401k Plan data: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND plan

SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 401k Plan overview

Plan Name	SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND
Plan identification number	501

SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Temporary disability (accident and sickness) Long-term disability cover Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

BOARD OF TRUSTEES, SEIU LOCAL 721 EMPLOYEE BENEFITS has sponsored the creation of one or more 401k plans.

Company Name: BOARD OF TRUSTEES, SEIU LOCAL 721 EMPLOYEE BENEFITS

Employer identification number (EIN): 263902233

NAIC Classification: 921000

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2021-07-01
501 2020-07-01
501 2019-07-01
501 2018-07-01
501 2017-07-01
501 2016-07-01 MILLER KAPLAN ARASE LLP
501 2015-07-01 MILLER KAPLAN ARASE LLP MILLER KAPLAN ARASE LLP 2017-04-12
501 2014-07-01 MILLER KAPLAN ARASE LLP MILLER KAPLAN ARASE LLP 2016-04-15
501 2013-07-01 SANDY S. GARCIA SANDY S. GARCIA 2015-04-12
501 2012-07-01 SANDY S. GARCIA SANDY S. GARCIA 2014-04-09
501 2011-07-01 LINDA DENT ROBERT SCHOONOVER 2013-04-12
501 2010-07-01 ROBERT SCHOONOVER
501 2009-07-01 ROBERT SCHOONOVER

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
501	2021-07-01
501	2020-07-01
501	2019-07-01
501	2018-07-01
501	2017-07-01
501	2016-07-01	MILLER KAPLAN ARASE LLP
501	2015-07-01	MILLER KAPLAN ARASE LLP	MILLER KAPLAN ARASE LLP	2017-04-12
501	2014-07-01	MILLER KAPLAN ARASE LLP	MILLER KAPLAN ARASE LLP	2016-04-15
501	2013-07-01	SANDY S. GARCIA	SANDY S. GARCIA	2015-04-12
501	2012-07-01	SANDY S. GARCIA	SANDY S. GARCIA	2014-04-09
501	2011-07-01	LINDA DENT	ROBERT SCHOONOVER	2013-04-12
501	2010-07-01	ROBERT SCHOONOVER
501	2009-07-01	ROBERT SCHOONOVER

Plan Statistics for SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND

401k plan membership statisitcs for SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND

Measure Date Value
2021: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2021 401k membership
Total participants, beginning-of-year 2021-07-01 16,363
Total number of active participants reported on line 7a of the Form 5500 2021-07-01 14,280
Number of retired or separated participants receiving benefits 2021-07-01 1,081
Number of other retired or separated participants entitled to future benefits 2021-07-01 0
Total of all active and inactive participants 2021-07-01 15,361
Total participants 2021-07-01 15,361
Number of employers contributing to the scheme 2021-07-01 12
2020: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2020 401k membership
Total participants, beginning-of-year 2020-07-01 15,226
Total number of active participants reported on line 7a of the Form 5500 2020-07-01 15,170
Number of retired or separated participants receiving benefits 2020-07-01 1,193
Number of other retired or separated participants entitled to future benefits 2020-07-01 0
Total of all active and inactive participants 2020-07-01 16,363
Total participants 2020-07-01 16,363
Number of employers contributing to the scheme 2020-07-01 12
2019: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2019 401k membership
Total participants, beginning-of-year 2019-07-01 16,065
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 13,930
Number of retired or separated participants receiving benefits 2019-07-01 1,296
Number of other retired or separated participants entitled to future benefits 2019-07-01 0
Total of all active and inactive participants 2019-07-01 15,226
Total participants 2019-07-01 15,226
Number of employers contributing to the scheme 2019-07-01 12
2018: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2018 401k membership
Total participants, beginning-of-year 2018-07-01 17,595
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 14,444
Number of retired or separated participants receiving benefits 2018-07-01 1,621
Total of all active and inactive participants 2018-07-01 16,065
Total participants 2018-07-01 16,065
Number of employers contributing to the scheme 2018-07-01 12
2017: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2017 401k membership
Total participants, beginning-of-year 2017-07-01 16,911
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 14,944
Number of retired or separated participants receiving benefits 2017-07-01 0
Number of other retired or separated participants entitled to future benefits 2017-07-01 2,651
Total of all active and inactive participants 2017-07-01 17,595
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-07-01 0
Total participants 2017-07-01 17,595
Number of participants with account balances 2017-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-07-01 0
Number of employers contributing to the scheme 2017-07-01 12
2016: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2016 401k membership
Total participants, beginning-of-year 2016-07-01 16,748
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 13,897
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 3,014
Total of all active and inactive participants 2016-07-01 16,911
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-07-01 0
Total participants 2016-07-01 16,911
Number of participants with account balances 2016-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-07-01 0
Number of employers contributing to the scheme 2016-07-01 12
2015: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2015 401k membership
Total participants, beginning-of-year 2015-07-01 15,016
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 13,538
Number of other retired or separated participants entitled to future benefits 2015-07-01 3,210
Total of all active and inactive participants 2015-07-01 16,748
Total participants 2015-07-01 16,748
Number of employers contributing to the scheme 2015-07-01 11
2014: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2014 401k membership
Total participants, beginning-of-year 2014-07-01 13,682
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 11,112
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 3,904
Total of all active and inactive participants 2014-07-01 15,016
Total participants 2014-07-01 15,016
Number of employers contributing to the scheme 2014-07-01 10
2013: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2013 401k membership
Total participants, beginning-of-year 2013-07-01 14,441
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 9,778
Number of other retired or separated participants entitled to future benefits 2013-07-01 3,904
Total of all active and inactive participants 2013-07-01 13,682
Total participants 2013-07-01 13,682
Number of employers contributing to the scheme 2013-07-01 10
2012: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2012 401k membership
Total participants, beginning-of-year 2012-07-01 14,870
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 11,864
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 2,577
Total of all active and inactive participants 2012-07-01 14,441
Total participants 2012-07-01 14,441
Number of employers contributing to the scheme 2012-07-01 3
2011: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2011 401k membership
Total participants, beginning-of-year 2011-07-01 15,956
Total number of active participants reported on line 7a of the Form 5500 2011-07-01 12,449
Number of retired or separated participants receiving benefits 2011-07-01 2,421
Number of other retired or separated participants entitled to future benefits 2011-07-01 0
Total of all active and inactive participants 2011-07-01 14,870
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2011-07-01 0
Total participants 2011-07-01 14,870
Number of participants with account balances 2011-07-01 0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2011-07-01 0
Number of employers contributing to the scheme 2011-07-01 3
2010: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2010 401k membership
Total participants, beginning-of-year 2010-07-01 16,210
Total number of active participants reported on line 7a of the Form 5500 2010-07-01 13,042
Number of retired or separated participants receiving benefits 2010-07-01 2,914
Number of other retired or separated participants entitled to future benefits 2010-07-01 0
Total of all active and inactive participants 2010-07-01 15,956
2009: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2009 401k membership
Total participants, beginning-of-year 2009-07-01 17,088
Total number of active participants reported on line 7a of the Form 5500 2009-07-01 13,440
Number of retired or separated participants receiving benefits 2009-07-01 2,770
Number of other retired or separated participants entitled to future benefits 2009-07-01 0
Total of all active and inactive participants 2009-07-01 16,210

