | 2011-06-30 | $59,102 |
| Contract administrator fees | 2011-06-30 | $109,949 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2011-06-30 | No |
| Did the plan have assets held for investment | 2011-06-30 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-06-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-06-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-06-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-06-30 | Unqualified |
| Accountancy firm name | 2011-06-30 | GROSSMAN YANAK & FORD, LLP |
| Accountancy firm EIN | 2011-06-30 | 251638525 |
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 235945 |
| Policy instance | 6 |
| Insurance contract or identification number | 235945 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $183,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 235945 |
| Policy instance | 5 |
| Insurance contract or identification number | 235945 | | Number of Individuals Covered | 156 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $48,024 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,215,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $48,024 | | Amount paid for insurance broker fees | 0 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Number of Individuals Covered | 124 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $388 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $3,880 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $388 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 285 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,051 | | 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 number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 17 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $40 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $40 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 178 | | Insurance policy start date | 2021-07-01 | | Insurance policy end date | 2022-06-30 | | Total amount of commissions paid to insurance broker | USD $790 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $79,624 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $790 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 180 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $9,379 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $74,670 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 15 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $504 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,722 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $504 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 284 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,075 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Number of Individuals Covered | 138 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $354 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $3,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $354 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 235945 |
| Policy instance | 5 |
| Insurance contract or identification number | 235945 | | Number of Individuals Covered | 310 | | Insurance policy start date | 2020-07-01 | | Insurance policy end date | 2021-06-30 | | Total amount of commissions paid to insurance broker | USD $55,728 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,649,670 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $55,728 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 235945 |
| Policy instance | 5 |
| Insurance contract or identification number | 235945 | | Number of Individuals Covered | 336 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $73,080 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,927,355 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $51,912 | | Insurance broker organization code? | 3 |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Number of Individuals Covered | 193 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $436 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $436 | | Insurance broker organization code? | 3 |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 280 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $15,562 | | 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 number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 20 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $551 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $551 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 189 | | Insurance policy start date | 2019-07-01 | | Insurance policy end date | 2020-06-30 | | Total amount of commissions paid to insurance broker | USD $7,782 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $72,517 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,782 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 85766 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 192 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,502 | | 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 number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 20 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,817 | | 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 number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 291 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,812 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Number of Individuals Covered | 189 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $544 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $5,441 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $544 | | Insurance broker organization code? | 3 |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 235945 |
| Policy instance | 5 |
| Insurance contract or identification number | 235945 | | Number of Individuals Covered | 555 | | Insurance policy start date | 2018-07-01 | | Insurance policy end date | 2019-06-30 | | Total amount of commissions paid to insurance broker | USD $87,048 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,052,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $87,048 | | Insurance broker organization code? | 3 |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 21 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $10 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,988 | | 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 number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 279 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,965 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Number of Individuals Covered | 140 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $336 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $3,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 188 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $146 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $68,775 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | 235945 |
| Policy instance | 5 |
| Insurance contract or identification number | 235945 | | Number of Individuals Covered | 311 | | Insurance policy start date | 2017-07-01 | | Insurance policy end date | 2018-06-30 | | Total amount of commissions paid to insurance broker | USD $74,808 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,704,755 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 179 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $6,293 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $63,120 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,293 | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 181842 |
| Policy instance | 5 |
| Insurance contract or identification number | VG 181842 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $1,974 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,162 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,974 | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Number of Individuals Covered | 175 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $242 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $2,419 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $242 | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 250 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,379 | | 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 number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 22 | | Insurance policy start date | 2015-07-01 | | Insurance policy end date | 2016-06-30 | | Total amount of commissions paid to insurance broker | USD $479 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,044 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $479 | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 241 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,005 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 0187 |
| Policy instance | 6 |
| Insurance contract or identification number | 0187 | | Number of Individuals Covered | 130 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $23,964 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,005,529 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 21872 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | VCS GROUP, INC. |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | 0176269 |
| Policy instance | 2 |
| Insurance contract or identification number | 0176269 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $547 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,878 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $547 | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 182 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $6,483 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,954 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,483 | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 181842 |
| Policy instance | 5 |
| Insurance contract or identification number | VG 181842 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $2,456 | | Total amount of fees paid to insurance company | USD $533 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,374 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,456 | | Amount paid for insurance broker fees | 533 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Number of Individuals Covered | 261 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $490 | | Total amount of fees paid to insurance company | USD $160 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,898 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $490 | | Amount paid for insurance broker fees | 160 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 204 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $1,253 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $62,964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,253 | | Insurance broker name | JRG ADVISORS, LLC |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | 0510155 |
| Policy instance | 2 |
| Insurance contract or identification number | 0510155 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $342 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $342 | | Insurance broker name | JRG ADVISORS, LLC |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 285 |
| Policy instance | 7 |
