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UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 401k Plan overview

Plan NameUFCW LOCAL 23 AND EMPLOYERS HEALTH FUND
Plan identification number 501

UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)

401k Sponsoring company profile

BD OF TRUSTEES UFCW, LOCAL 1776KS, WD AND EMPLOYERS HEALTH FUND has sponsored the creation of one or more 401k plans.

Company Name:BD OF TRUSTEES UFCW, LOCAL 1776KS, WD AND EMPLOYERS HEALTH FUND
Employer identification number (EIN):237083247
NAIC Classification:445110
NAIC Description:Supermarkets and Other Grocery (except Convenience) Stores

Form 5500 Filing Information

Submission information for form 5500 for 401k plan UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-10-01LANCE HUBER2024-06-06 KERI BROWN2024-06-11
5012021-10-01LANCE HUBER2023-06-13 KERI BROWN2023-06-21
5012020-10-01LANCE HUBER2022-06-08 RAYMOND A. HUBER2022-06-11
5012019-10-01LANCE HUBER2021-05-11 RAYMOND A. HUBER2021-05-14
5012018-10-01ANTHONY HELFER2020-06-24 RAYMOND HUBER2020-06-30
5012017-10-01ANTHONY HELFER2019-06-13 RAYMOND HUBER2019-06-13
5012016-10-01
5012015-10-01
5012014-10-01
5012013-10-01ANTHONY HELFER
5012012-10-01ANTHONY HELFER
5012011-10-01RAYMOND A. HUBER
5012010-10-01RAYMOND A HUBER
5012009-10-01RAYMOND A. HUBER

Plan Statistics for UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND

401k plan membership statisitcs for UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND

Measure Date Value
2022: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2022 401k membership
Total participants, beginning-of-year2022-10-015,433
Total number of active participants reported on line 7a of the Form 55002022-10-014,888
Number of retired or separated participants receiving benefits2022-10-01380
Number of other retired or separated participants entitled to future benefits2022-10-010
Total of all active and inactive participants2022-10-015,268
Number of employers contributing to the scheme2022-10-0167
2021: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2021 401k membership
Total participants, beginning-of-year2021-10-015,353
Total number of active participants reported on line 7a of the Form 55002021-10-015,016
Number of retired or separated participants receiving benefits2021-10-01417
Number of other retired or separated participants entitled to future benefits2021-10-010
Total of all active and inactive participants2021-10-015,433
Number of employers contributing to the scheme2021-10-0166
2020: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2020 401k membership
Total participants, beginning-of-year2020-10-015,452
Total number of active participants reported on line 7a of the Form 55002020-10-014,929
Number of retired or separated participants receiving benefits2020-10-01424
Number of other retired or separated participants entitled to future benefits2020-10-010
Total of all active and inactive participants2020-10-015,353
Number of employers contributing to the scheme2020-10-0174
2019: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2019 401k membership
Total participants, beginning-of-year2019-10-015,694
Total number of active participants reported on line 7a of the Form 55002019-10-015,022
Number of retired or separated participants receiving benefits2019-10-01430
Number of other retired or separated participants entitled to future benefits2019-10-010
Total of all active and inactive participants2019-10-015,452
Number of employers contributing to the scheme2019-10-0177
2018: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2018 401k membership
Total participants, beginning-of-year2018-10-016,592
Total number of active participants reported on line 7a of the Form 55002018-10-015,248
Number of retired or separated participants receiving benefits2018-10-01446
Number of other retired or separated participants entitled to future benefits2018-10-010
Total of all active and inactive participants2018-10-015,694
Number of employers contributing to the scheme2018-10-0181
2017: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2017 401k membership
Total participants, beginning-of-year2017-10-017,113
Total number of active participants reported on line 7a of the Form 55002017-10-015,862
Number of retired or separated participants receiving benefits2017-10-01730
Number of other retired or separated participants entitled to future benefits2017-10-010
Total of all active and inactive participants2017-10-016,592
Number of employers contributing to the scheme2017-10-0181
2016: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2016 401k membership
Total participants, beginning-of-year2016-10-017,342
Total number of active participants reported on line 7a of the Form 55002016-10-016,512
Number of retired or separated participants receiving benefits2016-10-01601
Number of other retired or separated participants entitled to future benefits2016-10-010
Total of all active and inactive participants2016-10-017,113
Number of employers contributing to the scheme2016-10-0193
2015: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2015 401k membership
Total participants, beginning-of-year2015-10-017,641
Total number of active participants reported on line 7a of the Form 55002015-10-016,746
Number of retired or separated participants receiving benefits2015-10-01596
Number of other retired or separated participants entitled to future benefits2015-10-010
Total of all active and inactive participants2015-10-017,342
Number of employers contributing to the scheme2015-10-0193
2014: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2014 401k membership
Total participants, beginning-of-year2014-10-017,735
Total number of active participants reported on line 7a of the Form 55002014-10-017,069
Number of retired or separated participants receiving benefits2014-10-01572
Number of other retired or separated participants entitled to future benefits2014-10-010
Total of all active and inactive participants2014-10-017,641
Number of employers contributing to the scheme2014-10-01105
2013: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2013 401k membership
Total participants, beginning-of-year2013-10-017,803
Total number of active participants reported on line 7a of the Form 55002013-10-017,143
Number of retired or separated participants receiving benefits2013-10-01592
Number of other retired or separated participants entitled to future benefits2013-10-010
Total of all active and inactive participants2013-10-017,735
Number of employers contributing to the scheme2013-10-01104
2012: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2012 401k membership
Total participants, beginning-of-year2012-10-017,862
Total number of active participants reported on line 7a of the Form 55002012-10-017,207
Number of retired or separated participants receiving benefits2012-10-01596
Number of other retired or separated participants entitled to future benefits2012-10-010
Total of all active and inactive participants2012-10-017,803
Number of employers contributing to the scheme2012-10-0199
2011: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2011 401k membership
Total participants, beginning-of-year2011-10-017,931
Total number of active participants reported on line 7a of the Form 55002011-10-017,270
Number of retired or separated participants receiving benefits2011-10-01592
Number of other retired or separated participants entitled to future benefits2011-10-010
Total of all active and inactive participants2011-10-017,862
Number of employers contributing to the scheme2011-10-0192
2010: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2010 401k membership
Total participants, beginning-of-year2010-10-018,098
Total number of active participants reported on line 7a of the Form 55002010-10-017,352
Number of retired or separated participants receiving benefits2010-10-01579
Number of other retired or separated participants entitled to future benefits2010-10-010
Total of all active and inactive participants2010-10-017,931
Number of employers contributing to the scheme2010-10-01101
2009: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2009 401k membership
Total participants, beginning-of-year2009-10-018,351
Total number of active participants reported on line 7a of the Form 55002009-10-017,511
Number of retired or separated participants receiving benefits2009-10-01587
Number of other retired or separated participants entitled to future benefits2009-10-010
Total of all active and inactive participants2009-10-018,098
Number of employers contributing to the scheme2009-10-01102

Financial Data on UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND

Measure Date Value
2023 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2023 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2023-09-30$-305,173
Total unrealized appreciation/depreciation of assets2023-09-30$-305,173
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-09-30$8,593,075
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2023-09-30$7,785,351
Total income from all sources (including contributions)2023-09-30$48,953,450
Total loss/gain on sale of assets2023-09-30$56,150
Total of all expenses incurred2023-09-30$47,483,132
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2023-09-30$45,944,800
Total contributions o plan (from employers,participants, others, non cash contrinutions)2023-09-30$46,149,693
Value of total assets at end of year2023-09-30$53,348,599
Value of total assets at beginning of year2023-09-30$51,070,557
Total of administrative expenses incurred including professional, contract, advisory and management fees2023-09-30$1,538,332
Total income from rents2023-09-30$76,623
Total interest from all sources2023-09-30$343,910
Total dividends received (eg from common stock, registered investment company shares)2023-09-30$1,194,035
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2023-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2023-09-30$1,109,554
Assets. Real estate other than employer real property at end of year2023-09-30$6,284,792
Assets. Real estate other than employer real property at beginning of year2023-09-30$7,416,105
Administrative expenses professional fees incurred2023-09-30$117,577
Was this plan covered by a fidelity bond2023-09-30Yes
Value of fidelity bond cover2023-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2023-09-30No
Contributions received from participants2023-09-30$590,353
Assets. Other investments not covered elsewhere at end of year2023-09-30$0
