SHIPLEY STORES, LLC has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan SHIPLEY STORES, LLC GROUP HEALTH PLAN
| Measure | Date | Value |
|---|
| 2020: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-01-01 | 3 |
| Total number of active participants reported on line 7a of the Form 5500 | 2020-01-01 | 0 |
| Number of retired or separated participants receiving benefits | 2020-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2020-01-01 | 0 |
| Total of all active and inactive participants | 2020-01-01 | 0 |
| Number of employers contributing to the scheme | 2020-01-01 | 0 |
| 2019: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-01-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-01-01 | 39 |
| Number of retired or separated participants receiving benefits | 2019-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2019-01-01 | 0 |
| Total of all active and inactive participants | 2019-01-01 | 39 |
| Number of employers contributing to the scheme | 2019-01-01 | 0 |
| 2018: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-01-01 | 62 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-01-01 | 38 |
| Number of retired or separated participants receiving benefits | 2018-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2018-01-01 | 0 |
| Total of all active and inactive participants | 2018-01-01 | 39 |
| Number of employers contributing to the scheme | 2018-01-01 | 0 |
| 2017: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-01-01 | 35 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-01-01 | 38 |
| Number of retired or separated participants receiving benefits | 2017-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2017-01-01 | 0 |
| Total of all active and inactive participants | 2017-01-01 | 38 |
| 2016: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-01-01 | 39 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-01-01 | 31 |
| Number of retired or separated participants receiving benefits | 2016-01-01 | 4 |
| Number of other retired or separated participants entitled to future benefits | 2016-01-01 | 0 |
| Total of all active and inactive participants | 2016-01-01 | 35 |
| 2015: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-01-01 | 29 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-01-01 | 39 |
| Number of retired or separated participants receiving benefits | 2015-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2015-01-01 | 0 |
| Total of all active and inactive participants | 2015-01-01 | 39 |
| 2014: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-01-01 | 30 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-01-01 | 29 |
| Number of retired or separated participants receiving benefits | 2014-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2014-01-01 | 0 |
| Total of all active and inactive participants | 2014-01-01 | 29 |
| 2013: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-01-01 | 26 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-01-01 | 23 |
| Number of retired or separated participants receiving benefits | 2013-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2013-01-01 | 0 |
| Total of all active and inactive participants | 2013-01-01 | 23 |
| 2012: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-01-01 | 50 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-01-01 | 25 |
| Number of retired or separated participants receiving benefits | 2012-01-01 | 1 |
| Number of other retired or separated participants entitled to future benefits | 2012-01-01 | 0 |
| Total of all active and inactive participants | 2012-01-01 | 26 |
| 2011: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-01-01 | 51 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-01-01 | 50 |
| Number of retired or separated participants receiving benefits | 2011-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2011-01-01 | 0 |
| Total of all active and inactive participants | 2011-01-01 | 50 |
| 2010: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-01-01 | 51 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-01-01 | 51 |
| Number of retired or separated participants receiving benefits | 2010-01-01 | 0 |
| Number of other retired or separated participants entitled to future benefits | 2010-01-01 | 0 |
| Total of all active and inactive participants | 2010-01-01 | 51 |
| Measure | Date | Value |
|---|
| 2020 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2020 401k financial data |
|---|
| Transfers to/from the plan | 2020-12-31 | $24,097 |
| Total plan liabilities at end of year | 2020-12-31 | $0 |
| Total plan liabilities at beginning of year | 2020-12-31 | $27,383 |
| Total plan assets at end of year | 2020-12-31 | $0 |
| Total plan assets at beginning of year | 2020-12-31 | $3,286 |
| Value of fidelity bond covering the plan | 2020-12-31 | $500,000 |
| Net plan assets at end of year (total assets less liabilities) | 2020-12-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-12-31 | $-24,097 |
| 2019 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2019 401k financial data |
|---|
| Total plan liabilities at end of year | 2019-12-31 | $27,383 |
| Total plan liabilities at beginning of year | 2019-12-31 | $30,397 |
