IATSE LOCAL 17 HEALTH & WELFARE INSURANCE TRUST FUND has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST
401k plan membership statisitcs for IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST
| Measure | Date | Value |
|---|
| 2022 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2022 401k financial data |
|---|
| Total income from all sources (including contributions) | 2022-12-31 | $876,978 |
| Total of all expenses incurred | 2022-12-31 | $414,526 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $401,021 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $871,284 |
| Value of total assets at end of year | 2022-12-31 | $1,646,651 |
| Value of total assets at beginning of year | 2022-12-31 | $1,184,199 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $13,505 |
| Total interest from all sources | 2022-12-31 | $5,694 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Administrative expenses professional fees incurred | 2022-12-31 | $11,670 |
| Was this plan covered by a fidelity bond | 2022-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $133,163 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $14,039 |
| Administrative expenses (other) incurred | 2022-12-31 | $1,835 |
| Total non interest bearing cash at end of year | 2022-12-31 | $100,000 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $100,000 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $462,452 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $1,646,651 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $1,184,199 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Interest earned on other investments | 2022-12-31 | $3,365 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $1,479,799 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $963,627 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $963,627 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $2,329 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $401,021 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | Yes |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $738,121 |
| Employer contributions (assets) at end of year | 2022-12-31 | $64,603 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $95,285 |
| 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 | 2022-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2022-12-31 | $2,249 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2022-12-31 | $11,248 |
| Did the plan have assets held for investment | 2022-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | W. ALLEN PRIEST CPA PLLC |
| Accountancy firm EIN | 2022-12-31 | 814447200 |
| 2021 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2021 401k financial data |
|---|
| Total income from all sources (including contributions) | 2021-12-31 | $483,956 |
| Total of all expenses incurred | 2021-12-31 | $380,368 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $367,824 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $481,450 |
| Value of total assets at end of year | 2021-12-31 | $1,184,199 |
| Value of total assets at beginning of year | 2021-12-31 | $1,080,611 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $12,544 |
| Total interest from all sources | 2021-12-31 | $2,506 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Administrative expenses professional fees incurred | 2021-12-31 | $8,400 |
| Was this plan covered by a fidelity bond | 2021-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $147,601 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $14,039 |
| Administrative expenses (other) incurred | 2021-12-31 | $4,144 |
| Total non interest bearing cash at end of year | 2021-12-31 | $100,000 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $63,339 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $103,588 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $1,184,199 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $1,080,611 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Interest earned on other investments | 2021-12-31 | $1,944 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $963,627 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $1,006,024 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $1,006,024 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-12-31 | $562 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $367,824 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | Yes |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $333,849 |
| Employer contributions (assets) at end of year | 2021-12-31 | $95,285 |
| 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 | 2021-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2021-12-31 | $11,248 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2021-12-31 | $11,248 |
| Did the plan have assets held for investment | 2021-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | W ALLEN PRIEST CPA PLLC |
| Accountancy firm EIN | 2021-12-31 | 814447200 |
| 2020 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2020 401k financial data |
|---|
| Total income from all sources (including contributions) | 2020-12-31 | $323,159 |
| Total of all expenses incurred | 2020-12-31 | $657,192 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $646,050 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $320,959 |
| Value of total assets at end of year | 2020-12-31 | $1,080,611 |
| Value of total assets at beginning of year | 2020-12-31 | $1,414,644 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $11,142 |
| Total interest from all sources | 2020-12-31 | $2,200 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Administrative expenses professional fees incurred | 2020-12-31 | $8,260 |
| Was this plan covered by a fidelity bond | 2020-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $169,014 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $100 |
| Administrative expenses (other) incurred | 2020-12-31 | $2,882 |
| Total non interest bearing cash at end of year | 2020-12-31 | $63,339 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $106,701 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $-334,033 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $1,080,611 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $1,414,644 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $1,006,024 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $1,265,896 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $1,265,896 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-12-31 | $2,200 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $646,050 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $151,945 |