Assets. Other investments not covered elsewhere at beginning of year2023-09-30$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2023-09-30$4,289,438
Value of other receiveables (less allowance for doubtful accounts) at end of year2023-09-30$1,264,983
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2023-09-30$988,842
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2023-09-30$1,975,251
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2023-09-30$1,226,361
Other income not declared elsewhere2023-09-30$15,664
Administrative expenses (other) incurred2023-09-30$1,298,734
Liabilities. Value of operating payables at end of year2023-09-30$72,491
Liabilities. Value of operating payables at beginning of year2023-09-30$66,307
Total non interest bearing cash at end of year2023-09-30$21,709
Total non interest bearing cash at beginning of year2023-09-30$1,974,742
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2023-09-30No
Value of net income/loss2023-09-30$1,470,318
Value of net assets at end of year (total assets less liabilities)2023-09-30$44,755,524
Value of net assets at beginning of year (total assets less liabilities)2023-09-30$43,285,206
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2023-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2023-09-30No
Were any leases to which the plan was party in default or uncollectible2023-09-30No
Investment advisory and management fees2023-09-30$122,021
Value of interest in registered invesment companies (eg mutual funds) at end of year2023-09-30$29,358,529
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2023-09-30$28,349,837
Income. Interest from corporate debt instruments2023-09-30$271,904
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2023-09-30$4,438,089
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2023-09-30$2,161,634
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2023-09-30$2,161,634
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2023-09-30$72,006
Expenses. Payments to insurance carriers foe the provision of benefits2023-09-30$41,528,257
Net investment gain/loss from registered investment companies (e.g. mutual funds)2023-09-30$1,422,548
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2023-09-30No
Was there a failure to transmit to the plan any participant contributions2023-09-30No
Has the plan failed to provide any benefit when due under the plan2023-09-30No
Contributions received in cash from employer2023-09-30$45,559,340
Employer contributions (assets) at end of year2023-09-30$10,903
Employer contributions (assets) at beginning of year2023-09-30$147,423
Income. Dividends from common stock2023-09-30$84,481
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2023-09-30$127,105
Asset. Corporate debt instrument debt (other) at end of year2023-09-30$5,499,517
Asset. Corporate debt instrument debt (other) at beginning of year2023-09-30$5,220,751
Assets. Corporate common stocks other than exployer securities at end of year2023-09-30$5,495,402
Assets. Corporate common stocks other than exployer securities at beginning of year2023-09-30$4,555,733
Liabilities. Value of benefit claims payable at end of year2023-09-30$6,545,333
Liabilities. Value of benefit claims payable at beginning of year2023-09-30$6,492,683
Assets. Value of buildings and other operty used in plan operation at end of year2023-09-30$974,675
Assets. Value of buildings and other operty used in plan operation at beginning of year2023-09-30$255,490
Did the plan have assets held for investment2023-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2023-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2023-09-30No
Aggregate proceeds on sale of assets2023-09-30$5,630,950
Aggregate carrying amount (costs) on sale of assets2023-09-30$5,574,800
Opinion of an independent qualified public accountant for this plan2023-09-30Unqualified
Accountancy firm name2023-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2023-09-30270889793
2022 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-09-30$-201,105
Total unrealized appreciation/depreciation of assets2022-09-30$-201,105
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$7,785,351
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-09-30$5,113,219
Total income from all sources (including contributions)2022-09-30$40,771,251
Total loss/gain on sale of assets2022-09-30$-110,776
Total of all expenses incurred2022-09-30$49,865,244
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-09-30$48,423,890
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-09-30$44,940,611
Value of total assets at end of year2022-09-30$51,070,557
Value of total assets at beginning of year2022-09-30$57,492,418
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-09-30$1,441,354
Total income from rents2022-09-30$89,450
Total interest from all sources2022-09-30$259,924
Total dividends received (eg from common stock, registered investment company shares)2022-09-30$1,079,773
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2022-09-30$996,698
Assets. Real estate other than employer real property at end of year2022-09-30$7,416,105
Assets. Real estate other than employer real property at beginning of year2022-09-30$5,625,885
Administrative expenses professional fees incurred2022-09-30$129,566
Was this plan covered by a fidelity bond2022-09-30Yes
Value of fidelity bond cover2022-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2022-09-30No
Contributions received from participants2022-09-30$699,068
Assets. Other investments not covered elsewhere at end of year2022-09-30$0
Assets. Other investments not covered elsewhere at beginning of year2022-09-30$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2022-09-30$3,702,154
Value of other receiveables (less allowance for doubtful accounts) at end of year2022-09-30$988,842
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2022-09-30$836,553
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2022-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2022-09-30$1,226,361
Other income not declared elsewhere2022-09-30$50,943
Administrative expenses (other) incurred2022-09-30$1,188,560
Liabilities. Value of operating payables at end of year2022-09-30$66,307
Liabilities. Value of operating payables at beginning of year2022-09-30$66,219
Total non interest bearing cash at end of year2022-09-30$1,974,742
Total non interest bearing cash at beginning of year2022-09-30$2,396,766
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Value of net income/loss2022-09-30$-9,093,993
Value of net assets at end of year (total assets less liabilities)2022-09-30$43,285,206
Value of net assets at beginning of year (total assets less liabilities)2022-09-30$52,379,199
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-09-30No
Were any leases to which the plan was party in default or uncollectible2022-09-30No
Investment advisory and management fees2022-09-30$123,228
Value of interest in registered invesment companies (eg mutual funds) at end of year2022-09-30$28,349,837
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2022-09-30$37,080,132
Income. Interest from corporate debt instruments2022-09-30$258,690
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-09-30$2,161,634
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-09-30$460,395
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-09-30$460,395
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-09-30$1,234
Expenses. Payments to insurance carriers foe the provision of benefits2022-09-30$44,557,421
Net investment gain/loss from registered investment companies (e.g. mutual funds)2022-09-30$-5,337,569
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-09-30Yes
Was there a failure to transmit to the plan any participant contributions2022-09-30No
Has the plan failed to provide any benefit when due under the plan2022-09-30No
Contributions received in cash from employer2022-09-30$44,241,543
Employer contributions (assets) at end of year2022-09-30$147,423
Employer contributions (assets) at beginning of year2022-09-30$14,312
Income. Dividends from common stock2022-09-30$83,075
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-09-30$164,315
Asset. Corporate debt instrument debt (other) at end of year2022-09-30$5,220,751
Asset. Corporate debt instrument debt (other) at beginning of year2022-09-30$5,505,163
Assets. Corporate common stocks other than exployer securities at end of year2022-09-30$4,555,733
Assets. Corporate common stocks other than exployer securities at beginning of year2022-09-30$5,311,886
Liabilities. Value of benefit claims payable at end of year2022-09-30$6,492,683
Liabilities. Value of benefit claims payable at beginning of year2022-09-30$3,820,639
Assets. Value of buildings and other operty used in plan operation at end of year2022-09-30$255,490
Assets. Value of buildings and other operty used in plan operation at beginning of year2022-09-30$261,326
Did the plan have assets held for investment2022-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-09-30No
Aggregate proceeds on sale of assets2022-09-30$4,497,578
Aggregate carrying amount (costs) on sale of assets2022-09-30$4,608,354
Opinion of an independent qualified public accountant for this plan2022-09-30Unqualified
Accountancy firm name2022-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2022-09-30270889793
2021 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-09-30$1,480,982
Total unrealized appreciation/depreciation of assets2021-09-30$1,480,982
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$5,113,219
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-09-30$5,339,499
Total income from all sources (including contributions)2021-09-30$48,003,623
Total loss/gain on sale of assets2021-09-30$566,085
Total of all expenses incurred2021-09-30$46,936,947
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-09-30$45,572,894
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-09-30$42,433,618
Value of total assets at end of year2021-09-30$57,492,418
Value of total assets at beginning of year2021-09-30$56,652,022
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-09-30$1,364,053
Total interest from all sources2021-09-30$249,954
Total dividends received (eg from common stock, registered investment company shares)2021-09-30$1,095,553
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2021-09-30$1,005,764
Assets. Real estate other than employer real property at end of year2021-09-30$5,625,885
Assets. Real estate other than employer real property at beginning of year2021-09-30$3,235,592