Measure	Date	Value
2021: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2021 401k membership
Total participants, beginning-of-year	2021-07-01	16,363
Total number of active participants reported on line 7a of the Form 5500	2021-07-01	14,280
Number of retired or separated participants receiving benefits	2021-07-01	1,081
Number of other retired or separated participants entitled to future benefits	2021-07-01	0
Total of all active and inactive participants	2021-07-01	15,361
Total participants	2021-07-01	15,361
Number of employers contributing to the scheme	2021-07-01	12
2020: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2020 401k membership
Total participants, beginning-of-year	2020-07-01	15,226
Total number of active participants reported on line 7a of the Form 5500	2020-07-01	15,170
Number of retired or separated participants receiving benefits	2020-07-01	1,193
Number of other retired or separated participants entitled to future benefits	2020-07-01	0
Total of all active and inactive participants	2020-07-01	16,363
Total participants	2020-07-01	16,363
Number of employers contributing to the scheme	2020-07-01	12
2019: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2019 401k membership
Total participants, beginning-of-year	2019-07-01	16,065
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	13,930
Number of retired or separated participants receiving benefits	2019-07-01	1,296
Number of other retired or separated participants entitled to future benefits	2019-07-01	0
Total of all active and inactive participants	2019-07-01	15,226
Total participants	2019-07-01	15,226
Number of employers contributing to the scheme	2019-07-01	12
2018: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2018 401k membership
Total participants, beginning-of-year	2018-07-01	17,595
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	14,444
Number of retired or separated participants receiving benefits	2018-07-01	1,621
Total of all active and inactive participants	2018-07-01	16,065
Total participants	2018-07-01	16,065
Number of employers contributing to the scheme	2018-07-01	12
2017: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2017 401k membership
Total participants, beginning-of-year	2017-07-01	16,911
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	14,944
Number of retired or separated participants receiving benefits	2017-07-01	0
Number of other retired or separated participants entitled to future benefits	2017-07-01	2,651
Total of all active and inactive participants	2017-07-01	17,595
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-07-01	0
Total participants	2017-07-01	17,595
Number of participants with account balances	2017-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-07-01	0
Number of employers contributing to the scheme	2017-07-01	12
2016: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2016 401k membership
Total participants, beginning-of-year	2016-07-01	16,748
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	13,897
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	3,014
Total of all active and inactive participants	2016-07-01	16,911
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-07-01	0
Total participants	2016-07-01	16,911
Number of participants with account balances	2016-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-07-01	0
Number of employers contributing to the scheme	2016-07-01	12
2015: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2015 401k membership
Total participants, beginning-of-year	2015-07-01	15,016
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	13,538
Number of other retired or separated participants entitled to future benefits	2015-07-01	3,210
Total of all active and inactive participants	2015-07-01	16,748
Total participants	2015-07-01	16,748
Number of employers contributing to the scheme	2015-07-01	11
2014: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2014 401k membership
Total participants, beginning-of-year	2014-07-01	13,682
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	11,112
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	3,904
Total of all active and inactive participants	2014-07-01	15,016
Total participants	2014-07-01	15,016
Number of employers contributing to the scheme	2014-07-01	10
2013: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2013 401k membership
Total participants, beginning-of-year	2013-07-01	14,441
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	9,778
Number of other retired or separated participants entitled to future benefits	2013-07-01	3,904
Total of all active and inactive participants	2013-07-01	13,682
Total participants	2013-07-01	13,682
Number of employers contributing to the scheme	2013-07-01	10
2012: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2012 401k membership
Total participants, beginning-of-year	2012-07-01	14,870
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	11,864
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	2,577
Total of all active and inactive participants	2012-07-01	14,441
Total participants	2012-07-01	14,441
Number of employers contributing to the scheme	2012-07-01	3
2011: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2011 401k membership
Total participants, beginning-of-year	2011-07-01	15,956
Total number of active participants reported on line 7a of the Form 5500	2011-07-01	12,449
Number of retired or separated participants receiving benefits	2011-07-01	2,421
Number of other retired or separated participants entitled to future benefits	2011-07-01	0
Total of all active and inactive participants	2011-07-01	14,870
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2011-07-01	0
Total participants	2011-07-01	14,870
Number of participants with account balances	2011-07-01	0
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2011-07-01	0
Number of employers contributing to the scheme	2011-07-01	3
2010: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2010 401k membership
Total participants, beginning-of-year	2010-07-01	16,210
Total number of active participants reported on line 7a of the Form 5500	2010-07-01	13,042
Number of retired or separated participants receiving benefits	2010-07-01	2,914
Number of other retired or separated participants entitled to future benefits	2010-07-01	0
Total of all active and inactive participants	2010-07-01	15,956
2009: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2009 401k membership
Total participants, beginning-of-year	2009-07-01	17,088
Total number of active participants reported on line 7a of the Form 5500	2009-07-01	13,440
Number of retired or separated participants receiving benefits	2009-07-01	2,770
Number of other retired or separated participants entitled to future benefits	2009-07-01	0
Total of all active and inactive participants	2009-07-01	16,210