| Employer contributions (assets) at beginning of year | 2020-12-31 | $31,229 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2020-12-31 | $11,248 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2020-12-31 | $10,718 |
| Did the plan have assets held for investment | 2020-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | W. ALLEN PRIEST CPA PLLC |
| Accountancy firm EIN | 2020-12-31 | 814447200 |
| 2019 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2019 401k financial data |
|---|
| Total income from all sources (including contributions) | 2019-12-31 | $924,340 |
| Total of all expenses incurred | 2019-12-31 | $668,045 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $657,149 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $918,709 |
| Value of total assets at end of year | 2019-12-31 | $1,414,644 |
| Value of total assets at beginning of year | 2019-12-31 | $1,158,349 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $10,896 |
| Total interest from all sources | 2019-12-31 | $5,631 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $8,600 |
| Was this plan covered by a fidelity bond | 2019-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $165,169 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $100 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $208,295 |
| Administrative expenses (other) incurred | 2019-12-31 | $2,296 |
| Total non interest bearing cash at end of year | 2019-12-31 | $106,701 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $102,401 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $256,295 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $1,414,644 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $1,158,349 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $1,265,896 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $812,915 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $812,915 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $5,631 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $657,149 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $753,540 |
| Employer contributions (assets) at end of year | 2019-12-31 | $31,229 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $32,985 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2019-12-31 | $10,718 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2019-12-31 | $1,753 |
| Did the plan have assets held for investment | 2019-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | W. ALLEN PRIEST CPA PLLC |
| Accountancy firm EIN | 2019-12-31 | 814447200 |
| 2018 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2018 401k financial data |
|---|
| Total income from all sources (including contributions) | 2018-12-31 | $785,796 |
| Total of all expenses incurred | 2018-12-31 | $539,421 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $528,475 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $783,667 |
| Value of total assets at end of year | 2018-12-31 | $1,158,349 |
| Value of total assets at beginning of year | 2018-12-31 | $911,974 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $10,946 |
| Total interest from all sources | 2018-12-31 | $2,129 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Administrative expenses professional fees incurred | 2018-12-31 | $8,350 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $50,000 |
| If this is an individual account plan, was there a blackout period | 2018-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2018-12-31 | Yes |
| Amount of non-exempt transactions with any party-in-interest | 2018-12-31 | $796 |
| Contributions received from participants | 2018-12-31 | $135,930 |
| Income. Received or receivable in cash from other sources (including rollovers) | 2018-12-31 | $34,567 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $208,295 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $58,355 |
| Administrative expenses (other) incurred | 2018-12-31 | $2,596 |
| Total non interest bearing cash at end of year | 2018-12-31 | $102,401 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $77,640 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Value of net income/loss | 2018-12-31 | $246,375 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $1,158,349 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $911,974 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $812,915 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $667,174 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $667,174 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-12-31 | $2,129 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $528,475 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2018-12-31 | Yes |
| Has the plan failed to provide any benefit when due under the plan | 2018-12-31 | No |
| Contributions received in cash from employer | 2018-12-31 | $613,170 |
| Employer contributions (assets) at end of year | 2018-12-31 | $32,985 |
| Employer contributions (assets) at beginning of year | 2018-12-31 | $107,220 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2018-12-31 | $1,753 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2018-12-31 | $1,585 |
| Did the plan have assets held for investment | 2018-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-12-31 | Unqualified |
| Accountancy firm name | 2018-12-31 | W. ALLEN PRIEST CPA PLLC |
| Accountancy firm EIN | 2018-12-31 | 814447200 |
| 2017 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2017 401k financial data |
|---|
| Total income from all sources (including contributions) | 2017-12-31 | $685,719 |
| Total of all expenses incurred | 2017-12-31 | $541,168 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $528,814 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $684,514 |
| Value of total assets at end of year | 2017-12-31 | $911,974 |
| Value of total assets at beginning of year | 2017-12-31 | $767,423 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $12,354 |
| Total interest from all sources | 2017-12-31 | $1,205 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Administrative expenses professional fees incurred | 2017-12-31 | $9,758 |