Administrative expenses professional fees incurred2021-09-30$169,999
Was this plan covered by a fidelity bond2021-09-30Yes
Value of fidelity bond cover2021-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2021-09-30No
Contributions received from participants2021-09-30$798,720
Assets. Other investments not covered elsewhere at end of year2021-09-30$0
Assets. Other investments not covered elsewhere at beginning of year2021-09-30$0
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2021-09-30$3,670,700
Value of other receiveables (less allowance for doubtful accounts) at end of year2021-09-30$836,553
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2021-09-30$631,367
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2021-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2021-09-30$1,226,361
Other income not declared elsewhere2021-09-30$13,955
Administrative expenses (other) incurred2021-09-30$1,070,323
Liabilities. Value of operating payables at end of year2021-09-30$66,219
Liabilities. Value of operating payables at beginning of year2021-09-30$230,575
Total non interest bearing cash at end of year2021-09-30$2,396,766
Total non interest bearing cash at beginning of year2021-09-30$2,333,237
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Value of net income/loss2021-09-30$1,066,676
Value of net assets at end of year (total assets less liabilities)2021-09-30$52,379,199
Value of net assets at beginning of year (total assets less liabilities)2021-09-30$51,312,523
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-09-30No
Were any leases to which the plan was party in default or uncollectible2021-09-30No
Investment advisory and management fees2021-09-30$123,731
Value of interest in registered invesment companies (eg mutual funds) at end of year2021-09-30$37,080,132
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2021-09-30$37,529,526
Income. Interest from corporate debt instruments2021-09-30$249,914
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-09-30$460,395
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-09-30$297,861
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-09-30$297,861
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-09-30$40
Expenses. Payments to insurance carriers foe the provision of benefits2021-09-30$41,730,928
Net investment gain/loss from registered investment companies (e.g. mutual funds)2021-09-30$2,163,476
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-09-30Yes
Was there a failure to transmit to the plan any participant contributions2021-09-30No
Has the plan failed to provide any benefit when due under the plan2021-09-30No
Contributions received in cash from employer2021-09-30$41,634,898
Employer contributions (assets) at end of year2021-09-30$14,312
Employer contributions (assets) at beginning of year2021-09-30$49,335
Income. Dividends from common stock2021-09-30$89,789
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-09-30$171,266
Asset. Corporate debt instrument debt (other) at end of year2021-09-30$5,505,163
Asset. Corporate debt instrument debt (other) at beginning of year2021-09-30$5,144,326
Assets. Corporate common stocks other than exployer securities at end of year2021-09-30$5,311,886
Assets. Corporate common stocks other than exployer securities at beginning of year2021-09-30$7,191,331
Liabilities. Value of benefit claims payable at end of year2021-09-30$3,820,639
Liabilities. Value of benefit claims payable at beginning of year2021-09-30$3,882,563
Assets. Value of buildings and other operty used in plan operation at end of year2021-09-30$261,326
Assets. Value of buildings and other operty used in plan operation at beginning of year2021-09-30$239,447
Did the plan have assets held for investment2021-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-09-30No
Aggregate proceeds on sale of assets2021-09-30$10,307,303
Aggregate carrying amount (costs) on sale of assets2021-09-30$9,741,218
Opinion of an independent qualified public accountant for this plan2021-09-30Unqualified
Accountancy firm name2021-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2021-09-30270889793
2020 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-09-30$933,041
Total unrealized appreciation/depreciation of assets2020-09-30$933,041
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$5,339,499
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-09-30$5,906,447
Total income from all sources (including contributions)2020-09-30$46,532,557
Total loss/gain on sale of assets2020-09-30$-91,691
Total of all expenses incurred2020-09-30$45,197,887
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-09-30$43,819,967
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-09-30$42,797,232
Value of total assets at end of year2020-09-30$56,652,022
Value of total assets at beginning of year2020-09-30$55,884,300
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-09-30$1,377,920
Total interest from all sources2020-09-30$246,249
Total dividends received (eg from common stock, registered investment company shares)2020-09-30$1,121,833
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2020-09-30$991,101
Assets. Real estate other than employer real property at end of year2020-09-30$3,235,592
Assets. Real estate other than employer real property at beginning of year2020-09-30$5,580,364
Administrative expenses professional fees incurred2020-09-30$135,112
Was this plan covered by a fidelity bond2020-09-30Yes
Value of fidelity bond cover2020-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2020-09-30No
Contributions received from participants2020-09-30$943,112
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2020-09-30$4,147,368
Value of other receiveables (less allowance for doubtful accounts) at end of year2020-09-30$631,367
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2020-09-30$556,953
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2020-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2020-09-30$1,226,361
Other income not declared elsewhere2020-09-30$6,331
Administrative expenses (other) incurred2020-09-30$1,120,014
Liabilities. Value of operating payables at end of year2020-09-30$230,575
Liabilities. Value of operating payables at beginning of year2020-09-30$83,866
Total non interest bearing cash at end of year2020-09-30$2,333,237
Total non interest bearing cash at beginning of year2020-09-30$1,932,682
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Value of net income/loss2020-09-30$1,334,670
Value of net assets at end of year (total assets less liabilities)2020-09-30$51,312,523
Value of net assets at beginning of year (total assets less liabilities)2020-09-30$49,977,853
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-09-30No
Were any leases to which the plan was party in default or uncollectible2020-09-30No
Investment advisory and management fees2020-09-30$122,794
Value of interest in registered invesment companies (eg mutual funds) at end of year2020-09-30$37,529,526
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2020-09-30$36,003,805
Income. Interest from corporate debt instruments2020-09-30$243,540
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-09-30$297,861
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-09-30$262,678
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-09-30$262,678
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-09-30$2,709
Expenses. Payments to insurance carriers foe the provision of benefits2020-09-30$39,497,028
Net investment gain/loss from registered investment companies (e.g. mutual funds)2020-09-30$1,519,562
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-09-30Yes
Was there a failure to transmit to the plan any participant contributions2020-09-30No
Has the plan failed to provide any benefit when due under the plan2020-09-30No
Contributions received in cash from employer2020-09-30$41,854,120
Employer contributions (assets) at end of year2020-09-30$49,335
Employer contributions (assets) at beginning of year2020-09-30$68,443
Income. Dividends from common stock2020-09-30$130,732
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-09-30$175,571
Asset. Corporate debt instrument debt (other) at end of year2020-09-30$5,144,326
Asset. Corporate debt instrument debt (other) at beginning of year2020-09-30$4,960,553
Assets. Corporate common stocks other than exployer securities at end of year2020-09-30$7,191,331
Assets. Corporate common stocks other than exployer securities at beginning of year2020-09-30$6,343,557
Liabilities. Value of benefit claims payable at end of year2020-09-30$3,882,563
Liabilities. Value of benefit claims payable at beginning of year2020-09-30$4,596,220
Assets. Value of buildings and other operty used in plan operation at end of year2020-09-30$239,447
Assets. Value of buildings and other operty used in plan operation at beginning of year2020-09-30$175,265
Did the plan have assets held for investment2020-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-09-30No
Aggregate proceeds on sale of assets2020-09-30$8,801,633
Aggregate carrying amount (costs) on sale of assets2020-09-30$8,893,324
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-09-30No
Opinion of an independent qualified public accountant for this plan2020-09-30Unqualified
Accountancy firm name2020-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2020-09-30270889793
2019 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-09-30$428,903
Total unrealized appreciation/depreciation of assets2019-09-30$428,903
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$5,906,447
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-09-30$7,042,925
Total income from all sources (including contributions)2019-09-30$49,293,087
Total loss/gain on sale of assets2019-09-30$-83,036
Total of all expenses incurred2019-09-30$48,735,060
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-09-30$47,318,883
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-09-30$46,519,202
Value of total assets at end of year2019-09-30$55,884,300
Value of total assets at beginning of year2019-09-30$56,462,751
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-09-30$1,416,177
Total interest from all sources2019-09-30$250,627
Total dividends received (eg from common stock, registered investment company shares)2019-09-30$1,144,522
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2019-09-30$1,014,670
Assets. Real estate other than employer real property at end of year2019-09-30$5,580,364