| Insurance contract or identification number | 285 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $12,639 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $535,365 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 8088 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | EMERSON, REID & COMPANY, INC. |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 384 |
| Policy instance | 6 |
| Insurance contract or identification number | 384 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $312 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 312 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 285 |
| Policy instance | 9 |
| Insurance contract or identification number | 285 | | Number of Individuals Covered | 90 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $12,639 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $535,365 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 384 |
| Policy instance | 8 |
| Insurance contract or identification number | 384 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $312 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 187 |
| Policy instance | 7 |
| Insurance contract or identification number | 187 | | Number of Individuals Covered | 4726 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $577,845 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,219,168 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 357 |
| Policy instance | 6 |
| Insurance contract or identification number | 357 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2013-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 181842 |
| Policy instance | 5 |
| Insurance contract or identification number | VG 181842 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Number of Individuals Covered | 27 | | Welfare Benefit Premiums Paid to Carrier | USD $23,703 | | Commission paid to Insurance Broker | USD $3,556 | | Amount paid for insurance broker fees | 356 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Number of Individuals Covered | 346 | | Welfare Benefit Premiums Paid to Carrier | USD $9,255 | | Commission paid to Insurance Broker | USD $926 | | Amount paid for insurance broker fees | 195 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 250 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,646 | | 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 number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 22 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $342 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,647 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 0187 |
| Policy instance | 8 |
| Insurance contract or identification number | 0187 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $45,813 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,466,661 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 35288 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | SINGLE SOURCE BENEFITS, INC. |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 384 |
| Policy instance | 8 |
| Insurance contract or identification number | 384 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $268 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,320 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 264 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS CORPORATION OF PA |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 357 |
| Policy instance | 6 |
| Insurance contract or identification number | 357 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $240 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,469 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 240 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | ASSOCIATES BENEFIT CORPORATION |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 187 |
| Policy instance | 7 |
| Insurance contract or identification number | 187 | | Number of Individuals Covered | 641 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $89,973 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,961,410 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 57118 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | SINGLE SOURCE BENEFITS, INC. |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 181842 |
| Policy instance | 5 |
| Insurance contract or identification number | VG 181842 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $2,115 | | Total amount of fees paid to insurance company | USD $194 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,097 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,115 | | Amount paid for insurance broker fees | 194 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 205 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $1,291 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $64,883 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,291 | | Insurance broker name | JRG ADVISORS, LLC |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 285 |
| Policy instance | 9 |
| Insurance contract or identification number | 285 | | Number of Individuals Covered | 103 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $13,201 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $608,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 8832 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | WILLIS CORPORATION OF PA |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Number of Individuals Covered | 352 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $575 | | Total amount of fees paid to insurance company | USD $73 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $6,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $575 | | Amount paid for insurance broker fees | 73 | | Additional information about fees paid to insurance broker | INSURANCE FEES | | Insurance broker organization code? | 3 | | Insurance broker name | JRG ADVISORS, LLC |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 260 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $512 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,386 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 512 | | Insurance broker organization code? | 3 | | Insurance broker name | HIGHMARK LIFE INSURANCE COMPANY |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 27 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $366 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,524 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Amount paid for insurance broker fees | 366 | | Insurance broker name | JRG ADVISORS, LLC |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 187 |
| Policy instance | 7 |
| Insurance contract or identification number | 187 | | Number of Individuals Covered | 754 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $108,167 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,395,925 | | 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 number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 27 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $366 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,524 | | 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 number | CBT - 001 COB |
| Policy instance | 3 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 277 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $553 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,283 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | GL 146173 |
| Policy instance | 4 |
| Insurance contract or identification number | GL 146173 | | Number of Individuals Covered | 415 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $476 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH & DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $4,757 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 ) |
| Policy contract number | VG 181842 |
| Policy instance | 5 |
| Insurance contract or identification number | VG 181842 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $2,178 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,519 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 357 |
| Policy instance | 6 |
| Insurance contract or identification number | 357 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $560 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $41,955 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HIGHMARK HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71768 ) |
| Policy contract number | 384 |
| Policy instance | 8 |
| Insurance contract or identification number | 384 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $12,677 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,677 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 205 | | Insurance policy start date | 2011-07-01 | | Insurance policy end date | 2012-06-30 | | Total amount of commissions paid to insurance broker | USD $1,291 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $70,201 | | 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 number | CBT - 001 COB |
| Policy instance | 7 |
| Insurance contract or identification number | CBT - 001 COB | | Number of Individuals Covered | 146 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $515 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,452 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KEYSTONE HEALTH PLAN WEST, INC (National Association of Insurance Commissioners NAIC id number: 95048 ) |
| Policy contract number | VARIOUS |
| Policy instance | 2 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 0 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $31,557 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED CONCORDIA LIFE AND HEALTH INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62294 ) |
| Policy contract number | VARIOUS |
| Policy instance | 5 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 124 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $76,533 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HM LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 93440 ) |
| Policy contract number | VARIOUS |
| Policy instance | 4 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 23 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $69,825 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | VARIOUS |
| Policy instance | 3 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 25 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $31,192 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 ) |
| Policy contract number | VARIOUS |
| Policy instance | 1 |
| Insurance contract or identification number | VARIOUS | | Number of Individuals Covered | 476 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,398,917 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED CONCORDIA DENTAL PLANS OF PENNSYLVANIA, INC. (National Association of Insurance Commissioners NAIC id number: 47089 ) |
| Policy contract number | 251264-000 |
| Policy instance | 6 |
| Insurance contract or identification number | 251264-000 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2010-07-01 | | Insurance policy end date | 2011-06-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,207 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