| Was this plan covered by a fidelity bond | 2017-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2017-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-12-31 | No |
| Contributions received from participants | 2017-12-31 | $148,846 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $58,355 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $150 |
| Administrative expenses (other) incurred | 2017-12-31 | $2,596 |
| Total non interest bearing cash at end of year | 2017-12-31 | $77,640 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $718,794 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Value of net income/loss | 2017-12-31 | $144,551 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $911,974 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $767,423 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $667,174 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-12-31 | $1,205 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $528,814 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2017-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-12-31 | No |
| Contributions received in cash from employer | 2017-12-31 | $535,668 |
| Employer contributions (assets) at end of year | 2017-12-31 | $107,220 |
| Employer contributions (assets) at beginning of year | 2017-12-31 | $46,623 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2017-12-31 | $1,585 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2017-12-31 | $1,856 |
| Did the plan have assets held for investment | 2017-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-12-31 | Unqualified |
| Accountancy firm name | 2017-12-31 | W. ALLEN PRIEST CPA PLLC |
| Accountancy firm EIN | 2017-12-31 | 814447200 |
| 2016 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2016 401k financial data |
|---|
| Total income from all sources (including contributions) | 2016-12-31 | $851,235 |
| Total of all expenses incurred | 2016-12-31 | $593,919 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $577,357 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $850,436 |
| Value of total assets at end of year | 2016-12-31 | $767,423 |
| Value of total assets at beginning of year | 2016-12-31 | $510,107 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $16,562 |
| Total interest from all sources | 2016-12-31 | $799 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Administrative expenses professional fees incurred | 2016-12-31 | $14,000 |
| Was this plan covered by a fidelity bond | 2016-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2016-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-12-31 | No |
| Contributions received from participants | 2016-12-31 | $158,430 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $150 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $150 |
| Administrative expenses (other) incurred | 2016-12-31 | $2,562 |
| Total non interest bearing cash at end of year | 2016-12-31 | $718,794 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $474,320 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-12-31 | No |
| Value of net income/loss | 2016-12-31 | $257,316 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $767,423 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $510,107 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-12-31 | $799 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $577,357 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2016-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-12-31 | No |
| Contributions received in cash from employer | 2016-12-31 | $692,006 |
| Employer contributions (assets) at end of year | 2016-12-31 | $46,623 |
| Employer contributions (assets) at beginning of year | 2016-12-31 | $33,627 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2016-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2016-12-31 | $1,856 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2016-12-31 | $2,010 |
| Did the plan have assets held for investment | 2016-12-31 | 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 | 2016-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-12-31 | Unqualified |
| Accountancy firm name | 2016-12-31 | W.ALLEN PRIEST CPA PLLC |
| Accountancy firm EIN | 2016-12-31 | 814447200 |
| 2015 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2015 401k financial data |
|---|
| Total income from all sources (including contributions) | 2015-12-31 | $755,356 |
| Total of all expenses incurred | 2015-12-31 | $512,435 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $507,868 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $754,977 |
| Value of total assets at end of year | 2015-12-31 | $510,107 |
| Value of total assets at beginning of year | 2015-12-31 | $267,186 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $4,567 |
| Total interest from all sources | 2015-12-31 | $379 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Administrative expenses professional fees incurred | 2015-12-31 | $2,062 |
| Was this plan covered by a fidelity bond | 2015-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2015-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-12-31 | No |
| Contributions received from participants | 2015-12-31 | $168,595 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $150 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $150 |
| Administrative expenses (other) incurred | 2015-12-31 | $2,505 |
| Total non interest bearing cash at end of year | 2015-12-31 | $474,320 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $231,181 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-12-31 | No |
| Value of net income/loss | 2015-12-31 | $242,921 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $510,107 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $267,186 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-12-31 | No |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-12-31 | $379 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $507,868 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-12-31 | No |
| Contributions received in cash from employer | 2015-12-31 | $586,382 |
| Employer contributions (assets) at end of year | 2015-12-31 | $33,627 |
| Employer contributions (assets) at beginning of year | 2015-12-31 | $34,300 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2015-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2015-12-31 | $2,010 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2015-12-31 | $1,555 |