Assets. Real estate other than employer real property at beginning of year2019-09-30$6,333,000
Administrative expenses professional fees incurred2019-09-30$175,931
Was this plan covered by a fidelity bond2019-09-30Yes
Value of fidelity bond cover2019-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2019-09-30No
Contributions received from participants2019-09-30$1,090,340
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2019-09-30$5,615,801
Value of other receiveables (less allowance for doubtful accounts) at end of year2019-09-30$556,953
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2019-09-30$694,476
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2019-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2019-09-30$1,226,361
Other income not declared elsewhere2019-09-30$14,146
Administrative expenses (other) incurred2019-09-30$1,109,356
Liabilities. Value of operating payables at end of year2019-09-30$83,866
Liabilities. Value of operating payables at beginning of year2019-09-30$65,175
Total non interest bearing cash at end of year2019-09-30$1,932,682
Total non interest bearing cash at beginning of year2019-09-30$3,322,881
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Value of net income/loss2019-09-30$558,027
Value of net assets at end of year (total assets less liabilities)2019-09-30$49,977,853
Value of net assets at beginning of year (total assets less liabilities)2019-09-30$49,419,826
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-09-30No
Were any leases to which the plan was party in default or uncollectible2019-09-30No
Investment advisory and management fees2019-09-30$130,890
Value of interest in registered invesment companies (eg mutual funds) at end of year2019-09-30$36,003,805
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2019-09-30$32,476,981
Income. Interest from corporate debt instruments2019-09-30$245,890
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-09-30$262,678
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-09-30$213,612
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-09-30$213,612
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-09-30$4,737
Expenses. Payments to insurance carriers foe the provision of benefits2019-09-30$41,505,381
Net investment gain/loss from registered investment companies (e.g. mutual funds)2019-09-30$1,018,723
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-09-30No
Was there a failure to transmit to the plan any participant contributions2019-09-30No
Has the plan failed to provide any benefit when due under the plan2019-09-30No
Contributions received in cash from employer2019-09-30$45,428,862
Employer contributions (assets) at end of year2019-09-30$68,443
Employer contributions (assets) at beginning of year2019-09-30$761,399
Income. Dividends from common stock2019-09-30$129,852
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-09-30$197,701
Asset. Corporate debt instrument debt (other) at end of year2019-09-30$4,960,553
Asset. Corporate debt instrument debt (other) at beginning of year2019-09-30$6,162,779
Assets. Corporate common stocks other than exployer securities at end of year2019-09-30$6,343,557
Assets. Corporate common stocks other than exployer securities at beginning of year2019-09-30$6,187,435
Liabilities. Value of benefit claims payable at end of year2019-09-30$4,596,220
Liabilities. Value of benefit claims payable at beginning of year2019-09-30$5,751,389
Assets. Value of buildings and other operty used in plan operation at end of year2019-09-30$175,265
Assets. Value of buildings and other operty used in plan operation at beginning of year2019-09-30$310,188
Did the plan have assets held for investment2019-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-09-30No
Aggregate proceeds on sale of assets2019-09-30$5,107,705
Aggregate carrying amount (costs) on sale of assets2019-09-30$5,190,741
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-09-30No
Opinion of an independent qualified public accountant for this plan2019-09-30Unqualified
Accountancy firm name2019-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2019-09-30270889793
2018 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-09-30$1,082,822
Total unrealized appreciation/depreciation of assets2018-09-30$1,082,822
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$7,042,925
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-09-30$8,004,832
Total income from all sources (including contributions)2018-09-30$51,451,571
Total loss/gain on sale of assets2018-09-30$-29,756
Total of all expenses incurred2018-09-30$52,345,809
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-09-30$50,967,739
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-09-30$48,016,409
Value of total assets at end of year2018-09-30$56,462,751
Value of total assets at beginning of year2018-09-30$58,318,896
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-09-30$1,378,070
Total interest from all sources2018-09-30$310,598
Total dividends received (eg from common stock, registered investment company shares)2018-09-30$959,408
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2018-09-30$844,168
Assets. Real estate other than employer real property at end of year2018-09-30$6,333,000
Assets. Real estate other than employer real property at beginning of year2018-09-30$5,850,058
Administrative expenses professional fees incurred2018-09-30$147,724
Was this plan covered by a fidelity bond2018-09-30Yes
Value of fidelity bond cover2018-09-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2018-09-30No
Contributions received from participants2018-09-30$980,393
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-09-30$6,410,378
Value of other receiveables (less allowance for doubtful accounts) at end of year2018-09-30$694,476
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2018-09-30$588,586
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2018-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2018-09-30$1,226,361
Other income not declared elsewhere2018-09-30$3,561
Administrative expenses (other) incurred2018-09-30$1,089,042
Liabilities. Value of operating payables at end of year2018-09-30$65,175
Liabilities. Value of operating payables at beginning of year2018-09-30$102,333
Total non interest bearing cash at end of year2018-09-30$3,322,881
Total non interest bearing cash at beginning of year2018-09-30$3,418,489
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Value of net income/loss2018-09-30$-894,238
Value of net assets at end of year (total assets less liabilities)2018-09-30$49,419,826
Value of net assets at beginning of year (total assets less liabilities)2018-09-30$50,314,064
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-09-30No
Were any leases to which the plan was party in default or uncollectible2018-09-30No
Investment advisory and management fees2018-09-30$141,304
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-09-30$32,476,981
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-09-30$36,529,447
Income. Interest from corporate debt instruments2018-09-30$306,754
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-09-30$213,612
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-09-30$233,554
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-09-30$233,554
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-09-30$3,844
Expenses. Payments to insurance carriers foe the provision of benefits2018-09-30$44,365,901
Net investment gain/loss from registered investment companies (e.g. mutual funds)2018-09-30$1,108,529
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-09-30Yes
Was there a failure to transmit to the plan any participant contributions2018-09-30No
Has the plan failed to provide any benefit when due under the plan2018-09-30No
Contributions received in cash from employer2018-09-30$47,036,016
Employer contributions (assets) at end of year2018-09-30$761,399
Employer contributions (assets) at beginning of year2018-09-30$52,563
Income. Dividends from common stock2018-09-30$115,240
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-09-30$191,460
Asset. Corporate debt instrument debt (other) at end of year2018-09-30$6,162,779
Asset. Corporate debt instrument debt (other) at beginning of year2018-09-30$6,020,285
Assets. Corporate common stocks other than exployer securities at end of year2018-09-30$6,187,435
Assets. Corporate common stocks other than exployer securities at beginning of year2018-09-30$5,310,177
Liabilities. Value of benefit claims payable at end of year2018-09-30$5,751,389
Liabilities. Value of benefit claims payable at beginning of year2018-09-30$6,676,138
Assets. Value of buildings and other operty used in plan operation at end of year2018-09-30$310,188
Assets. Value of buildings and other operty used in plan operation at beginning of year2018-09-30$315,737
Did the plan have assets held for investment2018-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-09-30No
Aggregate proceeds on sale of assets2018-09-30$4,305,720
Aggregate carrying amount (costs) on sale of assets2018-09-30$4,335,476
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-09-30No
Opinion of an independent qualified public accountant for this plan2018-09-30Unqualified
Accountancy firm name2018-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2018-09-30270889793
2017 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-09-30$546,060
Total unrealized appreciation/depreciation of assets2017-09-30$546,060
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$8,004,832
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-09-30$7,154,122
Total income from all sources (including contributions)2017-09-30$53,451,913
Total loss/gain on sale of assets2017-09-30$-54,182
Total of all expenses incurred2017-09-30$52,505,520
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-09-30$51,012,057
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-09-30$49,729,768
Value of total assets at end of year2017-09-30$58,318,896
Value of total assets at beginning of year2017-09-30$56,521,793
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-09-30$1,493,463
Total interest from all sources2017-09-30$284,944
Total dividends received (eg from common stock, registered investment company shares)2017-09-30$997,611
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2017-09-30$936,111
Assets. Real estate other than employer real property at end of year2017-09-30$5,850,058
Assets. Real estate other than employer real property at beginning of year2017-09-30$5,646,279