Financial Data on SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND

Measure	Date	Value
2022 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2022 401k financial data
Unrealized appreciation/depreciation of real estate assets	2022-06-30	$-388,454
Total unrealized appreciation/depreciation of assets	2022-06-30	$-388,454
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-30	$163,633
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2022-06-30	$117,981
Total income from all sources (including contributions)	2022-06-30	$4,570,328
Total loss/gain on sale of assets	2022-06-30	$-26,300
Total of all expenses incurred	2022-06-30	$4,029,615
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2022-06-30	$3,235,368
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2022-06-30	$5,028,413
Value of total assets at end of year	2022-06-30	$8,603,622
Value of total assets at beginning of year	2022-06-30	$8,017,257
Total of administrative expenses incurred including professional, contract, advisory and management fees	2022-06-30	$794,247
Total interest from all sources	2022-06-30	$106,579
Total dividends received (eg from common stock, registered investment company shares)	2022-06-30	$18,957
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2022-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2022-06-30	$18,957
Administrative expenses professional fees incurred	2022-06-30	$120,678
Was this plan covered by a fidelity bond	2022-06-30	Yes
Value of fidelity bond cover	2022-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2022-06-30	No
Contributions received from participants	2022-06-30	$3,192,896
Participant contributions at end of year	2022-06-30	$333,794
Participant contributions at beginning of year	2022-06-30	$313,496
Value of other receiveables (less allowance for doubtful accounts) at end of year	2022-06-30	$54,304
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2022-06-30	$64,833
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2022-06-30	$115,813
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2022-06-30	$51,871
Other income not declared elsewhere	2022-06-30	$23,816
Administrative expenses (other) incurred	2022-06-30	$120,204
Liabilities. Value of operating payables at end of year	2022-06-30	$12,504
Liabilities. Value of operating payables at beginning of year	2022-06-30	$11,746
Total non interest bearing cash at end of year	2022-06-30	$2,230,047
Total non interest bearing cash at beginning of year	2022-06-30	$2,462,142
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-06-30	No
Value of net income/loss	2022-06-30	$540,713
Value of net assets at end of year (total assets less liabilities)	2022-06-30	$8,439,989
Value of net assets at beginning of year (total assets less liabilities)	2022-06-30	$7,899,276
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2022-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2022-06-30	No
Were any leases to which the plan was party in default or uncollectible	2022-06-30	No
Investment advisory and management fees	2022-06-30	$14,549
Value of interest in registered invesment companies (eg mutual funds) at end of year	2022-06-30	$1,351,735
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2022-06-30	$798,855
Income. Interest from US Government securities	2022-06-30	$42,808
Income. Interest from corporate debt instruments	2022-06-30	$63,721
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2022-06-30	$175,678
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2022-06-30	$136,831
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2022-06-30	$136,831
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2022-06-30	$50
Expenses. Payments to insurance carriers foe the provision of benefits	2022-06-30	$3,235,368
Asset value of US Government securities at end of year	2022-06-30	$2,308,850
Asset value of US Government securities at beginning of year	2022-06-30	$2,174,289
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2022-06-30	$-192,683
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2022-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2022-06-30	No
Has the plan failed to provide any benefit when due under the plan	2022-06-30	No
Contributions received in cash from employer	2022-06-30	$1,835,517
Employer contributions (assets) at end of year	2022-06-30	$69,772
Employer contributions (assets) at beginning of year	2022-06-30	$72,720
Asset. Corporate debt instrument preferred debt at end of year	2022-06-30	$1,202,140
Asset. Corporate debt instrument preferred debt at beginning of year	2022-06-30	$1,173,341
Asset. Corporate debt instrument debt (other) at end of year	2022-06-30	$877,302
Asset. Corporate debt instrument debt (other) at beginning of year	2022-06-30	$820,750
Contract administrator fees	2022-06-30	$538,816
Liabilities. Value of benefit claims payable at end of year	2022-06-30	$35,316
Liabilities. Value of benefit claims payable at beginning of year	2022-06-30	$54,364
Did the plan have assets held for investment	2022-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2022-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2022-06-30	No
Aggregate proceeds on sale of assets	2022-06-30	$2,766,578
Aggregate carrying amount (costs) on sale of assets	2022-06-30	$2,792,878
Opinion of an independent qualified public accountant for this plan	2022-06-30	Unqualified
Accountancy firm name	2022-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2022-06-30	952036255
2021 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2021-06-30	$-83,447
Total unrealized appreciation/depreciation of assets	2021-06-30	$-83,447
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$117,981
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2021-06-30	$192,564
Total income from all sources (including contributions)	2021-06-30	$5,649,982
Total loss/gain on sale of assets	2021-06-30	$-12,524
Total of all expenses incurred	2021-06-30	$4,550,668
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2021-06-30	$3,787,518
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2021-06-30	$5,615,336
Value of total assets at end of year	2021-06-30	$8,017,257
Value of total assets at beginning of year	2021-06-30	$6,992,526
Total of administrative expenses incurred including professional, contract, advisory and management fees	2021-06-30	$763,150
Total interest from all sources	2021-06-30	$86,016
Total dividends received (eg from common stock, registered investment company shares)	2021-06-30	$13,924
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2021-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2021-06-30	$13,924
Administrative expenses professional fees incurred	2021-06-30	$112,707
Was this plan covered by a fidelity bond	2021-06-30	Yes
Value of fidelity bond cover	2021-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2021-06-30	No
Contributions received from participants	2021-06-30	$3,247,307
Participant contributions at end of year	2021-06-30	$313,496
Participant contributions at beginning of year	2021-06-30	$566,160
Value of other receiveables (less allowance for doubtful accounts) at end of year	2021-06-30	$64,833
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2021-06-30	$20,294
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2021-06-30	$51,871
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2021-06-30	$3,338
Other income not declared elsewhere	2021-06-30	$49,441
Administrative expenses (other) incurred	2021-06-30	$108,317
Liabilities. Value of operating payables at end of year	2021-06-30	$11,746
Liabilities. Value of operating payables at beginning of year	2021-06-30	$100,320
Total non interest bearing cash at end of year	2021-06-30	$2,462,142
Total non interest bearing cash at beginning of year	2021-06-30	$2,953,872
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-06-30	No
Value of net income/loss	2021-06-30	$1,099,314
Value of net assets at end of year (total assets less liabilities)	2021-06-30	$7,899,276
Value of net assets at beginning of year (total assets less liabilities)	2021-06-30	$6,799,962
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2021-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2021-06-30	No
Were any leases to which the plan was party in default or uncollectible	2021-06-30	No
Investment advisory and management fees	2021-06-30	$17,807
Value of interest in registered invesment companies (eg mutual funds) at end of year	2021-06-30	$798,855
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2021-06-30	$523,747
Income. Interest from US Government securities	2021-06-30	$35,888
Income. Interest from corporate debt instruments	2021-06-30	$50,120
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2021-06-30	$136,831
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2021-06-30	$108,278
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2021-06-30	$108,278
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2021-06-30	$8
Expenses. Payments to insurance carriers foe the provision of benefits	2021-06-30	$3,787,518
Asset value of US Government securities at end of year	2021-06-30	$2,174,289
Asset value of US Government securities at beginning of year	2021-06-30	$1,423,133
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2021-06-30	$-18,764
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2021-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2021-06-30	No
Has the plan failed to provide any benefit when due under the plan	2021-06-30	No
Contributions received in cash from employer	2021-06-30	$2,368,029
Employer contributions (assets) at end of year	2021-06-30	$72,720
Employer contributions (assets) at beginning of year	2021-06-30	$121,590
Asset. Corporate debt instrument preferred debt at end of year	2021-06-30	$1,173,341
Asset. Corporate debt instrument preferred debt at beginning of year	2021-06-30	$632,630
Asset. Corporate debt instrument debt (other) at end of year	2021-06-30	$820,750
Asset. Corporate debt instrument debt (other) at beginning of year	2021-06-30	$642,822
Contract administrator fees	2021-06-30	$524,319
Liabilities. Value of benefit claims payable at end of year	2021-06-30	$54,364
Liabilities. Value of benefit claims payable at beginning of year	2021-06-30	$88,906
Did the plan have assets held for investment	2021-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2021-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2021-06-30	No
Aggregate proceeds on sale of assets	2021-06-30	$3,076,268
Aggregate carrying amount (costs) on sale of assets	2021-06-30	$3,088,792
Opinion of an independent qualified public accountant for this plan	2021-06-30	Unqualified
Accountancy firm name	2021-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2021-06-30	952036255
2020 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2020-06-30	$114,386
Total unrealized appreciation/depreciation of assets	2020-06-30	$114,386
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$192,564
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2020-06-30	$718,405
Total income from all sources (including contributions)	2020-06-30	$5,889,447
Total loss/gain on sale of assets	2020-06-30	$-8,284
Total of all expenses incurred	2020-06-30	$4,753,283
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$3,963,836
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$5,462,394
Value of total assets at end of year	2020-06-30	$6,992,526
Value of total assets at beginning of year	2020-06-30	$6,382,203
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$789,447
Total interest from all sources	2020-06-30	$65,316
Total dividends received (eg from common stock, registered investment company shares)	2020-06-30	$13,214
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2020-06-30	$13,214
Administrative expenses professional fees incurred	2020-06-30	$102,918
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$3,885,815
Participant contributions at end of year	2020-06-30	$566,160
Participant contributions at beginning of year	2020-06-30	$581,163
Value of other receiveables (less allowance for doubtful accounts) at end of year	2020-06-30	$20,294
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2020-06-30	$21,301
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2020-06-30	$3,338
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2020-06-30	$205,380
Other income not declared elsewhere	2020-06-30	$216,988
Administrative expenses (other) incurred	2020-06-30	$151,908
Liabilities. Value of operating payables at end of year	2020-06-30	$100,320
Liabilities. Value of operating payables at beginning of year	2020-06-30	$110,690
Total non interest bearing cash at end of year	2020-06-30	$2,953,872
Total non interest bearing cash at beginning of year	2020-06-30	$2,540,325
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$1,136,164
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$6,799,962
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$5,663,798