| Total income from all sources | 2019-12-31 | $267,301 |
| Expenses. Total of all expenses incurred | 2019-12-31 | $266,247 |
| Benefits paid (including direct rollovers) | 2019-12-31 | $244,935 |
| Total plan assets at end of year | 2019-12-31 | $3,286 |
| Total plan assets at beginning of year | 2019-12-31 | $5,246 |
| Value of fidelity bond covering the plan | 2019-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2019-12-31 | $13,344 |
| Other income received | 2019-12-31 | $5,553 |
| Net income (gross income less expenses) | 2019-12-31 | $1,054 |
| Net plan assets at end of year (total assets less liabilities) | 2019-12-31 | $-24,097 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-12-31 | $-25,151 |
| Total contributions received or receivable from employer(s) | 2019-12-31 | $248,404 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2019-12-31 | $21,312 |
| 2018 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-12-31 | $30,397 |
| Total plan liabilities at beginning of year | 2018-12-31 | $38,119 |
| Total income from all sources | 2018-12-31 | $415,044 |
| Expenses. Total of all expenses incurred | 2018-12-31 | $404,897 |
| Benefits paid (including direct rollovers) | 2018-12-31 | $374,974 |
| Total plan assets at end of year | 2018-12-31 | $5,246 |
| Total plan assets at beginning of year | 2018-12-31 | $2,821 |
| Value of fidelity bond covering the plan | 2018-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2018-12-31 | $49,990 |
| Expenses. Other expenses not covered elsewhere | 2018-12-31 | $0 |
| Contributions received from other sources (not participants or employers) | 2018-12-31 | $0 |
| Other income received | 2018-12-31 | $6,129 |
| Noncash contributions received | 2018-12-31 | $0 |
| Net income (gross income less expenses) | 2018-12-31 | $10,147 |
| Net plan assets at end of year (total assets less liabilities) | 2018-12-31 | $-25,151 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-12-31 | $-35,298 |
| Total contributions received or receivable from employer(s) | 2018-12-31 | $358,925 |
| Value of certain deemed distributions of participant loans | 2018-12-31 | $0 |
| Value of corrective distributions | 2018-12-31 | $0 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2018-12-31 | $29,923 |
| 2017 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-12-31 | $38,119 |
| Total plan liabilities at beginning of year | 2017-12-31 | $33,133 |
| Total income from all sources | 2017-12-31 | $522,873 |
| Expenses. Total of all expenses incurred | 2017-12-31 | $543,607 |
| Benefits paid (including direct rollovers) | 2017-12-31 | $505,847 |
| Total plan assets at end of year | 2017-12-31 | $2,821 |
| Total plan assets at beginning of year | 2017-12-31 | $18,569 |
| Value of fidelity bond covering the plan | 2017-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2017-12-31 | $75,214 |
| Other income received | 2017-12-31 | $2,372 |
| Net income (gross income less expenses) | 2017-12-31 | $-20,734 |
| Net plan assets at end of year (total assets less liabilities) | 2017-12-31 | $-35,298 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-12-31 | $-14,564 |
| Total contributions received or receivable from employer(s) | 2017-12-31 | $445,287 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2017-12-31 | $37,760 |
| 2016 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-12-31 | $33,133 |
| Total plan liabilities at beginning of year | 2016-12-31 | $24,374 |
| Total income from all sources | 2016-12-31 | $228,227 |
| Expenses. Total of all expenses incurred | 2016-12-31 | $249,130 |
| Benefits paid (including direct rollovers) | 2016-12-31 | $209,328 |
| Total plan assets at end of year | 2016-12-31 | $18,569 |
| Total plan assets at beginning of year | 2016-12-31 | $30,713 |
| Value of fidelity bond covering the plan | 2016-12-31 | $500,000 |
| Total contributions received or receivable from participants | 2016-12-31 | $84,248 |
| Other income received | 2016-12-31 | $301 |
| Net income (gross income less expenses) | 2016-12-31 | $-20,903 |
| Net plan assets at end of year (total assets less liabilities) | 2016-12-31 | $-14,564 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-12-31 | $6,339 |
| Total contributions received or receivable from employer(s) | 2016-12-31 | $143,678 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2016-12-31 | $39,802 |
| 2015 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-12-31 | $24,374 |
| Total plan liabilities at beginning of year | 2015-12-31 | $80,910 |
| Total income from all sources | 2015-12-31 | $122,736 |
| Expenses. Total of all expenses incurred | 2015-12-31 | $36,084 |
| Benefits paid (including direct rollovers) | 2015-12-31 | $9,204 |
| Total plan assets at end of year | 2015-12-31 | $30,713 |
| Total plan assets at beginning of year | 2015-12-31 | $597 |
| Value of fidelity bond covering the plan | 2015-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2015-12-31 | $49,904 |
| Other income received | 2015-12-31 | $41 |
| Net income (gross income less expenses) | 2015-12-31 | $86,652 |
| Net plan assets at end of year (total assets less liabilities) | 2015-12-31 | $6,339 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-12-31 | $-80,313 |