Administrative expenses professional fees incurred2017-09-30$179,416
Was this plan covered by a fidelity bond2017-09-30Yes
Value of fidelity bond cover2017-09-30$500,000
Were there any nonexempt tranactions with any party-in-interest2017-09-30No
Contributions received from participants2017-09-30$1,035,084
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2017-09-30$6,563,783
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-09-30$588,586
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-09-30$308,692
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-09-30$1,226,361
Other income not declared elsewhere2017-09-30$15,458
Administrative expenses (other) incurred2017-09-30$1,179,830
Liabilities. Value of operating payables at end of year2017-09-30$102,333
Liabilities. Value of operating payables at beginning of year2017-09-30$333,762
Total non interest bearing cash at end of year2017-09-30$3,418,489
Total non interest bearing cash at beginning of year2017-09-30$3,616,612
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Value of net income/loss2017-09-30$946,393
Value of net assets at end of year (total assets less liabilities)2017-09-30$50,314,064
Value of net assets at beginning of year (total assets less liabilities)2017-09-30$49,367,671
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-09-30No
Were any leases to which the plan was party in default or uncollectible2017-09-30No
Investment advisory and management fees2017-09-30$134,217
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-09-30$36,529,447
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-09-30$41,665,998
Income. Interest from corporate debt instruments2017-09-30$283,065
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-09-30$233,554
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-09-30$246,980
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-09-30$246,980
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-09-30$1,879
Expenses. Payments to insurance carriers foe the provision of benefits2017-09-30$44,220,188
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-09-30$1,932,254
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-09-30Yes
Was there a failure to transmit to the plan any participant contributions2017-09-30No
Has the plan failed to provide any benefit when due under the plan2017-09-30No
Contributions received in cash from employer2017-09-30$48,694,684
Employer contributions (assets) at end of year2017-09-30$52,563
Employer contributions (assets) at beginning of year2017-09-30$28,870
Income. Dividends from common stock2017-09-30$61,500
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-09-30$228,086
Asset. Corporate debt instrument debt (other) at end of year2017-09-30$6,020,285
Asset. Corporate debt instrument debt (other) at beginning of year2017-09-30$4,709,380
Assets. Corporate common stocks other than exployer securities at end of year2017-09-30$5,310,177
Assets. Corporate common stocks other than exployer securities at beginning of year2017-09-30$0
Liabilities. Value of benefit claims payable at end of year2017-09-30$6,676,138
Liabilities. Value of benefit claims payable at beginning of year2017-09-30$5,593,999
Assets. Value of buildings and other operty used in plan operation at end of year2017-09-30$315,737
Assets. Value of buildings and other operty used in plan operation at beginning of year2017-09-30$298,982
Did the plan have assets held for investment2017-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-09-30No
Aggregate proceeds on sale of assets2017-09-30$4,865,209
Aggregate carrying amount (costs) on sale of assets2017-09-30$4,919,391
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-09-30No
Opinion of an independent qualified public accountant for this plan2017-09-30Unqualified
Accountancy firm name2017-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2017-09-30270889793
2016 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-09-30$575,120
Total unrealized appreciation/depreciation of assets2016-09-30$575,120
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$7,154,122
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-09-30$5,900,642
Total income from all sources (including contributions)2016-09-30$54,394,996
Total loss/gain on sale of assets2016-09-30$-64,651
Total of all expenses incurred2016-09-30$51,522,971
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-09-30$49,749,598
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-09-30$50,468,724
Value of total assets at end of year2016-09-30$56,521,793
Value of total assets at beginning of year2016-09-30$52,396,288
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-09-30$1,773,373
Total interest from all sources2016-09-30$273,920
Total dividends received (eg from common stock, registered investment company shares)2016-09-30$919,878
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2016-09-30$919,878
Assets. Real estate other than employer real property at end of year2016-09-30$5,646,279
Assets. Real estate other than employer real property at beginning of year2016-09-30$5,103,115
Administrative expenses professional fees incurred2016-09-30$177,007
Was this plan covered by a fidelity bond2016-09-30Yes
Value of fidelity bond cover2016-09-30$500,000
Were there any nonexempt tranactions with any party-in-interest2016-09-30No
Contributions received from participants2016-09-30$1,100,552
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-09-30$6,598,264
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-09-30$308,692
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-09-30$268,719
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-09-30$1,226,361
Other income not declared elsewhere2016-09-30$3,296
Administrative expenses (other) incurred2016-09-30$1,478,016
Liabilities. Value of operating payables at end of year2016-09-30$333,762
Liabilities. Value of operating payables at beginning of year2016-09-30$385,905
Total non interest bearing cash at end of year2016-09-30$3,616,612
Total non interest bearing cash at beginning of year2016-09-30$3,398,681
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Value of net income/loss2016-09-30$2,872,025
Value of net assets at end of year (total assets less liabilities)2016-09-30$49,367,671
Value of net assets at beginning of year (total assets less liabilities)2016-09-30$46,495,646
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-09-30No
Were any leases to which the plan was party in default or uncollectible2016-09-30No
Investment advisory and management fees2016-09-30$118,350
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-09-30$41,665,998
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-09-30$38,530,306
Income. Interest from corporate debt instruments2016-09-30$273,621
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-09-30$246,980
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-09-30$219,319
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-09-30$219,319
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-09-30$299
Expenses. Payments to insurance carriers foe the provision of benefits2016-09-30$42,928,123
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-09-30$2,218,709
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-09-30No
Was there a failure to transmit to the plan any participant contributions2016-09-30No
Has the plan failed to provide any benefit when due under the plan2016-09-30No
Contributions received in cash from employer2016-09-30$49,368,172
Employer contributions (assets) at end of year2016-09-30$28,870
Employer contributions (assets) at beginning of year2016-09-30$51,940
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-09-30$223,211
Asset. Corporate debt instrument debt (other) at end of year2016-09-30$4,709,380
Asset. Corporate debt instrument debt (other) at beginning of year2016-09-30$4,494,464
Liabilities. Value of benefit claims payable at end of year2016-09-30$5,593,999
Liabilities. Value of benefit claims payable at beginning of year2016-09-30$4,288,376
Assets. Value of buildings and other operty used in plan operation at end of year2016-09-30$298,982
Assets. Value of buildings and other operty used in plan operation at beginning of year2016-09-30$329,744
Did the plan have assets held for investment2016-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-09-30No
Aggregate proceeds on sale of assets2016-09-30$3,072,823
Aggregate carrying amount (costs) on sale of assets2016-09-30$3,137,474
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-09-30No
Opinion of an independent qualified public accountant for this plan2016-09-30Unqualified
Accountancy firm name2016-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2016-09-30270889793
2015 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-09-30$480,672
Total unrealized appreciation/depreciation of assets2015-09-30$480,672
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$5,900,642
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-09-30$5,590,735
Total income from all sources (including contributions)2015-09-30$52,315,154
Total loss/gain on sale of assets2015-09-30$-23,925
Total of all expenses incurred2015-09-30$49,963,639
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-09-30$48,379,761
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-09-30$51,260,488
Value of total assets at end of year2015-09-30$52,396,288
Value of total assets at beginning of year2015-09-30$49,734,866
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-09-30$1,583,878
Total interest from all sources2015-09-30$270,449
Total dividends received (eg from common stock, registered investment company shares)2015-09-30$899,899
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2015-09-30$899,899
Assets. Real estate other than employer real property at end of year2015-09-30$5,103,115
Assets. Real estate other than employer real property at beginning of year2015-09-30$4,435,014
Administrative expenses professional fees incurred2015-09-30$138,234
Was this plan covered by a fidelity bond2015-09-30Yes
Value of fidelity bond cover2015-09-30$500,000
Were there any nonexempt tranactions with any party-in-interest2015-09-30No
Contributions received from participants2015-09-30$1,256,548
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-09-30$6,181,610
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-09-30$268,719
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-09-30$207,322
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-09-30$1,226,361
