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H. B. FULLER COMPANY RETIREE MEDICAL PLAN 401k Plan overview

Plan NameH. B. FULLER COMPANY RETIREE MEDICAL PLAN
Plan identification number 509

H. B. FULLER COMPANY RETIREE MEDICAL PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance

401k Sponsoring company profile

H. B. FULLER COMPANY has sponsored the creation of one or more 401k plans.

Company Name:H. B. FULLER COMPANY
Employer identification number (EIN):410268370
NAIC Classification:325500

Additional information about H. B. FULLER COMPANY

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1964-02-28
Company Identification Number: 0002362706
Legal Registered Office Address: PO BOX 64683

SAINT PAUL
United States of America (USA)
55164

More information about H. B. FULLER COMPANY

Form 5500 Filing Information

Submission information for form 5500 for 401k plan H. B. FULLER COMPANY RETIREE MEDICAL PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5092021-12-01
5092020-12-01
5092019-12-01
5092018-12-01
5092017-12-01
5092016-12-01DAWN BERGIEN-SKARBALUS
5092016-12-01
5092015-12-01DAWN BERGIEN-SKARBALUS
5092015-12-01
5092014-12-01DAWN BERGIEN-SKARBALUS DAWN BERGIEN-SKARBALUS2016-09-15
5092013-12-01DAWN BERGIEN-SKARBALUS
5092012-12-01DAWN BERGIEN-SKARBALUS
5092011-12-01DAWN BERGIEN-SKARBALUS
5092010-12-01DOUGLAS S. PARR
5092009-12-01DOUGLAS S. PARR
5092008-12-01

Plan Statistics for H. B. FULLER COMPANY RETIREE MEDICAL PLAN

401k plan membership statisitcs for H. B. FULLER COMPANY RETIREE MEDICAL PLAN

Measure Date Value
2021: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2021 401k membership
Total participants, beginning-of-year2021-12-01593
Total number of active participants reported on line 7a of the Form 55002021-12-01136
Number of retired or separated participants receiving benefits2021-12-01590
Number of other retired or separated participants entitled to future benefits2021-12-010
Total of all active and inactive participants2021-12-01726
2020: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2020 401k membership
Total participants, beginning-of-year2020-12-01610
Total number of active participants reported on line 7a of the Form 55002020-12-010
Number of retired or separated participants receiving benefits2020-12-01593
Number of other retired or separated participants entitled to future benefits2020-12-010
Total of all active and inactive participants2020-12-01593
2019: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2019 401k membership
Total participants, beginning-of-year2019-12-01624
Total number of active participants reported on line 7a of the Form 55002019-12-010
Number of retired or separated participants receiving benefits2019-12-01610
Number of other retired or separated participants entitled to future benefits2019-12-010
Total of all active and inactive participants2019-12-01610
2018: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2018 401k membership
Total participants, beginning-of-year2018-12-01618
Total number of active participants reported on line 7a of the Form 55002018-12-010
Number of retired or separated participants receiving benefits2018-12-01624
Number of other retired or separated participants entitled to future benefits2018-12-010
Total of all active and inactive participants2018-12-01624
2017: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2017 401k membership
Total participants, beginning-of-year2017-12-01599
Total number of active participants reported on line 7a of the Form 55002017-12-010
Number of retired or separated participants receiving benefits2017-12-01618
Number of other retired or separated participants entitled to future benefits2017-12-010
Total of all active and inactive participants2017-12-01618
2016: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2016 401k membership
Total participants, beginning-of-year2016-12-01631
Total number of active participants reported on line 7a of the Form 55002016-12-010
Number of retired or separated participants receiving benefits2016-12-01599
Number of other retired or separated participants entitled to future benefits2016-12-010
Total of all active and inactive participants2016-12-01599
2015: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2015 401k membership
Total participants, beginning-of-year2015-12-01630
Total number of active participants reported on line 7a of the Form 55002015-12-010
Number of retired or separated participants receiving benefits2015-12-01631
Number of other retired or separated participants entitled to future benefits2015-12-010
Total of all active and inactive participants2015-12-01631
2014: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2014 401k membership
Total participants, beginning-of-year2014-12-01639
Total number of active participants reported on line 7a of the Form 55002014-12-010
Number of retired or separated participants receiving benefits2014-12-01630
Total of all active and inactive participants2014-12-01630
2013: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2013 401k membership
Total participants, beginning-of-year2013-12-01685
Total number of active participants reported on line 7a of the Form 55002013-12-010
Number of retired or separated participants receiving benefits2013-12-01639
Number of other retired or separated participants entitled to future benefits2013-12-010
Total of all active and inactive participants2013-12-01639
2012: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2012 401k membership
Total participants, beginning-of-year2012-12-01674
Total number of active participants reported on line 7a of the Form 55002012-12-010
Number of retired or separated participants receiving benefits2012-12-01685
Number of other retired or separated participants entitled to future benefits2012-12-010
Total of all active and inactive participants2012-12-01685
2011: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2011 401k membership
Total participants, beginning-of-year2011-12-01265
Total number of active participants reported on line 7a of the Form 55002011-12-010
Number of retired or separated participants receiving benefits2011-12-01236
Number of other retired or separated participants entitled to future benefits2011-12-010
Total of all active and inactive participants2011-12-01236
2010: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2010 401k membership
Total participants, beginning-of-year2010-12-01669
Total number of active participants reported on line 7a of the Form 55002010-12-010
Number of retired or separated participants receiving benefits2010-12-01646
Number of other retired or separated participants entitled to future benefits2010-12-0156
Total of all active and inactive participants2010-12-01702
2009: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2009 401k membership
Total participants, beginning-of-year2009-12-01790
Total number of active participants reported on line 7a of the Form 55002009-12-01638
Number of retired or separated participants receiving benefits2009-12-0131
Number of other retired or separated participants entitled to future benefits2009-12-010
Total of all active and inactive participants2009-12-01669