| Did the plan have assets held for investment | 2015-12-31 | 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 | 2015-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-12-31 | Unqualified |
| Accountancy firm name | 2015-12-31 | COMPTON KOTTKE & ASSOCIATES P.S.C. |
| Accountancy firm EIN | 2015-12-31 | 611031917 |
| 2014 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2014 401k financial data |
|---|
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $7,400 |
| Total income from all sources (including contributions) | 2014-12-31 | $648,469 |
| Total of all expenses incurred | 2014-12-31 | $686,103 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $674,885 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $648,390 |
| Value of total assets at end of year | 2014-12-31 | $267,186 |
| Value of total assets at beginning of year | 2014-12-31 | $312,220 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $11,218 |
| Total interest from all sources | 2014-12-31 | $79 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-12-31 | No |
| Administrative expenses professional fees incurred | 2014-12-31 | $7,600 |
| Was this plan covered by a fidelity bond | 2014-12-31 | Yes |
| Value of fidelity bond cover | 2014-12-31 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-12-31 | No |
| Contributions received from participants | 2014-12-31 | $188,938 |
| Administrative expenses (other) incurred | 2014-12-31 | $3,618 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $7,400 |
| Total non interest bearing cash at end of year | 2014-12-31 | $231,181 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $45,687 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Value of net income/loss | 2014-12-31 | $-37,634 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $267,186 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $304,820 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-12-31 | No |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $220,591 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $220,591 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $79 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-12-31 | No |
| Contributions received in cash from employer | 2014-12-31 | $459,452 |
| Employer contributions (assets) at end of year | 2014-12-31 | $34,300 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $44,137 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $674,885 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2014-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2014-12-31 | $1,705 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2014-12-31 | $1,805 |
| Did the plan have assets held for investment | 2014-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-12-31 | Unqualified |
| Accountancy firm name | 2014-12-31 | COMPTON KOTTKE & ASSOCIATES |
| Accountancy firm EIN | 2014-12-31 | 611031917 |
| 2013 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $7,400 |
| Total income from all sources (including contributions) | 2013-12-31 | $647,309 |
| Total of all expenses incurred | 2013-12-31 | $741,126 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $730,513 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $646,466 |
| Value of total assets at end of year | 2013-12-31 | $312,220 |
| Value of total assets at beginning of year | 2013-12-31 | $398,637 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $10,613 |
| Total interest from all sources | 2013-12-31 | $843 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-12-31 | No |
| Administrative expenses professional fees incurred | 2013-12-31 | $7,400 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $50,000 |
| If this is an individual account plan, was there a blackout period | 2013-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-12-31 | No |
| Contributions received from participants | 2013-12-31 | $142,770 |
| Administrative expenses (other) incurred | 2013-12-31 | $3,213 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $7,400 |
| Total non interest bearing cash at end of year | 2013-12-31 | $45,687 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $143,089 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Value of net income/loss | 2013-12-31 | $-93,817 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $304,820 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $398,637 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-12-31 | $220,591 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $219,677 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $219,677 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-12-31 | $843 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-12-31 | No |
| Contributions received in cash from employer | 2013-12-31 | $503,696 |
| Employer contributions (assets) at end of year | 2013-12-31 | $44,137 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $33,747 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $730,513 |
| 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 | 2013-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2013-12-31 | $1,805 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2013-12-31 | $2,124 |
| Did the plan have assets held for investment | 2013-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-12-31 | Unqualified |
| Accountancy firm name | 2013-12-31 | COMPTON KOTTKE & ASSOCIATES PSC |
| Accountancy firm EIN | 2013-12-31 | 611031917 |
| 2012 : IATSE LOCAL 17 HEALTH AND WELFARE INSURANCE TRUST 2012 401k financial data |
|---|
| Total income from all sources (including contributions) | 2012-12-31 | $625,446 |
| Total of all expenses incurred | 2012-12-31 | $735,696 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $723,171 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $622,588 |
| Value of total assets at end of year | 2012-12-31 | $398,637 |
| Value of total assets at beginning of year | 2012-12-31 | $508,887 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $12,525 |
| Total interest from all sources | 2012-12-31 | $2,858 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-12-31 | No |
| Administrative expenses professional fees incurred | 2012-12-31 | $8,820 |
| Was this plan covered by a fidelity bond | 2012-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2012-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $151,696 |
| Administrative expenses (other) incurred | 2012-12-31 | $3,705 |