Other income not declared elsewhere2015-09-30$16,796
Administrative expenses (other) incurred2015-09-30$1,336,760
Liabilities. Value of operating payables at end of year2015-09-30$385,905
Liabilities. Value of operating payables at beginning of year2015-09-30$501,664
Total non interest bearing cash at end of year2015-09-30$3,398,681
Total non interest bearing cash at beginning of year2015-09-30$4,826,973
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Value of net income/loss2015-09-30$2,351,515
Value of net assets at end of year (total assets less liabilities)2015-09-30$46,495,646
Value of net assets at beginning of year (total assets less liabilities)2015-09-30$44,144,131
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-09-30No
Were any leases to which the plan was party in default or uncollectible2015-09-30No
Investment advisory and management fees2015-09-30$108,884
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-09-30$38,530,306
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-09-30$35,926,240
Income. Interest from corporate debt instruments2015-09-30$270,374
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-09-30$219,319
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-09-30$17,878
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-09-30$17,878
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-09-30$75
Expenses. Payments to insurance carriers foe the provision of benefits2015-09-30$41,959,260
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-09-30$-589,225
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-09-30No
Was there a failure to transmit to the plan any participant contributions2015-09-30No
Has the plan failed to provide any benefit when due under the plan2015-09-30No
Contributions received in cash from employer2015-09-30$50,003,940
Employer contributions (assets) at end of year2015-09-30$51,940
Employer contributions (assets) at beginning of year2015-09-30$34,942
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-09-30$238,891
Asset. Corporate debt instrument debt (other) at end of year2015-09-30$4,494,464
Asset. Corporate debt instrument debt (other) at beginning of year2015-09-30$3,945,155
Liabilities. Value of benefit claims payable at end of year2015-09-30$4,288,376
Liabilities. Value of benefit claims payable at beginning of year2015-09-30$3,862,710
Assets. Value of buildings and other operty used in plan operation at end of year2015-09-30$329,744
Assets. Value of buildings and other operty used in plan operation at beginning of year2015-09-30$341,342
Did the plan have assets held for investment2015-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-09-30No
Aggregate proceeds on sale of assets2015-09-30$2,199,936
Aggregate carrying amount (costs) on sale of assets2015-09-30$2,223,861
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-09-30No
Opinion of an independent qualified public accountant for this plan2015-09-30Unqualified
Accountancy firm name2015-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2015-09-30270889793
2014 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-09-30$268,928
Total unrealized appreciation/depreciation of assets2014-09-30$268,928
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$5,590,735
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-09-30$4,791,184
Total income from all sources (including contributions)2014-09-30$53,709,148
Total loss/gain on sale of assets2014-09-30$-8,701
Total of all expenses incurred2014-09-30$49,360,577
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-09-30$47,701,867
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-09-30$50,246,273
Value of total assets at end of year2014-09-30$49,734,866
Value of total assets at beginning of year2014-09-30$44,586,744
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-09-30$1,658,710
Total interest from all sources2014-09-30$207,446
Total dividends received (eg from common stock, registered investment company shares)2014-09-30$765,615
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2014-09-30$765,615
Assets. Real estate other than employer real property at end of year2014-09-30$4,435,014
Assets. Real estate other than employer real property at beginning of year2014-09-30$0
Administrative expenses professional fees incurred2014-09-30$180,132
Was this plan covered by a fidelity bond2014-09-30Yes
Value of fidelity bond cover2014-09-30$500,000
Were there any nonexempt tranactions with any party-in-interest2014-09-30No
Contributions received from participants2014-09-30$1,289,187
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2014-09-30$6,174,784
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-09-30$207,322
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-09-30$332,464
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-09-30$1,226,361
Other income not declared elsewhere2014-09-30$4,973
Administrative expenses (other) incurred2014-09-30$1,392,538
Liabilities. Value of operating payables at end of year2014-09-30$501,664
Liabilities. Value of operating payables at beginning of year2014-09-30$62,314
Total non interest bearing cash at end of year2014-09-30$4,826,973
Total non interest bearing cash at beginning of year2014-09-30$4,484,908
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Value of net income/loss2014-09-30$4,348,571
Value of net assets at end of year (total assets less liabilities)2014-09-30$44,144,131
Value of net assets at beginning of year (total assets less liabilities)2014-09-30$39,795,560
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-09-30No
Were any leases to which the plan was party in default or uncollectible2014-09-30No
Investment advisory and management fees2014-09-30$86,040
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-09-30$35,926,240
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-09-30$39,373,789
Income. Interest from corporate debt instruments2014-09-30$207,346
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-09-30$17,878
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-09-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-09-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-09-30$100
Expenses. Payments to insurance carriers foe the provision of benefits2014-09-30$41,260,160
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-09-30$2,224,614
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-09-30Yes
Was there a failure to transmit to the plan any participant contributions2014-09-30No
Has the plan failed to provide any benefit when due under the plan2014-09-30No
Contributions received in cash from employer2014-09-30$48,957,086
Employer contributions (assets) at end of year2014-09-30$34,942
Employer contributions (assets) at beginning of year2014-09-30$46,799
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-09-30$266,923
Asset. Corporate debt instrument debt (other) at end of year2014-09-30$3,945,155
Asset. Corporate debt instrument debt (other) at beginning of year2014-09-30$0
Liabilities. Value of benefit claims payable at end of year2014-09-30$3,862,710
Liabilities. Value of benefit claims payable at beginning of year2014-09-30$3,502,509
Assets. Value of buildings and other operty used in plan operation at end of year2014-09-30$341,342
Assets. Value of buildings and other operty used in plan operation at beginning of year2014-09-30$348,784
Did the plan have assets held for investment2014-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-09-30No
Aggregate proceeds on sale of assets2014-09-30$5,607,508
Aggregate carrying amount (costs) on sale of assets2014-09-30$5,616,209
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-09-30No
Opinion of an independent qualified public accountant for this plan2014-09-30Unqualified
Accountancy firm name2014-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2014-09-30270889793
2013 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$4,791,184
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-09-30$4,866,206
Total income from all sources (including contributions)2013-09-30$49,030,875
Total loss/gain on sale of assets2013-09-30$0
Total of all expenses incurred2013-09-30$45,821,709
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-09-30$44,768,299
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-09-30$47,031,478
Value of total assets at end of year2013-09-30$44,586,744
Value of total assets at beginning of year2013-09-30$41,452,600
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-09-30$1,053,410
Total interest from all sources2013-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2013-09-30$973,566
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2013-09-30$973,566
Administrative expenses professional fees incurred2013-09-30$144,318
Was this plan covered by a fidelity bond2013-09-30Yes
Value of fidelity bond cover2013-09-30$500,000
Were there any nonexempt tranactions with any party-in-interest2013-09-30No
Contributions received from participants2013-09-30$1,327,902
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2013-09-30$5,384,500
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-09-30$332,464
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-09-30$132,009
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2013-09-30$1,226,361
Other income not declared elsewhere2013-09-30$4,383
Administrative expenses (other) incurred2013-09-30$894,092
Liabilities. Value of operating payables at end of year2013-09-30$62,314
Liabilities. Value of operating payables at beginning of year2013-09-30$40,404
Total non interest bearing cash at end of year2013-09-30$4,484,908
Total non interest bearing cash at beginning of year2013-09-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Value of net income/loss2013-09-30$3,209,166
Value of net assets at end of year (total assets less liabilities)2013-09-30$39,795,560
Value of net assets at beginning of year (total assets less liabilities)2013-09-30$36,586,394
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-09-30No
Were any leases to which the plan was party in default or uncollectible2013-09-30No
Investment advisory and management fees2013-09-30$15,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-09-30$39,373,789
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-09-30$38,978,775
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-09-30$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-09-30$2,033,246
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-09-30$2,033,246
Expenses. Payments to insurance carriers foe the provision of benefits2013-09-30$39,088,705