| Total contributions received or receivable from employer(s) | 2015-12-31 | $72,791 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2015-12-31 | $26,880 |
| 2014 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-12-31 | $80,910 |
| Total plan liabilities at beginning of year | 2014-12-31 | $50,685 |
| Total income from all sources | 2014-12-31 | $454,589 |
| Expenses. Total of all expenses incurred | 2014-12-31 | $485,543 |
| Benefits paid (including direct rollovers) | 2014-12-31 | $459,163 |
| Total plan assets at end of year | 2014-12-31 | $597 |
| Total plan assets at beginning of year | 2014-12-31 | $1,326 |
| Value of fidelity bond covering the plan | 2014-12-31 | $1,000,000 |
| Total contributions received or receivable from participants | 2014-12-31 | $67,988 |
| Other income received | 2014-12-31 | $30 |
| Net income (gross income less expenses) | 2014-12-31 | $-30,954 |
| Net plan assets at end of year (total assets less liabilities) | 2014-12-31 | $-80,313 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-12-31 | $-49,359 |
| Total contributions received or receivable from employer(s) | 2014-12-31 | $386,571 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2014-12-31 | $26,380 |
| 2013 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-12-31 | $50,685 |
| Total plan liabilities at beginning of year | 2013-12-31 | $16,210 |
| Total income from all sources | 2013-12-31 | $352,952 |
| Expenses. Total of all expenses incurred | 2013-12-31 | $386,101 |
| Benefits paid (including direct rollovers) | 2013-12-31 | $363,788 |
| Total plan assets at end of year | 2013-12-31 | $1,326 |
| Total plan assets at beginning of year | 2013-12-31 | $0 |
| Total contributions received or receivable from participants | 2013-12-31 | $75,201 |
| Other income received | 2013-12-31 | $50 |
| Net income (gross income less expenses) | 2013-12-31 | $-33,149 |
| Net plan assets at end of year (total assets less liabilities) | 2013-12-31 | $-49,359 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-12-31 | $-16,210 |
| Total contributions received or receivable from employer(s) | 2013-12-31 | $277,701 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2013-12-31 | $22,313 |
| 2012 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-12-31 | $16,210 |
| Total plan liabilities at beginning of year | 2012-12-31 | $29,910 |
| Total income from all sources | 2012-12-31 | $257,300 |
| Expenses. Total of all expenses incurred | 2012-12-31 | $243,600 |
| Benefits paid (including direct rollovers) | 2012-12-31 | $215,667 |
| Total contributions received or receivable from participants | 2012-12-31 | $71,212 |
| Other income received | 2012-12-31 | $168 |
| Net income (gross income less expenses) | 2012-12-31 | $13,700 |
| Net plan assets at end of year (total assets less liabilities) | 2012-12-31 | $-16,210 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-12-31 | $-29,910 |
| Total contributions received or receivable from employer(s) | 2012-12-31 | $185,920 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2012-12-31 | $27,933 |
| 2011 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-12-31 | $29,910 |
| Total plan liabilities at beginning of year | 2011-12-31 | $102,279 |
| Total income from all sources | 2011-12-31 | $448,566 |
| Expenses. Total of all expenses incurred | 2011-12-31 | $376,197 |
| Benefits paid (including direct rollovers) | 2011-12-31 | $334,606 |
| Total contributions received or receivable from participants | 2011-12-31 | $120,452 |
| Other income received | 2011-12-31 | $128 |
| Net income (gross income less expenses) | 2011-12-31 | $72,369 |
| Net plan assets at end of year (total assets less liabilities) | 2011-12-31 | $-29,910 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-12-31 | $-102,279 |
| Total contributions received or receivable from employer(s) | 2011-12-31 | $327,986 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2011-12-31 | $41,591 |
| 2010 : SHIPLEY STORES, LLC GROUP HEALTH PLAN 2010 401k financial data |
|---|
| Total plan liabilities at end of year | 2010-12-31 | $102,279 |
| Total income from all sources | 2010-12-31 | $493,468 |
| Expenses. Total of all expenses incurred | 2010-12-31 | $595,747 |
| Benefits paid (including direct rollovers) | 2010-12-31 | $485,652 |
| Total contributions received or receivable from participants | 2010-12-31 | $117,491 |
| Expenses. Other expenses not covered elsewhere | 2010-12-31 | $71,102 |
| Other income received | 2010-12-31 | $73 |
| Net income (gross income less expenses) | 2010-12-31 | $-102,279 |
| Net plan assets at end of year (total assets less liabilities) | 2010-12-31 | $-102,279 |
| Net plan assets at beginning of year (total assets less liabilities) | 2010-12-31 | $0 |
| Total contributions received or receivable from employer(s) | 2010-12-31 | $375,904 |
| Expenses. Administrative service providers (salaries,fees and commissions) | 2010-12-31 | $38,993 |
| 2020: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2020 form 5500 responses |
|---|
| 2020-01-01 | Type of plan entity | Single employer plan |