Financial Data on H. B. FULLER COMPANY RETIREE MEDICAL PLAN

Measure Date Value
2022 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2022 401k financial data
Total unrealized appreciation/depreciation of assets2022-11-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-11-30$6,868
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-11-30$280,907
Total income from all sources (including contributions)2022-11-30$-12,349,956
Total loss/gain on sale of assets2022-11-30$0
Total of all expenses incurred2022-11-30$2,295,481
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-11-30$2,160,212
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-11-30$124,596
Value of total assets at end of year2022-11-30$120,781,869
Value of total assets at beginning of year2022-11-30$135,701,345
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-11-30$135,269
Total interest from all sources2022-11-30$-12,474,552
Total dividends received (eg from common stock, registered investment company shares)2022-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-11-30No
Administrative expenses professional fees incurred2022-11-30$133,620
Was this plan covered by a fidelity bond2022-11-30Yes
Value of fidelity bond cover2022-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2022-11-30No
Contributions received from participants2022-11-30$124,596
Administrative expenses (other) incurred2022-11-30$1,649
Liabilities. Value of operating payables at end of year2022-11-30$6,868
Liabilities. Value of operating payables at beginning of year2022-11-30$10,329
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-11-30No
Value of net income/loss2022-11-30$-14,645,437
Value of net assets at end of year (total assets less liabilities)2022-11-30$120,775,001
Value of net assets at beginning of year (total assets less liabilities)2022-11-30$135,420,438
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-11-30No
Were any leases to which the plan was party in default or uncollectible2022-11-30No
Interest earned on other investments2022-11-30$-12,490,489
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-11-30$1,336,090
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-11-30$216,938
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-11-30$216,938
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-11-30$15,937
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2022-11-30$119,445,779
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2022-11-30$135,484,407
Expenses. Payments to insurance carriers foe the provision of benefits2022-11-30$302,265
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-11-30Yes
Was there a failure to transmit to the plan any participant contributions2022-11-30No
Has the plan failed to provide any benefit when due under the plan2022-11-30No
Contributions received in cash from employer2022-11-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-11-30$1,857,947
Liabilities. Value of benefit claims payable at end of year2022-11-30$0
Liabilities. Value of benefit claims payable at beginning of year2022-11-30$270,578
Did the plan have assets held for investment2022-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-11-30No
Opinion of an independent qualified public accountant for this plan2022-11-30Unqualified
Accountancy firm name2022-11-30BAKER TILLY US, LLP
Accountancy firm EIN2022-11-30390859910
2021 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-11-30$28,856,266
Total unrealized appreciation/depreciation of assets2021-11-30$28,856,266
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-11-30$280,907
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-11-30$279,913
Total income from all sources (including contributions)2021-11-30$29,523,337
Total loss/gain on sale of assets2021-11-30$0
Total of all expenses incurred2021-11-30$2,878,101
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-11-30$2,208,590
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-11-30$666,956
Value of total assets at end of year2021-11-30$135,701,345
Value of total assets at beginning of year2021-11-30$109,055,115
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-11-30$669,511
Total interest from all sources2021-11-30$115
Total dividends received (eg from common stock, registered investment company shares)2021-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-11-30No
Administrative expenses professional fees incurred2021-11-30$669,511
Was this plan covered by a fidelity bond2021-11-30Yes
Value of fidelity bond cover2021-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2021-11-30No
Contributions received from participants2021-11-30$166,956
Liabilities. Value of operating payables at end of year2021-11-30$10,329
Liabilities. Value of operating payables at beginning of year2021-11-30$20,588
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-11-30No
Value of net income/loss2021-11-30$26,645,236
Value of net assets at end of year (total assets less liabilities)2021-11-30$135,420,438
Value of net assets at beginning of year (total assets less liabilities)2021-11-30$108,775,202
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-11-30No
Were any leases to which the plan was party in default or uncollectible2021-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-11-30$216,938
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-11-30$650,175
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-11-30$650,175
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-11-30$115
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2021-11-30$135,484,407
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2021-11-30$108,404,940
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-11-30Yes
Was there a failure to transmit to the plan any participant contributions2021-11-30No
Has the plan failed to provide any benefit when due under the plan2021-11-30No
Contributions received in cash from employer2021-11-30$500,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-11-30$2,208,590
Liabilities. Value of benefit claims payable at end of year2021-11-30$270,578