| Total non interest bearing cash at end of year | 2012-12-31 | $143,089 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $203,298 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Value of net income/loss | 2012-12-31 | $-110,250 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $398,637 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $508,887 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-12-31 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-12-31 | $219,677 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $216,942 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $216,942 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $2,858 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-12-31 | No |
| Contributions received in cash from employer | 2012-12-31 | $470,892 |
| Employer contributions (assets) at end of year | 2012-12-31 | $33,747 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $29,634 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $723,171 |
| 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 | 2012-12-31 | No |
| Assets. Value of buildings and other operty used in plan operation at end of year | 2012-12-31 | $2,124 |
| Assets. Value of buildings and other operty used in plan operation at beginning of year | 2012-12-31 | $59,013 |
| Did the plan have assets held for investment | 2012-12-31 | No |
| Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-12-31 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-12-31 | Unqualified |
| Accountancy firm name | 2012-12-31 | COMPTON, KOTTKE & ASSOCIATES P.S.C. |
| Accountancy firm EIN | 2012-12-31 | 611031917 |
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 921285 |
| Policy instance | 3 |
| Insurance contract or identification number | 921285 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $121 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $121 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00526564 |
| Policy instance | 2 |
| Insurance contract or identification number | 00526564 | | Number of Individuals Covered | 132 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $1,845 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,756 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,845 | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W26963 |
| Policy instance | 1 |
| Insurance contract or identification number | W26963 | | Number of Individuals Covered | 70 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $11,288 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $366,358 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,288 | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W26963 |
| Policy instance | 1 |
| Insurance contract or identification number | W26963 | | Number of Individuals Covered | 78 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $12,298 | | Total amount of fees paid to insurance company | USD $281 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $352,402 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,450 | | Amount paid for insurance broker fees | 281 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00526564 |
| Policy instance | 2 |
| Insurance contract or identification number | 00526564 | | Number of Individuals Covered | 133 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $1,082 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,059 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,082 | | Insurance broker organization code? | 3 |
|
| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 921285 |
| Policy instance | 3 |
| Insurance contract or identification number | 921285 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $168 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,686 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $98 |
|
| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00526564 |
| Policy instance | 2 |
| Insurance contract or identification number | 00526564 | | Number of Individuals Covered | 139 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,171 | | Total amount of fees paid to insurance company | USD $4,697 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $82,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,171 | | Amount paid for insurance broker fees | 4697 | | Insurance broker organization code? | 3 |
|
| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W26963 |
| Policy instance | 1 |
| Insurance contract or identification number | W26963 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $14,036 | | Total amount of fees paid to insurance company | USD $3,480 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $498,588 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,138 | | Amount paid for insurance broker fees | 3480 | | Additional information about fees paid to insurance broker | FEES INCLUDE BONUS, OVERRIDE AND NON MONETARY COMPENSATION. PURPOSE O | | Insurance broker organization code? | 3 |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | W26963 |
| Policy instance | 1 |
| Insurance contract or identification number | W26963 | | Number of Individuals Covered | 87 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $13,376 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $554,700 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,376 | | Insurance broker organization code? | 3 |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00526564 |
| Policy instance | 2 |
| Insurance contract or identification number | 00526564 | | Number of Individuals Covered | 144 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $10,876 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $107,287 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $10,876 | | Insurance broker organization code? | 3 |
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| SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 ) |
| Policy contract number | 921285 |
| Policy instance | 3 |
| Insurance contract or identification number | 921285 | | Number of Individuals Covered | 44 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Total amount of commissions paid to insurance broker | USD $452 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,935 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $402 | | Insurance broker organization code? | 3 |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 00248813 |
| Policy instance | 1 |