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-09-30$1,021,448
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-09-30Yes
Was there a failure to transmit to the plan any participant contributions2013-09-30No
Has the plan failed to provide any benefit when due under the plan2013-09-30No
Contributions received in cash from employer2013-09-30$45,703,576
Employer contributions (assets) at end of year2013-09-30$46,799
Employer contributions (assets) at beginning of year2013-09-30$30,324
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-09-30$295,094
Liabilities. Value of benefit claims payable at end of year2013-09-30$3,502,509
Liabilities. Value of benefit claims payable at beginning of year2013-09-30$3,599,441
Assets. Value of buildings and other operty used in plan operation at end of year2013-09-30$348,784
Assets. Value of buildings and other operty used in plan operation at beginning of year2013-09-30$278,246
Did the plan have assets held for investment2013-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-09-30No
Opinion of an independent qualified public accountant for this plan2013-09-30Unqualified
Accountancy firm name2013-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2013-09-30270889793
2012 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$4,866,206
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-09-30$4,764,452
Total income from all sources (including contributions)2012-09-30$48,291,845
Total loss/gain on sale of assets2012-09-30$0
Total of all expenses incurred2012-09-30$46,498,109
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-09-30$45,501,606
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-09-30$44,593,645
Value of total assets at end of year2012-09-30$41,452,600
Value of total assets at beginning of year2012-09-30$39,557,110
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-09-30$996,503
Total interest from all sources2012-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2012-09-30$1,033,574
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2012-09-30$1,033,574
Administrative expenses professional fees incurred2012-09-30$122,330
Was this plan covered by a fidelity bond2012-09-30Yes
Value of fidelity bond cover2012-09-30$500,000
Were there any nonexempt tranactions with any party-in-interest2012-09-30No
Contributions received from participants2012-09-30$1,357,116
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2012-09-30$5,601,460
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-09-30$132,009
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-09-30$419,379
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2012-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2012-09-30$1,226,361
Other income not declared elsewhere2012-09-30$15,117
Administrative expenses (other) incurred2012-09-30$866,673
Liabilities. Value of operating payables at end of year2012-09-30$40,404
Liabilities. Value of operating payables at beginning of year2012-09-30$42,794
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Value of net income/loss2012-09-30$1,793,736
Value of net assets at end of year (total assets less liabilities)2012-09-30$36,586,394
Value of net assets at beginning of year (total assets less liabilities)2012-09-30$34,792,658
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-09-30No
Were any leases to which the plan was party in default or uncollectible2012-09-30No
Investment advisory and management fees2012-09-30$7,500
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-09-30$38,978,775
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-09-30$36,545,691
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-09-30$2,033,246
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-09-30$1,662,774
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-09-30$1,662,774
Expenses. Payments to insurance carriers foe the provision of benefits2012-09-30$39,606,789
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-09-30$2,649,509
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-09-30No
Was there a failure to transmit to the plan any participant contributions2012-09-30No
Has the plan failed to provide any benefit when due under the plan2012-09-30No
Contributions received in cash from employer2012-09-30$43,236,529
Employer contributions (assets) at end of year2012-09-30$30,324
Employer contributions (assets) at beginning of year2012-09-30$65,862
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-09-30$293,357
Liabilities. Value of benefit claims payable at end of year2012-09-30$3,599,441
Liabilities. Value of benefit claims payable at beginning of year2012-09-30$3,495,297
Assets. Value of buildings and other operty used in plan operation at end of year2012-09-30$278,246
Assets. Value of buildings and other operty used in plan operation at beginning of year2012-09-30$863,404
Did the plan have assets held for investment2012-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-09-30No
Opinion of an independent qualified public accountant for this plan2012-09-30Unqualified
Accountancy firm name2012-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2012-09-30270889793
2011 : UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-09-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-09-30$4,764,452
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-09-30$3,523,823
Total income from all sources (including contributions)2011-09-30$44,054,547
Total loss/gain on sale of assets2011-09-30$0
Total of all expenses incurred2011-09-30$45,213,188
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-09-30$44,054,926
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-09-30$42,781,333
Value of total assets at end of year2011-09-30$39,557,110
Value of total assets at beginning of year2011-09-30$39,475,122
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-09-30$1,158,262
Total interest from all sources2011-09-30$0
Total dividends received (eg from common stock, registered investment company shares)2011-09-30$1,048,819
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-09-30No
Total dividends received from registered investment company shares (eg mutual funds)2011-09-30$1,048,819
Administrative expenses professional fees incurred2011-09-30$110,589
Was this plan covered by a fidelity bond2011-09-30Yes
Value of fidelity bond cover2011-09-30$500,000
Were there any nonexempt tranactions with any party-in-interest2011-09-30No
Contributions received from participants2011-09-30$2,207,916
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-09-30$5,589,714
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-09-30$419,379
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-09-30$402,854
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2011-09-30$1,226,361
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2011-09-30$930,233
Other income not declared elsewhere2011-09-30$6,454
Administrative expenses (other) incurred2011-09-30$1,042,673
Liabilities. Value of operating payables at end of year2011-09-30$42,794
Liabilities. Value of operating payables at beginning of year2011-09-30$54,108
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Value of net income/loss2011-09-30$-1,158,641
Value of net assets at end of year (total assets less liabilities)2011-09-30$34,792,658
Value of net assets at beginning of year (total assets less liabilities)2011-09-30$35,951,299
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-09-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-09-30No
Were any leases to which the plan was party in default or uncollectible2011-09-30No
Investment advisory and management fees2011-09-30$5,000
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-09-30$36,545,691
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-09-30$34,978,932
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-09-30$1,662,774
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-09-30$2,208,168
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-09-30$2,208,168
Expenses. Payments to insurance carriers foe the provision of benefits2011-09-30$38,140,518
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-09-30$217,941
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-09-30Yes
Was there a failure to transmit to the plan any participant contributions2011-09-30No
Has the plan failed to provide any benefit when due under the plan2011-09-30No
Contributions received in cash from employer2011-09-30$40,573,417
Employer contributions (assets) at end of year2011-09-30$65,862
Employer contributions (assets) at beginning of year2011-09-30$553,115
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-09-30$324,694
Liabilities. Value of benefit claims payable at end of year2011-09-30$3,495,297
Liabilities. Value of benefit claims payable at beginning of year2011-09-30$2,539,482
Assets. Value of buildings and other operty used in plan operation at end of year2011-09-30$863,404
Assets. Value of buildings and other operty used in plan operation at beginning of year2011-09-30$1,332,053
Did the plan have assets held for investment2011-09-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-09-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-09-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-09-30No
Opinion of an independent qualified public accountant for this plan2011-09-30Unqualified
Accountancy firm name2011-09-30DICLAUDIO & KRAMER, LLC
Accountancy firm EIN2011-09-30270889793

Form 5500 Responses for UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND

2022: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2022 form 5500 responses
2022-10-01Type of plan entityMulti-employer plan
2022-10-01Submission has been amendedNo
2022-10-01This submission is the final filingNo
2022-10-01This return/report is a short plan year return/report (less than 12 months)No
2022-10-01Plan is a collectively bargained planYes
2022-10-01Plan funding arrangement – TrustYes
2022-10-01Plan benefit arrangement – InsuranceYes
2022-10-01Plan benefit arrangement - TrustYes
2021: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2021 form 5500 responses
2021-10-01Type of plan entityMulti-employer plan
2021-10-01Submission has been amendedNo
2021-10-01This submission is the final filingNo
2021-10-01This return/report is a short plan year return/report (less than 12 months)No
2021-10-01Plan is a collectively bargained planYes
2021-10-01Plan funding arrangement – TrustYes
2021-10-01Plan benefit arrangement – InsuranceYes
2021-10-01Plan benefit arrangement - TrustYes