Liabilities. Value of benefit claims payable at beginning of year2021-11-30$259,325
Did the plan have assets held for investment2021-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-11-30No
Opinion of an independent qualified public accountant for this plan2021-11-30Unqualified
Accountancy firm name2021-11-30BAKER TILLY US, LLP
Accountancy firm EIN2021-11-30390859910
2020 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-11-30$15,806,329
Total unrealized appreciation/depreciation of assets2020-11-30$15,806,329
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-11-30$279,913
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-11-30$440,393
Total income from all sources (including contributions)2020-11-30$17,416,401
Total loss/gain on sale of assets2020-11-30$0
Total of all expenses incurred2020-11-30$2,674,305
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-11-30$2,522,622
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-11-30$1,608,918
Value of total assets at end of year2020-11-30$109,055,115
Value of total assets at beginning of year2020-11-30$94,473,499
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-11-30$151,683
Total interest from all sources2020-11-30$1,154
Total dividends received (eg from common stock, registered investment company shares)2020-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-11-30No
Administrative expenses professional fees incurred2020-11-30$149,448
Was this plan covered by a fidelity bond2020-11-30Yes
Value of fidelity bond cover2020-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2020-11-30No
Contributions received from participants2020-11-30$108,918
Administrative expenses (other) incurred2020-11-30$2,235
Liabilities. Value of operating payables at end of year2020-11-30$20,588
Liabilities. Value of operating payables at beginning of year2020-11-30$3,147
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Value of net income/loss2020-11-30$14,742,096
Value of net assets at end of year (total assets less liabilities)2020-11-30$108,775,202
Value of net assets at beginning of year (total assets less liabilities)2020-11-30$94,033,106
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-11-30No
Were any leases to which the plan was party in default or uncollectible2020-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-11-30$650,175
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-11-30$391,821
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-11-30$391,821
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-11-30$1,154
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2020-11-30$108,404,940
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2020-11-30$94,081,678
Expenses. Payments to insurance carriers foe the provision of benefits2020-11-30$418,337
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-11-30Yes
Was there a failure to transmit to the plan any participant contributions2020-11-30No
Has the plan failed to provide any benefit when due under the plan2020-11-30No
Contributions received in cash from employer2020-11-30$1,500,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-11-30$2,104,285
Liabilities. Value of benefit claims payable at end of year2020-11-30$259,325
Liabilities. Value of benefit claims payable at beginning of year2020-11-30$437,246
Did the plan have assets held for investment2020-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-11-30Yes
Opinion of an independent qualified public accountant for this plan2020-11-30Disclaimer
Accountancy firm name2020-11-30BAKER TILLY US, LLP
Accountancy firm EIN2020-11-30390859910
2019 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-11-30$12,189,456
Total unrealized appreciation/depreciation of assets2019-11-30$12,189,456
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-11-30$440,393
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-11-30$83,608
Total income from all sources (including contributions)2019-11-30$14,537,688
Total loss/gain on sale of assets2019-11-30$0
Total of all expenses incurred2019-11-30$3,331,529
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-11-30$3,201,772
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-11-30$2,339,528
Value of total assets at end of year2019-11-30$94,473,499
Value of total assets at beginning of year2019-11-30$82,910,555
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-11-30$129,757
Total interest from all sources2019-11-30$8,704
Total dividends received (eg from common stock, registered investment company shares)2019-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-11-30No
Administrative expenses professional fees incurred2019-11-30$129,757
Was this plan covered by a fidelity bond2019-11-30Yes
Value of fidelity bond cover2019-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2019-11-30No
Contributions received from participants2019-11-30$239,528
Liabilities. Value of operating payables at end of year2019-11-30$3,147
Liabilities. Value of operating payables at beginning of year2019-11-30$26,142
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Value of net income/loss2019-11-30$11,206,159
Value of net assets at end of year (total assets less liabilities)2019-11-30$94,033,106
Value of net assets at beginning of year (total assets less liabilities)2019-11-30$82,826,947
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-11-30No
Were any leases to which the plan was party in default or uncollectible2019-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-11-30$391,821
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-11-30$464,937
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-11-30$464,937
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-11-30$8,704
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2019-11-30$94,081,678
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2019-11-30$82,445,618
Expenses. Payments to insurance carriers foe the provision of benefits2019-11-30$527,635
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-11-30Yes
Was there a failure to transmit to the plan any participant contributions2019-11-30No