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Investment advisory and management fees	2020-06-30	$10,076
Value of interest in registered invesment companies (eg mutual funds) at end of year	2020-06-30	$523,747
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2020-06-30	$490,519
Income. Interest from US Government securities	2020-06-30	$27,958
Income. Interest from corporate debt instruments	2020-06-30	$36,675
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2020-06-30	$108,278
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2020-06-30	$89,286
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2020-06-30	$89,286
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2020-06-30	$683
Expenses. Payments to insurance carriers foe the provision of benefits	2020-06-30	$3,963,836
Asset value of US Government securities at end of year	2020-06-30	$1,423,133
Asset value of US Government securities at beginning of year	2020-06-30	$1,313,730
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2020-06-30	$25,433
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2020-06-30	No
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Contributions received in cash from employer	2020-06-30	$1,576,579
Employer contributions (assets) at end of year	2020-06-30	$121,590
Employer contributions (assets) at beginning of year	2020-06-30	$119,588
Asset. Corporate debt instrument preferred debt at end of year	2020-06-30	$632,630
Asset. Corporate debt instrument preferred debt at beginning of year	2020-06-30	$610,148
Asset. Corporate debt instrument debt (other) at end of year	2020-06-30	$642,822
Asset. Corporate debt instrument debt (other) at beginning of year	2020-06-30	$616,143
Contract administrator fees	2020-06-30	$524,545
Liabilities. Value of benefit claims payable at end of year	2020-06-30	$88,906
Liabilities. Value of benefit claims payable at beginning of year	2020-06-30	$402,335
Did the plan have assets held for investment	2020-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	No
Aggregate proceeds on sale of assets	2020-06-30	$1,539,997
Aggregate carrying amount (costs) on sale of assets	2020-06-30	$1,548,281
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-06-30	No
Opinion of an independent qualified public accountant for this plan	2020-06-30	Unqualified
Accountancy firm name	2020-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2020-06-30	952036255
2019 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2019-06-30	$103,270
Total unrealized appreciation/depreciation of assets	2019-06-30	$103,270
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$718,405
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2019-06-30	$726,252
Total income from all sources (including contributions)	2019-06-30	$5,713,107
Total loss/gain on sale of assets	2019-06-30	$-27,092
Total of all expenses incurred	2019-06-30	$4,888,645
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-06-30	$4,096,713
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-06-30	$5,553,862
Value of total assets at end of year	2019-06-30	$6,382,203
Value of total assets at beginning of year	2019-06-30	$5,565,588
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-06-30	$791,932
Total interest from all sources	2019-06-30	$57,752
Total dividends received (eg from common stock, registered investment company shares)	2019-06-30	$10,258
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2019-06-30	$10,258
Administrative expenses professional fees incurred	2019-06-30	$123,856
Was this plan covered by a fidelity bond	2019-06-30	Yes
Value of fidelity bond cover	2019-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2019-06-30	No
Contributions received from participants	2019-06-30	$4,013,593
Participant contributions at end of year	2019-06-30	$581,163
Participant contributions at beginning of year	2019-06-30	$538,404
Value of other receiveables (less allowance for doubtful accounts) at end of year	2019-06-30	$21,301
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2019-06-30	$20,678
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2019-06-30	$205,380
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2019-06-30	$201,146
Other income not declared elsewhere	2019-06-30	$2,245
Administrative expenses (other) incurred	2019-06-30	$153,352
Liabilities. Value of operating payables at end of year	2019-06-30	$110,690
Liabilities. Value of operating payables at beginning of year	2019-06-30	$50,104
Total non interest bearing cash at end of year	2019-06-30	$2,540,325
Total non interest bearing cash at beginning of year	2019-06-30	$1,925,527
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Value of net income/loss	2019-06-30	$824,462
Value of net assets at end of year (total assets less liabilities)	2019-06-30	$5,663,798
Value of net assets at beginning of year (total assets less liabilities)	2019-06-30	$4,839,336
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-06-30	No
Were any leases to which the plan was party in default or uncollectible	2019-06-30	No
Investment advisory and management fees	2019-06-30	$5,679
Value of interest in registered invesment companies (eg mutual funds) at end of year	2019-06-30	$490,519
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2019-06-30	$148,424
Income. Interest from US Government securities	2019-06-30	$23,812
Income. Interest from corporate debt instruments	2019-06-30	$32,671
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2019-06-30	$89,286
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2019-06-30	$68,011
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2019-06-30	$68,011
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2019-06-30	$1,269
Expenses. Payments to insurance carriers foe the provision of benefits	2019-06-30	$4,096,713
Asset value of US Government securities at end of year	2019-06-30	$1,313,730
Asset value of US Government securities at beginning of year	2019-06-30	$1,614,942
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2019-06-30	$12,812
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2019-06-30	No
Has the plan failed to provide any benefit when due under the plan	2019-06-30	No
Contributions received in cash from employer	2019-06-30	$1,540,269
Employer contributions (assets) at end of year	2019-06-30	$119,588
Employer contributions (assets) at beginning of year	2019-06-30	$117,452
Asset. Corporate debt instrument preferred debt at end of year	2019-06-30	$610,148
Asset. Corporate debt instrument preferred debt at beginning of year	2019-06-30	$736,425
Asset. Corporate debt instrument debt (other) at end of year	2019-06-30	$616,143
Asset. Corporate debt instrument debt (other) at beginning of year	2019-06-30	$395,725
Contract administrator fees	2019-06-30	$509,045
Liabilities. Value of benefit claims payable at end of year	2019-06-30	$402,335
Liabilities. Value of benefit claims payable at beginning of year	2019-06-30	$475,002
Did the plan have assets held for investment	2019-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-06-30	No
Aggregate proceeds on sale of assets	2019-06-30	$736,074
Aggregate carrying amount (costs) on sale of assets	2019-06-30	$763,166
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-06-30	No
Opinion of an independent qualified public accountant for this plan	2019-06-30	Unqualified
Accountancy firm name	2019-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2019-06-30	952036255
2018 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2018-06-30	$-63,807
Total unrealized appreciation/depreciation of assets	2018-06-30	$-63,807
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$726,252
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-06-30	$687,520
Total income from all sources (including contributions)	2018-06-30	$5,663,683
Total loss/gain on sale of assets	2018-06-30	$-9,753
Total of all expenses incurred	2018-06-30	$4,715,293
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-06-30	$3,922,983
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-06-30	$5,650,465
Value of total assets at end of year	2018-06-30	$5,565,588
Value of total assets at beginning of year	2018-06-30	$4,578,466
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-06-30	$792,310
Total interest from all sources	2018-06-30	$61,529
Total dividends received (eg from common stock, registered investment company shares)	2018-06-30	$1,482
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-06-30	No
Total dividends received from registered investment company shares (eg mutual funds)	2018-06-30	$1,482
Administrative expenses professional fees incurred	2018-06-30	$115,445
Was this plan covered by a fidelity bond	2018-06-30	Yes
Value of fidelity bond cover	2018-06-30	$50,000
Were there any nonexempt tranactions with any party-in-interest	2018-06-30	No
Contributions received from participants	2018-06-30	$4,013,151
Participant contributions at end of year	2018-06-30	$538,404
Participant contributions at beginning of year	2018-06-30	$401,189
Value of other receiveables (less allowance for doubtful accounts) at end of year	2018-06-30	$20,678
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2018-06-30	$22,012
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2018-06-30	$201,146
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2018-06-30	$243,960
Other income not declared elsewhere	2018-06-30	$22,748
Administrative expenses (other) incurred	2018-06-30	$160,346
Liabilities. Value of operating payables at end of year	2018-06-30	$50,104
Liabilities. Value of operating payables at beginning of year	2018-06-30	$92,299
Total non interest bearing cash at end of year	2018-06-30	$1,925,527
Total non interest bearing cash at beginning of year	2018-06-30	$1,115,950
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Value of net income/loss	2018-06-30	$948,390
Value of net assets at end of year (total assets less liabilities)	2018-06-30	$4,839,336
Value of net assets at beginning of year (total assets less liabilities)	2018-06-30	$3,890,946
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-06-30	No
Were any leases to which the plan was party in default or uncollectible	2018-06-30	No
Investment advisory and management fees	2018-06-30	$7,474
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-06-30	$148,424
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-06-30	$0
Income. Interest from US Government securities	2018-06-30	$28,806
Income. Interest from corporate debt instruments	2018-06-30	$32,203
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-06-30	$68,011
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-06-30	$50,043
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-06-30	$50,043
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-06-30	$520
Expenses. Payments to insurance carriers foe the provision of benefits	2018-06-30	$3,922,983
Asset value of US Government securities at end of year	2018-06-30	$1,614,942
Asset value of US Government securities at beginning of year	2018-06-30	$1,502,844
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-06-30	$1,019
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2018-06-30	No
Has the plan failed to provide any benefit when due under the plan	2018-06-30	No
Contributions received in cash from employer	2018-06-30	$1,637,314
Employer contributions (assets) at end of year	2018-06-30	$117,452
Employer contributions (assets) at beginning of year	2018-06-30	$67,591
Asset. Corporate debt instrument preferred debt at end of year	2018-06-30	$736,425
Asset. Corporate debt instrument debt (other) at end of year	2018-06-30	$395,725
Asset. Corporate debt instrument debt (other) at beginning of year	2018-06-30	$1,418,837
Contract administrator fees	2018-06-30	$509,045
Liabilities. Value of benefit claims payable at end of year	2018-06-30	$475,002
Liabilities. Value of benefit claims payable at beginning of year	2018-06-30	$351,261
Did the plan have assets held for investment	2018-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-06-30	No
Aggregate proceeds on sale of assets	2018-06-30	$325,757
Aggregate carrying amount (costs) on sale of assets	2018-06-30	$335,510
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-06-30	No
Opinion of an independent qualified public accountant for this plan	2018-06-30	Unqualified
Accountancy firm name	2018-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2018-06-30	952036255
2017 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets	2017-06-30	$-58,817
Total unrealized appreciation/depreciation of assets	2017-06-30	$-58,817
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$687,520
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-06-30	$753,941
Total income from all sources (including contributions)	2017-06-30	$5,003,231
Total loss/gain on sale of assets	2017-06-30	$-4,475
Total of all expenses incurred	2017-06-30	$4,688,369
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-06-30	$3,964,478