| 2020-01-01 | This submission is the final filing | Yes |
| 2020-01-01 | Plan funding arrangement – Insurance | Yes |
| 2020-01-01 | Plan funding arrangement – Trust | Yes |
| 2020-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2020-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-01-01 | Plan benefit arrangement - Trust | Yes |
| 2020-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2019: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2019 form 5500 responses |
|---|
| 2019-01-01 | Type of plan entity | Single employer plan |
| 2019-01-01 | Plan funding arrangement – Insurance | Yes |
| 2019-01-01 | Plan funding arrangement – Trust | Yes |
| 2019-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2019-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-01-01 | Plan benefit arrangement - Trust | Yes |
| 2019-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2018: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2018 form 5500 responses |
|---|
| 2018-01-01 | Type of plan entity | Single employer plan |
| 2018-01-01 | Plan funding arrangement – Insurance | Yes |
| 2018-01-01 | Plan funding arrangement – Trust | Yes |
| 2018-01-01 | Plan funding arrangement – General assets of the sponsor | Yes |
| 2018-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-01-01 | Plan benefit arrangement - Trust | Yes |
| 2018-01-01 | Plan benefit arrangement – General assets of the sponsor | Yes |
| 2017: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2017 form 5500 responses |
|---|
| 2017-01-01 | Type of plan entity | Single employer plan |
| 2017-01-01 | Submission has been amended | No |
| 2017-01-01 | This submission is the final filing | No |
| 2017-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2017-01-01 | Plan is a collectively bargained plan | No |
| 2017-01-01 | Plan funding arrangement – Insurance | Yes |
| 2017-01-01 | Plan funding arrangement – Trust | Yes |
| 2017-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-01-01 | Plan benefit arrangement - Trust | Yes |
| 2016: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2016 form 5500 responses |
|---|
| 2016-01-01 | Type of plan entity | Single employer plan |
| 2016-01-01 | Submission has been amended | No |
| 2016-01-01 | This submission is the final filing | No |
| 2016-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2016-01-01 | Plan is a collectively bargained plan | No |
| 2016-01-01 | Plan funding arrangement – Insurance | Yes |
| 2016-01-01 | Plan funding arrangement – Trust | Yes |
| 2016-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-01-01 | Plan benefit arrangement - Trust | Yes |
| 2015: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2015 form 5500 responses |
|---|
| 2015-01-01 | Type of plan entity | Single employer plan |
| 2015-01-01 | Submission has been amended | No |
| 2015-01-01 | This submission is the final filing | No |
| 2015-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2015-01-01 | Plan is a collectively bargained plan | No |
| 2015-01-01 | Plan funding arrangement – Insurance | Yes |
| 2015-01-01 | Plan funding arrangement – Trust | Yes |
| 2015-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-01-01 | Plan benefit arrangement - Trust | Yes |
| 2014: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2014 form 5500 responses |
|---|
| 2014-01-01 | Type of plan entity | Single employer plan |
| 2014-01-01 | Submission has been amended | No |
| 2014-01-01 | This submission is the final filing | No |
| 2014-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2014-01-01 | Plan is a collectively bargained plan | No |
| 2014-01-01 | Plan funding arrangement – Insurance | Yes |
| 2014-01-01 | Plan funding arrangement – Trust | Yes |
| 2014-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-01-01 | Plan benefit arrangement - Trust | Yes |
| 2013: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2013 form 5500 responses |
|---|
| 2013-01-01 | Type of plan entity | Single employer plan |
| 2013-01-01 | Submission has been amended | No |
| 2013-01-01 | This submission is the final filing | No |
| 2013-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2013-01-01 | Plan is a collectively bargained plan | No |
| 2013-01-01 | Plan funding arrangement – Insurance | Yes |
| 2013-01-01 | Plan funding arrangement – Trust | Yes |
| 2013-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-01-01 | Plan benefit arrangement - Trust | Yes |
| 2012: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2012 form 5500 responses |
|---|
| 2012-01-01 | Type of plan entity | Single employer plan |
| 2012-01-01 | Submission has been amended | No |
| 2012-01-01 | This submission is the final filing | No |
| 2012-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2012-01-01 | Plan is a collectively bargained plan | No |
| 2012-01-01 | Plan funding arrangement – Insurance | Yes |
| 2012-01-01 | Plan funding arrangement – Trust | Yes |
| 2012-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-01-01 | Plan benefit arrangement - Trust | Yes |
| 2011: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2011 form 5500 responses |
|---|
| 2011-01-01 | Type of plan entity | Single employer plan |