2020: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2020 form 5500 responses
2020-10-01Type of plan entityMulti-employer plan
2020-10-01Submission has been amendedNo
2020-10-01This submission is the final filingNo
2020-10-01This return/report is a short plan year return/report (less than 12 months)No
2020-10-01Plan is a collectively bargained planYes
2020-10-01Plan funding arrangement – TrustYes
2020-10-01Plan benefit arrangement – InsuranceYes
2020-10-01Plan benefit arrangement - TrustYes
2019: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2019 form 5500 responses
2019-10-01Type of plan entityMulti-employer plan
2019-10-01Submission has been amendedNo
2019-10-01This submission is the final filingNo
2019-10-01This return/report is a short plan year return/report (less than 12 months)No
2019-10-01Plan is a collectively bargained planYes
2019-10-01Plan funding arrangement – TrustYes
2019-10-01Plan benefit arrangement – InsuranceYes
2019-10-01Plan benefit arrangement - TrustYes
2018: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2018 form 5500 responses
2018-10-01Type of plan entityMulti-employer plan
2018-10-01Submission has been amendedNo
2018-10-01This submission is the final filingNo
2018-10-01This return/report is a short plan year return/report (less than 12 months)No
2018-10-01Plan is a collectively bargained planYes
2018-10-01Plan funding arrangement – TrustYes
2018-10-01Plan benefit arrangement – InsuranceYes
2018-10-01Plan benefit arrangement - TrustYes
2017: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2017 form 5500 responses
2017-10-01Type of plan entityMulti-employer plan
2017-10-01Submission has been amendedNo
2017-10-01This submission is the final filingNo
2017-10-01This return/report is a short plan year return/report (less than 12 months)No
2017-10-01Plan is a collectively bargained planYes
2017-10-01Plan funding arrangement – TrustYes
2017-10-01Plan benefit arrangement – InsuranceYes
2017-10-01Plan benefit arrangement - TrustYes
2016: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2016 form 5500 responses
2016-10-01Type of plan entityMulti-employer plan
2016-10-01Submission has been amendedNo
2016-10-01This submission is the final filingNo
2016-10-01This return/report is a short plan year return/report (less than 12 months)No
2016-10-01Plan is a collectively bargained planYes
2016-10-01Plan funding arrangement – TrustYes
2016-10-01Plan benefit arrangement – InsuranceYes
2016-10-01Plan benefit arrangement - TrustYes
2015: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2015 form 5500 responses
2015-10-01Type of plan entityMulti-employer plan
2015-10-01Submission has been amendedNo
2015-10-01This submission is the final filingNo
2015-10-01This return/report is a short plan year return/report (less than 12 months)No
2015-10-01Plan is a collectively bargained planYes
2015-10-01Plan funding arrangement – TrustYes
2015-10-01Plan benefit arrangement – InsuranceYes
2015-10-01Plan benefit arrangement - TrustYes
2014: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2014 form 5500 responses
2014-10-01Type of plan entityMulti-employer plan
2014-10-01Submission has been amendedNo
2014-10-01This submission is the final filingNo
2014-10-01This return/report is a short plan year return/report (less than 12 months)No
2014-10-01Plan is a collectively bargained planYes
2014-10-01Plan funding arrangement – TrustYes
2014-10-01Plan benefit arrangement – InsuranceYes
2014-10-01Plan benefit arrangement - TrustYes
2013: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2013 form 5500 responses
2013-10-01Type of plan entityMulti-employer plan
2013-10-01Submission has been amendedNo
2013-10-01This submission is the final filingNo
2013-10-01This return/report is a short plan year return/report (less than 12 months)No
2013-10-01Plan is a collectively bargained planYes
2013-10-01Plan funding arrangement – TrustYes
2013-10-01Plan benefit arrangement – InsuranceYes
2013-10-01Plan benefit arrangement - TrustYes
2012: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2012 form 5500 responses
2012-10-01Type of plan entityMulti-employer plan
2012-10-01Submission has been amendedNo
2012-10-01This submission is the final filingNo
2012-10-01This return/report is a short plan year return/report (less than 12 months)No
2012-10-01Plan is a collectively bargained planYes
2012-10-01Plan funding arrangement – TrustYes
2012-10-01Plan benefit arrangement – InsuranceYes
2012-10-01Plan benefit arrangement - TrustYes
2011: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2011 form 5500 responses
2011-10-01Type of plan entityMulti-employer plan
2011-10-01Submission has been amendedNo
2011-10-01This submission is the final filingNo
2011-10-01This return/report is a short plan year return/report (less than 12 months)No
2011-10-01Plan is a collectively bargained planYes
2011-10-01Plan funding arrangement – TrustYes
2011-10-01Plan benefit arrangement – InsuranceYes
2011-10-01Plan benefit arrangement - TrustYes
2010: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2010 form 5500 responses
2010-10-01Type of plan entityMulti-employer plan
2010-10-01Submission has been amendedNo
2010-10-01This submission is the final filingNo
2010-10-01This return/report is a short plan year return/report (less than 12 months)No
2010-10-01Plan is a collectively bargained planYes
2010-10-01Plan funding arrangement – TrustYes
2010-10-01Plan benefit arrangement – InsuranceYes
2010-10-01Plan benefit arrangement - TrustYes
2009: UFCW LOCAL 23 AND EMPLOYERS HEALTH FUND 2009 form 5500 responses
2009-10-01Type of plan entityMulti-employer plan
2009-10-01Submission has been amendedNo
2009-10-01This submission is the final filingNo
2009-10-01This return/report is a short plan year return/report (less than 12 months)No
2009-10-01Plan is a collectively bargained planYes
2009-10-01Plan funding arrangement – TrustYes
2009-10-01Plan benefit arrangement – InsuranceYes
2009-10-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HIGHMARK BLUE SHIELD (National Association of Insurance Commissioners NAIC id number: 54771 )
Policy contract number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered164
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE / KHPW-HMO
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $533,902
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered5080
Insurance policy start date2022-10-01
Insurance policy end date2023-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $210,551
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered180
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE / KHPW-HMO
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $584,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered5196
Insurance policy start date2021-10-01
Insurance policy end date2022-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $208,269
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered5238
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $213,595
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered191
Insurance policy start date2020-10-01
Insurance policy end date2021-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE / KHPW-HMO
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $548,751
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered197
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE / KHPW-HMO
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $697,910
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered5365
Insurance policy start date2019-10-01
Insurance policy end date2020-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $211,118
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered5410
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $212,978
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered204
Insurance policy start date2018-10-01
Insurance policy end date2019-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE / KHPW-HMO
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,054,739
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered5852
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $204,102
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered385
Insurance policy start date2017-10-01
Insurance policy end date2018-09-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE / KHPW-HMO
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,748,328
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered6729
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $233,484
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered350
Insurance policy start date2014-10-01
Insurance policy end date2015-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE / KHPW-HMO
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,661,418
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered370
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,590,583
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered6944
Insurance policy start date2013-10-01
Insurance policy end date2014-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $220,197
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered6964
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $189,902
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered366
Insurance policy start date2012-10-01
Insurance policy end date2013-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,420,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered7034
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $194,447
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered375
Insurance policy start date2011-10-01
Insurance policy end date2012-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,324,000
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 number028241
Policy instance 2
Insurance contract or identification number028241
Number of Individuals Covered377
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedFREEDOM BLUE
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $1,275,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberMG19135
Policy instance 1
Insurance contract or identification numberMG19135
Number of Individuals Covered6962
Insurance policy start date2010-10-01
Insurance policy end date2011-09-30
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedPOOLED AD & D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $184,757
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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