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-06-30	$4,988,554
Value of total assets at end of year	2017-06-30	$4,578,466
Value of total assets at beginning of year	2017-06-30	$4,330,025
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-06-30	$723,891
Total interest from all sources	2017-06-30	$52,917
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-06-30	No
Administrative expenses professional fees incurred	2017-06-30	$102,398
Was this plan covered by a fidelity bond	2017-06-30	Yes
Value of fidelity bond cover	2017-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2017-06-30	No
Contributions received from participants	2017-06-30	$3,598,204
Participant contributions at end of year	2017-06-30	$401,189
Participant contributions at beginning of year	2017-06-30	$372,313
Value of other receiveables (less allowance for doubtful accounts) at end of year	2017-06-30	$22,012
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2017-06-30	$4,400
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2017-06-30	$243,960
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2017-06-30	$253,606
Other income not declared elsewhere	2017-06-30	$25,052
Administrative expenses (other) incurred	2017-06-30	$100,003
Liabilities. Value of operating payables at end of year	2017-06-30	$92,299
Liabilities. Value of operating payables at beginning of year	2017-06-30	$174,513
Total non interest bearing cash at end of year	2017-06-30	$1,115,950
Total non interest bearing cash at beginning of year	2017-06-30	$3,901,509
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Value of net income/loss	2017-06-30	$314,862
Value of net assets at end of year (total assets less liabilities)	2017-06-30	$3,890,946
Value of net assets at beginning of year (total assets less liabilities)	2017-06-30	$3,576,084
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-06-30	No
Were any leases to which the plan was party in default or uncollectible	2017-06-30	No
Investment advisory and management fees	2017-06-30	$12,259
Income. Interest from US Government securities	2017-06-30	$21,242
Income. Interest from corporate debt instruments	2017-06-30	$31,338
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-06-30	$50,043
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-06-30	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-06-30	$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2017-06-30	$337
Expenses. Payments to insurance carriers foe the provision of benefits	2017-06-30	$3,964,478
Asset value of US Government securities at end of year	2017-06-30	$1,502,844
Asset value of US Government securities at beginning of year	2017-06-30	$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-06-30	Yes
Was there a failure to transmit to the plan any participant contributions	2017-06-30	No
Has the plan failed to provide any benefit when due under the plan	2017-06-30	No
Contributions received in cash from employer	2017-06-30	$1,390,350
Employer contributions (assets) at end of year	2017-06-30	$67,591
Employer contributions (assets) at beginning of year	2017-06-30	$51,803
Asset. Corporate debt instrument debt (other) at end of year	2017-06-30	$1,418,837
Asset. Corporate debt instrument debt (other) at beginning of year	2017-06-30	$0
Contract administrator fees	2017-06-30	$509,231
Liabilities. Value of benefit claims payable at end of year	2017-06-30	$351,261
Liabilities. Value of benefit claims payable at beginning of year	2017-06-30	$325,822
Did the plan have assets held for investment	2017-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-06-30	No
Aggregate proceeds on sale of assets	2017-06-30	$3,769,190
Aggregate carrying amount (costs) on sale of assets	2017-06-30	$3,773,665
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-06-30	No
Opinion of an independent qualified public accountant for this plan	2017-06-30	Unqualified
Accountancy firm name	2017-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2017-06-30	952036255
2016 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$753,941
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-06-30	$652,538
Total income from all sources (including contributions)	2016-06-30	$4,609,634
Total of all expenses incurred	2016-06-30	$4,396,226
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-06-30	$3,601,449
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-06-30	$4,503,719
Value of total assets at end of year	2016-06-30	$4,330,025
Value of total assets at beginning of year	2016-06-30	$4,015,214
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-06-30	$794,777
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-06-30	No
Administrative expenses professional fees incurred	2016-06-30	$102,118
Was this plan covered by a fidelity bond	2016-06-30	Yes
Value of fidelity bond cover	2016-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2016-06-30	No
Contributions received from participants	2016-06-30	$3,256,923
Participant contributions at end of year	2016-06-30	$372,313
Participant contributions at beginning of year	2016-06-30	$253,013
Value of other receiveables (less allowance for doubtful accounts) at end of year	2016-06-30	$4,400
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2016-06-30	$8,495
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2016-06-30	$253,606
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2016-06-30	$189,777
Other income not declared elsewhere	2016-06-30	$105,915
Administrative expenses (other) incurred	2016-06-30	$183,613
Liabilities. Value of operating payables at end of year	2016-06-30	$174,513
Liabilities. Value of operating payables at beginning of year	2016-06-30	$183,622
Total non interest bearing cash at end of year	2016-06-30	$3,901,509
Total non interest bearing cash at beginning of year	2016-06-30	$3,619,465
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Value of net income/loss	2016-06-30	$213,408
Value of net assets at end of year (total assets less liabilities)	2016-06-30	$3,576,084
Value of net assets at beginning of year (total assets less liabilities)	2016-06-30	$3,362,676
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-06-30	No
Were any leases to which the plan was party in default or uncollectible	2016-06-30	No
Expenses. Payments to insurance carriers foe the provision of benefits	2016-06-30	$3,601,449
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-06-30	No
Was there a failure to transmit to the plan any participant contributions	2016-06-30	No
Has the plan failed to provide any benefit when due under the plan	2016-06-30	No
Contributions received in cash from employer	2016-06-30	$1,246,796
Employer contributions (assets) at end of year	2016-06-30	$51,803
Employer contributions (assets) at beginning of year	2016-06-30	$134,241
Contract administrator fees	2016-06-30	$509,046
Liabilities. Value of benefit claims payable at end of year	2016-06-30	$325,822
Liabilities. Value of benefit claims payable at beginning of year	2016-06-30	$279,139
Did the plan have assets held for investment	2016-06-30	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-06-30	No
Opinion of an independent qualified public accountant for this plan	2016-06-30	Unqualified
Accountancy firm name	2016-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2016-06-30	952036255
2015 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$652,538
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-06-30	$186,211
Total income from all sources (including contributions)	2015-06-30	$4,339,451
Total of all expenses incurred	2015-06-30	$4,111,715
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-06-30	$3,357,869
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-06-30	$4,338,773
Value of total assets at end of year	2015-06-30	$4,015,214
Value of total assets at beginning of year	2015-06-30	$3,321,151
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-06-30	$753,846
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-06-30	No
Administrative expenses professional fees incurred	2015-06-30	$103,408
Was this plan covered by a fidelity bond	2015-06-30	Yes
Value of fidelity bond cover	2015-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2015-06-30	No
Contributions received from participants	2015-06-30	$2,961,452
Participant contributions at end of year	2015-06-30	$253,013
Participant contributions at beginning of year	2015-06-30	$228,399
Value of other receiveables (less allowance for doubtful accounts) at end of year	2015-06-30	$8,495
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2015-06-30	$20,810
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2015-06-30	$189,777
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2015-06-30	$183,647
Other income not declared elsewhere	2015-06-30	$678
Administrative expenses (other) incurred	2015-06-30	$141,384
Liabilities. Value of operating payables at end of year	2015-06-30	$183,622
Liabilities. Value of operating payables at beginning of year	2015-06-30	$0
Total non interest bearing cash at end of year	2015-06-30	$3,619,465
Total non interest bearing cash at beginning of year	2015-06-30	$601,675
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Value of net income/loss	2015-06-30	$227,736
Value of net assets at end of year (total assets less liabilities)	2015-06-30	$3,362,676
Value of net assets at beginning of year (total assets less liabilities)	2015-06-30	$3,134,940
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-06-30	No
Were any leases to which the plan was party in default or uncollectible	2015-06-30	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-06-30	$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-06-30	$2,367,505
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-06-30	$2,367,505
Expenses. Payments to insurance carriers foe the provision of benefits	2015-06-30	$3,357,869
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-06-30	No
Was there a failure to transmit to the plan any participant contributions	2015-06-30	No
Has the plan failed to provide any benefit when due under the plan	2015-06-30	No
Contributions received in cash from employer	2015-06-30	$1,377,321
Employer contributions (assets) at end of year	2015-06-30	$134,241
Employer contributions (assets) at beginning of year	2015-06-30	$102,762
Contract administrator fees	2015-06-30	$509,054
Liabilities. Value of benefit claims payable at end of year	2015-06-30	$279,139
Liabilities. Value of benefit claims payable at beginning of year	2015-06-30	$2,564
Did the plan have assets held for investment	2015-06-30	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-06-30	No
Opinion of an independent qualified public accountant for this plan	2015-06-30	Unqualified
Accountancy firm name	2015-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2015-06-30	952036255
2014 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$186,211
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-06-30	$189,023
Total income from all sources (including contributions)	2014-06-30	$4,037,262
Total of all expenses incurred	2014-06-30	$3,693,730
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-30	$3,005,369
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-30	$4,036,737
Value of total assets at end of year	2014-06-30	$3,321,151
Value of total assets at beginning of year	2014-06-30	$2,980,431
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-30	$688,361
Total interest from all sources	2014-06-30	$525
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-30	No
Administrative expenses professional fees incurred	2014-06-30	$101,606
Was this plan covered by a fidelity bond	2014-06-30	Yes
Value of fidelity bond cover	2014-06-30	$500,000
Were there any nonexempt tranactions with any party-in-interest	2014-06-30	No
Contributions received from participants	2014-06-30	$2,577,393
Participant contributions at end of year	2014-06-30	$228,399
Participant contributions at beginning of year	2014-06-30	$163,471
Value of other receiveables (less allowance for doubtful accounts) at end of year	2014-06-30	$8,988
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2014-06-30	$93,796
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2014-06-30	$183,647
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2014-06-30	$176,907
Administrative expenses (other) incurred	2014-06-30	$77,708
Liabilities. Value of operating payables at end of year	2014-06-30	$0
Liabilities. Value of operating payables at beginning of year	2014-06-30	$6,609
Total non interest bearing cash at end of year	2014-06-30	$601,675
Total non interest bearing cash at beginning of year	2014-06-30	$2,103,481
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Value of net income/loss	2014-06-30	$343,532
Value of net assets at end of year (total assets less liabilities)	2014-06-30	$3,134,940
Value of net assets at beginning of year (total assets less liabilities)	2014-06-30	$2,791,408
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-30	No