| Insurance contract or identification number | 00248813 | | Number of Individuals Covered | 73 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $13,240 | | Total amount of fees paid to insurance company | USD $800 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $442,165 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,240 | | Amount paid for insurance broker fees | 800 | | Additional information about fees paid to insurance broker | BONUS FEE | | Insurance broker organization code? | 3 |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00526564 |
| Policy instance | 2 |
| Insurance contract or identification number | 00526564 | | Number of Individuals Covered | 146 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $7,603 | | Total amount of fees paid to insurance company | USD $2,895 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $70,617 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,603 | | Amount paid for insurance broker fees | 2895 | | Additional information about fees paid to insurance broker | BONUS COMMISSION | | Insurance broker organization code? | 3 |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | K184 |
| Policy instance | 3 |
| Insurance contract or identification number | K184 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $416 | | Total amount of fees paid to insurance company | USD $20 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $4,154 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $416 | | Amount paid for insurance broker fees | 20 | | Additional information about fees paid to insurance broker | BONUS COMMISSIONS | | Insurance broker organization code? | 3 |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | K184 |
| Policy instance | 3 |
| Insurance contract or identification number | K184 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $325 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,245 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $325 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS |
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| THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 ) |
| Policy contract number | 00526564 |
| Policy instance | 2 |
| Insurance contract or identification number | 00526564 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $6,985 | | Total amount of fees paid to insurance company | USD $3,028 | | Vision Insurance Welfare Benefit | Yes | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Long Term Disability Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $60,683 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,985 | | Amount paid for insurance broker fees | 3028 | | Additional information about fees paid to insurance broker | MARKETING FEE | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS |
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| BLUEGRASS FAMILY HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 95071 ) |
| Policy contract number | 031965-01/02 |
| Policy instance | 1 |
| Insurance contract or identification number | 031965-01/02 | | Number of Individuals Covered | 71 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $9,739 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $460,839 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $9,739 | | Insurance broker organization code? | 3 | | Insurance broker name | EPIC INSURANCE SOLUTIONS |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | K184 |
| Policy instance | 5 |
| Insurance contract or identification number | K184 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $345 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $345 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010168538 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010168538 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2014-12-01 | | Insurance policy end date | 2015-11-30 | | Total amount of commissions paid to insurance broker | USD $2,443 | | Total amount of fees paid to insurance company | USD $0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,443 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30000110 |
| Policy instance | 3 |
| Insurance contract or identification number | 30000110 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $717 | | Total amount of fees paid to insurance company | USD $0 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,334 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $717 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 00195098 |
| Policy instance | 2 |
| Insurance contract or identification number | 00195098 | | Number of Individuals Covered | 45 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $13,640 | | Total amount of fees paid to insurance company | USD $0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $427,912 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,640 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G3210/G4479 |
| Policy instance | 1 |
| Insurance contract or identification number | G3210/G4479 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2015-03-01 | | Insurance policy end date | 2016-02-28 | | Total amount of commissions paid to insurance broker | USD $3,863 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $19,316 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,863 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF LOUISVILLE |
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| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G3210/G4479 |
| Policy instance | 1 |
| Insurance contract or identification number | G3210/G4479 | | Number of Individuals Covered | 129 | | Insurance policy start date | 2014-03-01 | | Insurance policy end date | 2015-02-28 | | Total amount of commissions paid to insurance broker | USD $3,452 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,262 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,452 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF LOUISVILLE |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 00195098 |
| Policy instance | 2 |
| Insurance contract or identification number | 00195098 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $13,788 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $594,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,788 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30000110 |
| Policy instance | 3 |