| 2011-01-01 | Submission has been amended | No |
| 2011-01-01 | This submission is the final filing | No |
| 2011-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2011-01-01 | Plan is a collectively bargained plan | No |
| 2011-01-01 | Plan funding arrangement – Insurance | Yes |
| 2011-01-01 | Plan funding arrangement – Trust | Yes |
| 2011-01-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-01-01 | Plan benefit arrangement - Trust | Yes |
| 2010: SHIPLEY STORES, LLC GROUP HEALTH PLAN 2010 form 5500 responses |
|---|
| 2010-01-01 | Type of plan entity | Single employer plan |
| 2010-01-01 | First time form 5500 has been submitted | Yes |
| 2010-01-01 | Submission has been amended | No |
| 2010-01-01 | This submission is the final filing | No |
| 2010-01-01 | This return/report is a short plan year return/report (less than 12 months) | No |
| 2010-01-01 | Plan is a collectively bargained plan | No |
| 2010-01-01 | Plan funding arrangement – Trust | Yes |
| 2010-01-01 | Plan benefit arrangement - Trust | Yes |
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-014733-000 |
| Policy instance | 1 |
| Insurance contract or identification number | 16-014733-000 | | Number of Individuals Covered | 231 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $13,154 | | Welfare Benefit Premiums Paid to Carrier | USD $652,559 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 13154 | | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | | Insurance broker organization code? | 3 |
|
| SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 16-014733-000 |
| Policy instance | 2 |
| Insurance contract or identification number | 16-014733-000 | | Number of Individuals Covered | 239 | | Insurance policy start date | 2019-04-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $5,358 | | Welfare Benefit Premiums Paid to Carrier | USD $370,231 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $0 | | Amount paid for insurance broker fees | 5358 | | Additional information about fees paid to insurance broker | GROUP VOLUME BONUS | | Insurance broker organization code? | 3 |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | SL30400027-181 |
| Policy instance | 1 |
| Insurance contract or identification number | SL30400027-181 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-03-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $32,144 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | SL30400027-181 |
| Policy instance | 1 |
| Insurance contract or identification number | SL30400027-181 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $122,070 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CONTINENTAL AMERICAN INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71730 ) |
| Policy contract number | 0000021943 |
| Policy instance | 2 |
| Insurance contract or identification number | 0000021943 | | Number of Individuals Covered | 0 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | SUPPLEMENTAL | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | KBP |
| Policy instance | 1 |
| Insurance contract or identification number | KBP | | Number of Individuals Covered | 38 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $120,028 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | KBP |
| Policy instance | 1 |
| Insurance contract or identification number | KBP | | Number of Individuals Covered | 39 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $89,352 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | KBP |
| Policy instance | 1 |
| Insurance contract or identification number | KBP | | Number of Individuals Covered | 29 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-03-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $13,333 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EVEREST REINSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 69019 ) |
| Policy contract number | KBP |
| Policy instance | 2 |
| Insurance contract or identification number | KBP | | Number of Individuals Covered | 29 | | Insurance policy start date | 2014-04-01 | | Insurance policy end date | 2014-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $38,394 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | KBP |
| Policy instance | 1 |
| Insurance contract or identification number | KBP | | Number of Individuals Covered | 23 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $64,014 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | KBP |
| Policy instance | 1 |
| Insurance contract or identification number | KBP | | Number of Individuals Covered | 26 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $73,760 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| EXCESS REINSURANCE UNDERWRITERS (National Association of Insurance Commissioners NAIC id number: 26921 ) |
| Policy contract number | KBP |
| Policy instance | 1 |
| Insurance contract or identification number | KBP | | Number of Individuals Covered | 50 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | 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 plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $83,616 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