Has the plan failed to provide any benefit when due under the plan2019-11-30No
Contributions received in cash from employer2019-11-30$2,100,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-11-30$2,674,137
Liabilities. Value of benefit claims payable at end of year2019-11-30$437,246
Liabilities. Value of benefit claims payable at beginning of year2019-11-30$57,466
Did the plan have assets held for investment2019-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-11-30Yes
Opinion of an independent qualified public accountant for this plan2019-11-30Disclaimer
Accountancy firm name2019-11-30BAKER TILLY US, LLP
Accountancy firm EIN2019-11-30390859910
2018 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-11-30$4,231,827
Total unrealized appreciation/depreciation of assets2018-11-30$4,231,827
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-11-30$83,608
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-11-30$149,785
Total income from all sources (including contributions)2018-11-30$6,573,658
Total loss/gain on sale of assets2018-11-30$0
Total of all expenses incurred2018-11-30$2,896,930
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-11-30$2,716,567
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-11-30$2,329,843
Value of total assets at end of year2018-11-30$82,910,555
Value of total assets at beginning of year2018-11-30$79,300,004
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-11-30$180,363
Total interest from all sources2018-11-30$11,988
Total dividends received (eg from common stock, registered investment company shares)2018-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-11-30No
Administrative expenses professional fees incurred2018-11-30$180,363
Was this plan covered by a fidelity bond2018-11-30Yes
Value of fidelity bond cover2018-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2018-11-30No
Contributions received from participants2018-11-30$329,843
Liabilities. Value of operating payables at end of year2018-11-30$26,142
Liabilities. Value of operating payables at beginning of year2018-11-30$31,228
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-11-30No
Value of net income/loss2018-11-30$3,676,728
Value of net assets at end of year (total assets less liabilities)2018-11-30$82,826,947
Value of net assets at beginning of year (total assets less liabilities)2018-11-30$79,150,219
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-11-30No
Were any leases to which the plan was party in default or uncollectible2018-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-11-30$464,937
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-11-30$405,665
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-11-30$405,665
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-11-30$11,988
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-11-30$82,445,618
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-11-30$78,894,339
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-11-30Yes
Was there a failure to transmit to the plan any participant contributions2018-11-30No
Has the plan failed to provide any benefit when due under the plan2018-11-30No
Contributions received in cash from employer2018-11-30$2,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-11-30$2,716,567
Liabilities. Value of benefit claims payable at end of year2018-11-30$57,466
Liabilities. Value of benefit claims payable at beginning of year2018-11-30$118,557
Did the plan have assets held for investment2018-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-11-30Yes
Opinion of an independent qualified public accountant for this plan2018-11-30Disclaimer
Accountancy firm name2018-11-30BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN2018-11-30390859910
2017 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-11-30$14,715,973
Total unrealized appreciation/depreciation of assets2017-11-30$14,715,973
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$104,629
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-11-30$77,955
Total income from all sources (including contributions)2017-11-30$15,920,417
Total loss/gain on sale of assets2017-11-30$0
Total of all expenses incurred2017-11-30$3,287,218
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-11-30$3,171,444
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-11-30$1,200,457
Value of total assets at end of year2017-11-30$79,300,004
Value of total assets at beginning of year2017-11-30$66,640,131
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-11-30$115,774
Total interest from all sources2017-11-30$3,987
Total dividends received (eg from common stock, registered investment company shares)2017-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-11-30No
Was this plan covered by a fidelity bond2017-11-30Yes
Value of fidelity bond cover2017-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2017-11-30No
Contributions received from participants2017-11-30$200,457
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-11-30$-45,156
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-11-30$0
Liabilities. Value of operating payables at end of year2017-11-30$31,228
Liabilities. Value of operating payables at beginning of year2017-11-30$4,554
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Value of net income/loss2017-11-30$12,633,199
Value of net assets at end of year (total assets less liabilities)2017-11-30$79,195,375
Value of net assets at beginning of year (total assets less liabilities)2017-11-30$66,562,176
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-11-30No
Were any leases to which the plan was party in default or uncollectible2017-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-11-30$405,665
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-11-30$576,268
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-11-30$576,268
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-11-30$3,987
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-11-30$78,894,339
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-11-30$66,063,863
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-11-30Yes