Were any leases to which the plan was party in default or uncollectible	2014-06-30	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-06-30	$2,367,505
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-06-30	$501,328
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-06-30	$501,328
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-06-30	$525
Expenses. Payments to insurance carriers foe the provision of benefits	2014-06-30	$3,005,369
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-30	No
Was there a failure to transmit to the plan any participant contributions	2014-06-30	No
Has the plan failed to provide any benefit when due under the plan	2014-06-30	No
Contributions received in cash from employer	2014-06-30	$1,459,344
Employer contributions (assets) at end of year	2014-06-30	$102,762
Employer contributions (assets) at beginning of year	2014-06-30	$108,740
Contract administrator fees	2014-06-30	$509,047
Liabilities. Value of benefit claims payable at end of year	2014-06-30	$2,564
Liabilities. Value of benefit claims payable at beginning of year	2014-06-30	$5,507
Assets. Value of buildings and other operty used in plan operation at end of year	2014-06-30	$11,822
Assets. Value of buildings and other operty used in plan operation at beginning of year	2014-06-30	$9,615
Did the plan have assets held for investment	2014-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-30	No
Opinion of an independent qualified public accountant for this plan	2014-06-30	Unqualified
Accountancy firm name	2014-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2014-06-30	952036255
2013 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$189,023
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$523,921
Total income from all sources (including contributions)	2013-06-30	$3,889,959
Total of all expenses incurred	2013-06-30	$3,511,592
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$2,804,818
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$3,843,593
Value of total assets at end of year	2013-06-30	$2,980,431
Value of total assets at beginning of year	2013-06-30	$2,936,962
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$706,774
Total interest from all sources	2013-06-30	$1,275
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Administrative expenses professional fees incurred	2013-06-30	$99,244
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$500,000
If this is an individual account plan, was there a blackout period	2013-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Contributions received from participants	2013-06-30	$2,363,727
Participant contributions at end of year	2013-06-30	$163,471
Participant contributions at beginning of year	2013-06-30	$265,243
Value of other receiveables (less allowance for doubtful accounts) at end of year	2013-06-30	$93,796
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2013-06-30	$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2013-06-30	$176,907
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2013-06-30	$168,567
Other income not declared elsewhere	2013-06-30	$45,091
Administrative expenses (other) incurred	2013-06-30	$109,953
Liabilities. Value of operating payables at end of year	2013-06-30	$6,609
Liabilities. Value of operating payables at beginning of year	2013-06-30	$54,756
Total non interest bearing cash at end of year	2013-06-30	$2,103,481
Total non interest bearing cash at beginning of year	2013-06-30	$1,429,051
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Value of net income/loss	2013-06-30	$378,367
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$2,791,408
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$2,413,041
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-06-30	No
Were any leases to which the plan was party in default or uncollectible	2013-06-30	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-06-30	$501,328
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-06-30	$1,125,414
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-06-30	$1,125,414
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-06-30	$1,275
Expenses. Payments to insurance carriers foe the provision of benefits	2013-06-30	$2,804,818
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-06-30	No
Was there a failure to transmit to the plan any participant contributions	2013-06-30	No
Has the plan failed to provide any benefit when due under the plan	2013-06-30	No
Contributions received in cash from employer	2013-06-30	$1,479,866
Employer contributions (assets) at end of year	2013-06-30	$108,740
Employer contributions (assets) at beginning of year	2013-06-30	$117,254
Contract administrator fees	2013-06-30	$497,577
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-06-30	No
Liabilities. Value of benefit claims payable at end of year	2013-06-30	$5,507
Liabilities. Value of benefit claims payable at beginning of year	2013-06-30	$300,598
Assets. Value of buildings and other operty used in plan operation at end of year	2013-06-30	$9,615
Assets. Value of buildings and other operty used in plan operation at beginning of year	2013-06-30	$0
Did the plan have assets held for investment	2013-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-06-30	No
Opinion of an independent qualified public accountant for this plan	2013-06-30	Unqualified
Accountancy firm name	2013-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2013-06-30	952036255
2012 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$523,921
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-06-30	$189,172
Total income from all sources (including contributions)	2012-06-30	$4,079,414
Total of all expenses incurred	2012-06-30	$3,617,242
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-06-30	$2,923,473
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-06-30	$4,041,847
Value of total assets at end of year	2012-06-30	$2,936,962
Value of total assets at beginning of year	2012-06-30	$2,140,041
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-06-30	$693,769
Total interest from all sources	2012-06-30	$3,555
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-06-30	No
Administrative expenses professional fees incurred	2012-06-30	$110,490
Was this plan covered by a fidelity bond	2012-06-30	Yes
Value of fidelity bond cover	2012-06-30	$500,000
If this is an individual account plan, was there a blackout period	2012-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2012-06-30	No
Contributions received from participants	2012-06-30	$2,494,087
Participant contributions at end of year	2012-06-30	$265,243
Participant contributions at beginning of year	2012-06-30	$191,921
Value of other receiveables (less allowance for doubtful accounts) at end of year	2012-06-30	$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2012-06-30	$450,274
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2012-06-30	$168,567
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2012-06-30	$130,477
Other income not declared elsewhere	2012-06-30	$34,012
Administrative expenses (other) incurred	2012-06-30	$94,597
Liabilities. Value of operating payables at end of year	2012-06-30	$54,756
Liabilities. Value of operating payables at beginning of year	2012-06-30	$58,695
Total non interest bearing cash at end of year	2012-06-30	$1,429,051
Total non interest bearing cash at beginning of year	2012-06-30	$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Value of net income/loss	2012-06-30	$462,172
Value of net assets at end of year (total assets less liabilities)	2012-06-30	$2,413,041
Value of net assets at beginning of year (total assets less liabilities)	2012-06-30	$1,950,869
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-06-30	No
Were any leases to which the plan was party in default or uncollectible	2012-06-30	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-06-30	$1,125,414
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-06-30	$1,320,191
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-06-30	$1,320,191
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-06-30	$3,555
Expenses. Payments to insurance carriers foe the provision of benefits	2012-06-30	$2,923,473
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-06-30	No
Was there a failure to transmit to the plan any participant contributions	2012-06-30	No
Has the plan failed to provide any benefit when due under the plan	2012-06-30	No
Contributions received in cash from employer	2012-06-30	$1,547,760
Employer contributions (assets) at end of year	2012-06-30	$117,254
Employer contributions (assets) at beginning of year	2012-06-30	$177,655
Contract administrator fees	2012-06-30	$488,682
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2012-06-30	No
Liabilities. Value of benefit claims payable at end of year	2012-06-30	$300,598
Liabilities. Value of benefit claims payable at beginning of year	2012-06-30	$0
Did the plan have assets held for investment	2012-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-06-30	No
Opinion of an independent qualified public accountant for this plan	2012-06-30	Unqualified
Accountancy firm name	2012-06-30	MILLER KAPLAN ARASE LLP
Accountancy firm EIN	2012-06-30	952036255
2011 : SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$189,172
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2011-06-30	$524,851
Total income from all sources (including contributions)	2011-06-30	$4,159,742
Total of all expenses incurred	2011-06-30	$3,590,389
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2011-06-30	$2,882,997
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2011-06-30	$4,117,189
Value of total assets at end of year	2011-06-30	$2,140,041
Value of total assets at beginning of year	2011-06-30	$1,906,367
Total of administrative expenses incurred including professional, contract, advisory and management fees	2011-06-30	$707,392
Total interest from all sources	2011-06-30	$7,486
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2011-06-30	No
Administrative expenses professional fees incurred	2011-06-30	$113,321
Was this plan covered by a fidelity bond	2011-06-30	Yes
Value of fidelity bond cover	2011-06-30	$500,000
If this is an individual account plan, was there a blackout period	2011-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2011-06-30	No
Contributions received from participants	2011-06-30	$2,556,352
Participant contributions at end of year	2011-06-30	$191,921
Participant contributions at beginning of year	2011-06-30	$130,695
Value of other receiveables (less allowance for doubtful accounts) at end of year	2011-06-30	$450,274
Value of other receiveables (less allowance for doubtful accounts) at beginning of year	2011-06-30	$44,743
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year	2011-06-30	$130,477
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2011-06-30	$456,402
Other income not declared elsewhere	2011-06-30	$35,067
Administrative expenses (other) incurred	2011-06-30	$91,602
Liabilities. Value of operating payables at end of year	2011-06-30	$58,695
Liabilities. Value of operating payables at beginning of year	2011-06-30	$68,449
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Value of net income/loss	2011-06-30	$569,353
Value of net assets at end of year (total assets less liabilities)	2011-06-30	$1,950,869
Value of net assets at beginning of year (total assets less liabilities)	2011-06-30	$1,381,516
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2011-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2011-06-30	No
Were any leases to which the plan was party in default or uncollectible	2011-06-30	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2011-06-30	$1,320,191
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2011-06-30	$1,063,747
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2011-06-30	$1,063,747
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2011-06-30	$7,486
Expenses. Payments to insurance carriers foe the provision of benefits	2011-06-30	$2,882,997
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2011-06-30	No
Was there a failure to transmit to the plan any participant contributions	2011-06-30	No
Has the plan failed to provide any benefit when due under the plan	2011-06-30	No
Contributions received in cash from employer	2011-06-30	$1,560,837
Employer contributions (assets) at end of year	2011-06-30	$177,655
Employer contributions (assets) at beginning of year	2011-06-30	$667,182
Contract administrator fees	2011-06-30	$502,469
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2011-06-30	No
Did the plan have assets held for investment	2011-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2011-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2011-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2011-06-30	No
Opinion of an independent qualified public accountant for this plan	2011-06-30	Unqualified
Accountancy firm name	2011-06-30	LINDQUIST LLP
Accountancy firm EIN	2011-06-30	522385296