| Insurance contract or identification number | 30000110 | | Number of Individuals Covered | 47 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $9,334 | | 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 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $717 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010168538 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010168538 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2013-12-01 | | Insurance policy end date | 2014-11-30 | | Total amount of commissions paid to insurance broker | USD $2,405 | | Total amount of fees paid to insurance company | USD $420 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,405 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 420 | | Insurance broker name | BROWN AND BROWN OF FLORIDA |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | K184 |
| Policy instance | 5 |
| Insurance contract or identification number | K184 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2014-07-01 | | Insurance policy end date | 2015-06-30 | | Total amount of commissions paid to insurance broker | USD $345 | | 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 $3,733 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $345 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G3210/G4479 |
| Policy instance | 1 |
| Insurance contract or identification number | G3210/G4479 | | Number of Individuals Covered | 135 | | Insurance policy start date | 2013-03-01 | | Insurance policy end date | 2014-02-28 | | Total amount of commissions paid to insurance broker | USD $3,533 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISMEMBERMENT | | Welfare Benefit Premiums Paid to Carrier | USD $17,664 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,533 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF LOUISVILLE |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 00195098 |
| Policy instance | 2 |
| Insurance contract or identification number | 00195098 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $13,788 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $594,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $13,788 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30000110 |
| Policy instance | 3 |
| Insurance contract or identification number | 30000110 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $748 | | 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 $9,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $748 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65676 ) |
| Policy contract number | 000010168538 |
| Policy instance | 4 |
| Insurance contract or identification number | 000010168538 | | Number of Individuals Covered | 46 | | Insurance policy start date | 2012-12-01 | | Insurance policy end date | 2013-11-30 | | Total amount of commissions paid to insurance broker | USD $2,825 | | Total amount of fees paid to insurance company | USD $420 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $12,025 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,405 | | Insurance broker organization code? | 3 | | Amount paid for insurance broker fees | 420 | | Additional information about fees paid to insurance broker | BROKER BONUS | | Insurance broker name | BROWN AND BROWN OF FLORIDA |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | K184 |
| Policy instance | 5 |
| Insurance contract or identification number | K184 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2013-07-01 | | Insurance policy end date | 2014-06-30 | | Total amount of commissions paid to insurance broker | USD $380 | | 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 $3,802 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $380 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| UNION SECURITY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70408 ) |
| Policy contract number | K184 |
| Policy instance | 5 |
| Insurance contract or identification number | K184 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $403 | | 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 $4,034 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $306 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | FAE02174 |
| Policy instance | 4 |
| Insurance contract or identification number | FAE02174 | | Number of Individuals Covered | 50 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-11-30 | | Total amount of commissions paid to insurance broker | USD $2,605 | | 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 | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,027 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,605 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 39616 ) |
| Policy contract number | 30000110 |
| Policy instance | 3 |
| Insurance contract or identification number | 30000110 | | Number of Individuals Covered | 53 | | Insurance policy start date | 2012-07-01 | | Insurance policy end date | 2013-06-30 | | Total amount of commissions paid to insurance broker | USD $748 | | 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 $9,950 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $748 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| ANTHEM HEALTH PLAN OF KENTUCKY D.B.A. ANTHEM BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 95120 ) |
| Policy contract number | 00195098 |
| Policy instance | 2 |
| Insurance contract or identification number | 00195098 | | Number of Individuals Covered | 49 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $3,060 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $582,546 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,060 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF KENTUCKY, INC. |
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| THE UNION LABOR LIFE INSURANCE CO. (National Association of Insurance Commissioners NAIC id number: 52414 ) |
| Policy contract number | G3165/G4441 |
| Policy instance | 1 |
| Insurance contract or identification number | G3165/G4441 | | Number of Individuals Covered | 136 | | Insurance policy start date | 2012-03-01 | | Insurance policy end date | 2013-02-28 | | Total amount of commissions paid to insurance broker | USD $3,572 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | ACCIDENTAL DEATH AND DISABILITY | | Welfare Benefit Premiums Paid to Carrier | USD $17,859 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $3,572 | | Insurance broker organization code? | 3 | | Insurance broker name | BROWN AND BROWN OF LOUISVILLE |
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