Form 5500 Responses for SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND

2021: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2021 form 5500 responses
2021-07-01	Type of plan entity	Multi-employer plan
2021-07-01	Plan is a collectively bargained plan	Yes
2021-07-01	Plan funding arrangement – Trust	Yes
2021-07-01	Plan benefit arrangement – Insurance	Yes
2020: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2020 form 5500 responses
2020-07-01	Type of plan entity	Multi-employer plan
2020-07-01	Plan is a collectively bargained plan	Yes
2020-07-01	Plan funding arrangement – Trust	Yes
2020-07-01	Plan benefit arrangement – Insurance	Yes
2019: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2019 form 5500 responses
2019-07-01	Type of plan entity	Multi-employer plan
2019-07-01	Plan is a collectively bargained plan	Yes
2019-07-01	Plan funding arrangement – Trust	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2018: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2018 form 5500 responses
2018-07-01	Type of plan entity	Multi-employer plan
2018-07-01	Plan is a collectively bargained plan	Yes
2018-07-01	Plan funding arrangement – Trust	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2017: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2017 form 5500 responses
2017-07-01	Type of plan entity	Multi-employer plan
2017-07-01	Plan is a collectively bargained plan	Yes
2017-07-01	Plan funding arrangement – Trust	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2016: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2016 form 5500 responses
2016-07-01	Type of plan entity	Multi-employer plan
2016-07-01	Plan is a collectively bargained plan	Yes
2016-07-01	Plan funding arrangement – Trust	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2015: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2015 form 5500 responses
2015-07-01	Type of plan entity	Multi-employer plan
2015-07-01	Plan is a collectively bargained plan	Yes
2015-07-01	Plan funding arrangement – Trust	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2014: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2014 form 5500 responses
2014-07-01	Type of plan entity	Multi-employer plan
2014-07-01	Plan is a collectively bargained plan	Yes
2014-07-01	Plan funding arrangement – Trust	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2013: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2013 form 5500 responses
2013-07-01	Type of plan entity	Multi-employer plan
2013-07-01	Plan is a collectively bargained plan	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2012: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2012 form 5500 responses
2012-07-01	Type of plan entity	Multi-employer plan
2012-07-01	Plan is a collectively bargained plan	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2011: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2011 form 5500 responses
2011-07-01	Type of plan entity	Multi-employer plan
2011-07-01	Plan is a collectively bargained plan	Yes
2011-07-01	Plan funding arrangement – Trust	Yes
2011-07-01	Plan benefit arrangement – Insurance	Yes
2010: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2010 form 5500 responses
2010-07-01	Type of plan entity	Single employer plan
2010-07-01	Plan is a collectively bargained plan	Yes
2010-07-01	Plan funding arrangement – Trust	Yes
2010-07-01	Plan benefit arrangement – Insurance	Yes
2009: SEIU LOCAL 721 EMPLOYEE BENEFITS TRUST FUND 2009 form 5500 responses
2009-07-01	Type of plan entity	Single employer plan
2009-07-01	This submission is the final filing	No
2009-07-01	Plan is a collectively bargained plan	Yes
2009-07-01	Plan funding arrangement – Trust	Yes
2009-07-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H0-4, P6-10

Policy instance

Insurance contract or identification number	3991H0-4, P6-10
Number of Individuals Covered	1658
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $446,651
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	5143
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Number of Individuals Covered	743
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Other welfare benefits provided	CANCER/CATASTROPHIC CUSTODIAL CARE
Welfare Benefit Premiums Paid to Carrier	USD $20,401
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 143794

Policy instance

Insurance contract or identification number	GL 143794
Number of Individuals Covered	16
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $788
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 117634

Policy instance

Insurance contract or identification number	LTD 117634
Number of Individuals Covered	11
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,936
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326461

Policy instance

Insurance contract or identification number	VPS 326461
Number of Individuals Covered	248
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $248,262
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Number of Individuals Covered	5528
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	5167
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $66,578
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

US LEGAL SERVICES OF WISCONSIN, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

00000

Policy instance

Insurance contract or identification number	00000
Number of Individuals Covered	2077
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $321,809
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 128861

Policy instance

Insurance contract or identification number	LTD 128861
Number of Individuals Covered	182
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $58,392
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ACN GROUP OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 933-0 )

Policy contract number

9001014

Policy instance

Insurance contract or identification number	9001014
Number of Individuals Covered	1696
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Other welfare benefits provided	OPTUM DIRECT CHIROPRACTIC PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $62,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000805

Policy instance

Insurance contract or identification number	1000805
Number of Individuals Covered	93
Insurance policy start date	2020-10-01
Insurance policy end date	2021-09-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,671
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

729420

Policy instance

Insurance contract or identification number	729420
Number of Individuals Covered	5818
Insurance policy start date	2021-07-01
Insurance policy end date	2022-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $288,136
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326465

Policy instance

Insurance contract or identification number	VPS 326465
Number of Individuals Covered	475
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $531,480
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326462

Policy instance

Insurance contract or identification number	VPS 326462
Number of Individuals Covered	169
Insurance policy start date	2021-03-01
Insurance policy end date	2022-02-28
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $113,608
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Number of Individuals Covered	23
Insurance policy start date	2021-01-01
Insurance policy end date	2021-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $2,759
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Number of Individuals Covered	6552
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326461

Policy instance

Insurance contract or identification number	VPS 326461
Number of Individuals Covered	264
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $309,675
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 117634

Policy instance

Insurance contract or identification number	LTD 117634
Number of Individuals Covered	12
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,942
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 143794

Policy instance

Insurance contract or identification number	GL 143794
Number of Individuals Covered	12
Insurance policy start date	2020-03-01
Insurance policy end date	2021-03-28
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $901
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Number of Individuals Covered	810
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Other welfare benefits provided	CANCER/CATASTROPHIC CUSTODIAL CARE
Welfare Benefit Premiums Paid to Carrier	USD $22,273
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	5323
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	3865
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $61,896
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H1-4, P1-11

Policy instance

Insurance contract or identification number	3991H1-4, P1-11
Number of Individuals Covered	1872
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $434,798
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Number of Individuals Covered	49
Insurance policy start date	2020-01-01
Insurance policy end date	2020-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,446
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

ACN GROUP OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 933-0 )

Policy contract number

00087873

Policy instance

Insurance contract or identification number	00087873
Number of Individuals Covered	1643
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Other welfare benefits provided	DIRECT CHIROPRACTIC
Welfare Benefit Premiums Paid to Carrier	USD $59,222
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

US LEGAL SERVICES OF WISCONSIN, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	2077
Insurance policy start date	2020-03-01
Insurance policy end date	2021-04-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $394,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000805

Policy instance

Insurance contract or identification number	1000805
Number of Individuals Covered	103
Insurance policy start date	2019-10-01
Insurance policy end date	2020-09-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,844
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

729420

Policy instance

Insurance contract or identification number	729420
Number of Individuals Covered	6322
Insurance policy start date	2020-07-01
Insurance policy end date	2021-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $358,339
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326465

Policy instance

Insurance contract or identification number	VPS 326465
Number of Individuals Covered	514
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $695,406
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326462

Policy instance

Insurance contract or identification number	VPS 326462
Number of Individuals Covered	176
Insurance policy start date	2020-03-01
Insurance policy end date	2021-02-28
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $189,536
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Number of Individuals Covered	4932
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326461

Policy instance

Insurance contract or identification number	VPS 326461
Number of Individuals Covered	265
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $284,581
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 117634

Policy instance

Insurance contract or identification number	LTD 117634
Number of Individuals Covered	14
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $14,653
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 143794

Policy instance

Insurance contract or identification number	GL 143794
Number of Individuals Covered	14
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,003
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Other welfare benefits provided	CANCER/CATASTROPHIC CUSTODIAL CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	5524
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	4282
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $36,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H0-6, P8-10

Policy instance

Insurance contract or identification number	3991H0-6, P8-10
Number of Individuals Covered	1999
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $385,272
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Number of Individuals Covered	51
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

US LEGAL SERVICES OF WISCONSIN, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

Policy instance

Number of Individuals Covered	1942
Insurance policy start date	2019-03-01
Insurance policy end date	2020-04-30
Other welfare benefits provided	LEGAL
Welfare Benefit Premiums Paid to Carrier	USD $380,114
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

U. S. BEHAVIORAL HEALTH PLAN, CALIFORNIA DBA OPTUMHEALTH (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

15209

Policy instance

Insurance contract or identification number	15209
Number of Individuals Covered	180
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Other welfare benefits provided	EMPLOYEE ASSISTANCE PROGRAM
Welfare Benefit Premiums Paid to Carrier	USD $4,107
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 62146 )

Policy contract number

1000805

Policy instance

Insurance contract or identification number	1000805
Number of Individuals Covered	120
Insurance policy start date	2018-10-01
Insurance policy end date	2019-09-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $4,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

729420

Policy instance

Insurance contract or identification number	729420
Number of Individuals Covered	7374
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $268,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326465

Policy instance

Insurance contract or identification number	VPS 326465
Number of Individuals Covered	201
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $680,171
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326462

Policy instance

Insurance contract or identification number	VPS 326462
Number of Individuals Covered	201
Insurance policy start date	2019-01-01
Insurance policy end date	2019-12-31
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $208,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Other welfare benefits provided	CANCER/CATASTROPHIC CUSTODIAL CARE
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326461

Policy instance

Insurance contract or identification number	VPS 326461
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Number of Individuals Covered	5741
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Life Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H1-8,P6-P12

Policy instance

Insurance contract or identification number	3991H1-8,P6-P12
Number of Individuals Covered	2008
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $267,966
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Number of Individuals Covered	49
Insurance policy start date	2018-01-01
Insurance policy end date	2018-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,767
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326462

Policy instance

Insurance contract or identification number	VPS 326462
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

729420

Policy instance

Insurance contract or identification number	729420
Number of Individuals Covered	5198
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $310,854
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326465

Policy instance

Insurance contract or identification number	VPS 326465
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

U. S. BEHAVIORAL HEALTH PLAN, CALIFORNIA DBA OPTUMHEALTH (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

15209

Policy instance

Insurance contract or identification number	15209
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326462

Policy instance

Insurance contract or identification number	VPS 326462
Number of Individuals Covered	236
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $237,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326465

Policy instance

Insurance contract or identification number	VPS 326465
Number of Individuals Covered	605
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $731,862
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	5107
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H1-4, P1-11

Policy instance

Insurance contract or identification number	3991H1-4, P1-11
Number of Individuals Covered	2254
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $315,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

U. S. BEHAVIORAL HEALTH PLAN, CALIFORNIA DBA OPTUMHEALTH (National Association of Insurance Commissioners NAIC id number: N/A )

Policy contract number

15209

Policy instance

Insurance contract or identification number	15209
Number of Individuals Covered	166
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	5408
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $57,390
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Number of Individuals Covered	6141
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326461

Policy instance

Insurance contract or identification number	VPS 326461
Number of Individuals Covered	259
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $289,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Number of Individuals Covered	1100
Insurance policy start date	2016-10-01
Insurance policy end date	2017-09-30
Other welfare benefits provided	CANCER/CATASTROPHIC CUSTODIAL CARE
Welfare Benefit Premiums Paid to Carrier	USD $29,456
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326465

Policy instance

Insurance contract or identification number	VPS 326465
Number of Individuals Covered	664
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $673,075
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326462

Policy instance

Insurance contract or identification number	VPS 326462
Number of Individuals Covered	268
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $231,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Number of Individuals Covered	58
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $3,479
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H1-4, P1-11

Policy instance

Insurance contract or identification number	3991H1-4, P1-11
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $289,071
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	5784
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $47,335
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Number of Individuals Covered	6631
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326461

Policy instance

Insurance contract or identification number	VPS 326461
Number of Individuals Covered	239
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $234,240
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 117634

Policy instance

Insurance contract or identification number	LTD 117634
Number of Individuals Covered	14
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,391
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	4549
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $455,303
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Number of Individuals Covered	1228
Insurance policy start date	2014-10-01
Insurance policy end date	2015-09-30
Other welfare benefits provided	CANCER/CATASTROPHIC CUSTODIAL CARE
Welfare Benefit Premiums Paid to Carrier	USD $43,765
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 143794

Policy instance

Insurance contract or identification number	GL 143794
Number of Individuals Covered	14
Insurance policy start date	2015-07-01
Insurance policy end date	2016-06-30
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $911
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

LTD 117634

Policy instance

Insurance contract or identification number	LTD 117634
Number of Individuals Covered	14
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $1,621
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326465

Policy instance

Insurance contract or identification number	VPS 326465
Number of Individuals Covered	714
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $715,637
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326462

Policy instance

Insurance contract or identification number	VPS 326462
Number of Individuals Covered	287
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $244,449
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H1-4, P1-11

Policy instance

Insurance contract or identification number	3991H1-4, P1-11
Number of Individuals Covered	1023
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $310,370
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	6196
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,439
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VPS 326461

Policy instance

Insurance contract or identification number	VPS 326461
Number of Individuals Covered	251
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Other welfare benefits provided	VOLUNTARY SHORT TERM DISABILITY
Welfare Benefit Premiums Paid to Carrier	USD $237,101
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	3400
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 143794

Policy instance

Insurance contract or identification number	GL 143794
Number of Individuals Covered	14
Insurance policy start date	2014-07-01
Insurance policy end date	2015-06-30
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH AND DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $1,201
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Insurance policy start date	2013-10-01
Insurance policy end date	2014-09-30
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid as a credit?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	3222
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Number of Individuals Covered	3733
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid as a credit?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539966

Policy instance

Insurance contract or identification number	VIP 539966
Number of Individuals Covered	1532
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DSB INCOME PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $625,254
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539977

Policy instance

Insurance contract or identification number	VIP 539977
Number of Individuals Covered	596
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DSB INCOME PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $209,186
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539978

Policy instance

Insurance contract or identification number	VIP 539978
Number of Individuals Covered	528
Insurance policy start date	2013-07-01
Insurance policy end date	2014-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DSB INCOME PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $201,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H1-4, P1-11

Policy instance

Insurance contract or identification number	3991H1-4, P1-11
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	6574
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $40,875
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0729420

Policy instance

Insurance contract or identification number	0729420
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H1-4, P1-11

Policy instance

Insurance contract or identification number	3991H1-4, P1-11
Number of Individuals Covered	1097
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $406,281
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	7239
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $46,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539978

Policy instance

Insurance contract or identification number	VIP 539978
Number of Individuals Covered	264
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DSB INCOME PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $224,626
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539977

Policy instance

Insurance contract or identification number	VIP 539977
Number of Individuals Covered	298
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DSB INCOME PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $228,843
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539966

Policy instance

Insurance contract or identification number	VIP 539966
Number of Individuals Covered	766
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DSB INCOME PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $506,082
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Number of Individuals Covered	1443
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $62,299
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	3233
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H1-4, P1-9

Policy instance

Insurance contract or identification number	3991H1-4, P1-9
Number of Individuals Covered	1156
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $277,341
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539966

Policy instance

Insurance contract or identification number	VIP 539966
Number of Individuals Covered	1400
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DSB INCOME PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $541,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Number of Individuals Covered	62
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,203
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	7239
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $50,358
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

0729420

Policy instance

Insurance contract or identification number	0729420
Number of Individuals Covered	7769
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $435,367
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Number of Individuals Covered	7681
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Number of Individuals Covered	1970
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Health Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Were dividends or retroactive rate refunds paid as a credit?	Yes
Welfare Benefit Premiums Paid to Carrier	USD $85,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539977

Policy instance

Insurance contract or identification number	VIP 539977
Number of Individuals Covered	619
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DSB INCOME PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $235,870
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539978

Policy instance

Insurance contract or identification number	VIP 539978
Number of Individuals Covered	637
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Temporary Disability Insurance Welfare Benefit	Yes
Long Term Disability Insurance Welfare Benefit	Yes
Other welfare benefits provided	VOLUNTARY DSB INCOME PROTECTION
Welfare Benefit Premiums Paid to Carrier	USD $231,859
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	3161
Insurance policy start date	2011-07-01
Insurance policy end date	2012-06-30
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740325-000

Policy instance

Insurance contract or identification number	740325-000
Number of Individuals Covered	70
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $5,857
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 00000 )

Policy contract number

12242127

Policy instance

Insurance contract or identification number	12242127
Number of Individuals Covered	3133
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $323,860
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

TRUSTMARK LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 62863 )

Policy contract number

DY531

Policy instance

Insurance contract or identification number	DY531
Number of Individuals Covered	1672
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Health Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539966

Policy instance

Insurance contract or identification number	VIP 539966
Number of Individuals Covered	1198
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $529,749
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539977

Policy instance

Insurance contract or identification number	VIP 539977
Number of Individuals Covered	541
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $180,845
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

VIP 539978

Policy instance

Insurance contract or identification number	VIP 539978
Number of Individuals Covered	528
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Long Term Disability Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $165,689
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITED CONCORDIA DENTAL PLANS OF CALIFORNIA, INC. (National Association of Insurance Commissioners NAIC id number: 95789 )

Policy contract number

740324-000

Policy instance

Insurance contract or identification number	740324-000
Number of Individuals Covered	8316
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

DENTAL HEALTH SERVICES (National Association of Insurance Commissioners NAIC id number: 41067 )

Policy contract number

3991H1-4 P1-5

Policy instance

Insurance contract or identification number	3991H1-4 P1-5
Number of Individuals Covered	1395
Insurance policy start date	2010-07-01
Insurance policy end date	2011-06-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $301,618
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )

Policy contract number

677360G

Policy instance

Insurance contract or identification number	677360G
Number of Individuals Covered	7856
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Life Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $67,235
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 )

Policy contract number

MULTI

Policy instance

Insurance contract or identification number	MULTI
Number of Individuals Covered	7924
Insurance policy start date	2010-03-01
Insurance policy end date	2011-02-28
Total amount of commissions paid to insurance broker	USD $0
Total amount of fees paid to insurance company	USD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating plan	No
Contracts With Unallocated Funds Deposit Administration	0
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $467,154
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

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Company Name:	BOARD OF TRUSTEES, SEIU LOCAL 721 EMPLOYEE BENEFITS
Employer identification number (EIN):	263902233
NAIC Classification:	921000