Was there a failure to transmit to the plan any participant contributions2017-11-30No
Has the plan failed to provide any benefit when due under the plan2017-11-30No
Contributions received in cash from employer2017-11-30$1,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-11-30$3,171,444
Contract administrator fees2017-11-30$115,774
Liabilities. Value of benefit claims payable at end of year2017-11-30$118,557
Liabilities. Value of benefit claims payable at beginning of year2017-11-30$73,401
Did the plan have assets held for investment2017-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-11-30Yes
Opinion of an independent qualified public accountant for this plan2017-11-30Disclaimer
Accountancy firm name2017-11-30BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN2017-11-30390859910
2016 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-11-30$4,519,568
Total unrealized appreciation/depreciation of assets2016-11-30$4,519,568
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$77,955
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-11-30$65,162
Total income from all sources (including contributions)2016-11-30$7,302,397
Total loss/gain on sale of assets2016-11-30$0
Total of all expenses incurred2016-11-30$3,259,780
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-11-30$3,128,790
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-11-30$2,782,318
Value of total assets at end of year2016-11-30$66,640,131
Value of total assets at beginning of year2016-11-30$62,584,721
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-11-30$130,990
Total interest from all sources2016-11-30$511
Total dividends received (eg from common stock, registered investment company shares)2016-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-11-30No
Was this plan covered by a fidelity bond2016-11-30Yes
Value of fidelity bond cover2016-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2016-11-30No
Contributions received from participants2016-11-30$282,318
Liabilities. Value of operating payables at end of year2016-11-30$4,554
Liabilities. Value of operating payables at beginning of year2016-11-30$5,990
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Value of net income/loss2016-11-30$4,042,617
Value of net assets at end of year (total assets less liabilities)2016-11-30$66,562,176
Value of net assets at beginning of year (total assets less liabilities)2016-11-30$62,519,559
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-11-30No
Were any leases to which the plan was party in default or uncollectible2016-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-11-30$576,268
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-11-30$286,120
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-11-30$286,120
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-11-30$511
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-11-30$66,063,863
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-11-30$62,298,601
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-11-30Yes
Was there a failure to transmit to the plan any participant contributions2016-11-30No
Has the plan failed to provide any benefit when due under the plan2016-11-30No
Contributions received in cash from employer2016-11-30$2,500,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-11-30$3,128,790
Contract administrator fees2016-11-30$130,990
Liabilities. Value of benefit claims payable at end of year2016-11-30$73,401
Liabilities. Value of benefit claims payable at beginning of year2016-11-30$59,172
Did the plan have assets held for investment2016-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-11-30Yes
Opinion of an independent qualified public accountant for this plan2016-11-30Disclaimer
Accountancy firm name2016-11-30BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN2016-11-30390859910
2015 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-11-30$1,517,955
Total unrealized appreciation/depreciation of assets2015-11-30$1,517,955
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$65,162
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-11-30$171,361
Total income from all sources (including contributions)2015-11-30$2,845,994
Total loss/gain on sale of assets2015-11-30$0
Total of all expenses incurred2015-11-30$3,231,331
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-11-30$3,001,465
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-11-30$1,327,929
Value of total assets at end of year2015-11-30$62,584,721
Value of total assets at beginning of year2015-11-30$63,076,257
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-11-30$229,866
Total interest from all sources2015-11-30$110
Total dividends received (eg from common stock, registered investment company shares)2015-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-11-30No
Was this plan covered by a fidelity bond2015-11-30Yes
Value of fidelity bond cover2015-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2015-11-30No
Contributions received from participants2015-11-30$327,929
Liabilities. Value of operating payables at end of year2015-11-30$5,990
Liabilities. Value of operating payables at beginning of year2015-11-30$44,744
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Value of net income/loss2015-11-30$-385,337
Value of net assets at end of year (total assets less liabilities)2015-11-30$62,519,559
Value of net assets at beginning of year (total assets less liabilities)2015-11-30$62,904,896
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-11-30No
Were any leases to which the plan was party in default or uncollectible2015-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-11-30$286,120
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-11-30$1,096,332
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-11-30$1,096,332
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-11-30$110
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-11-30$62,298,601
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-11-30$61,979,925
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-11-30Yes
Was there a failure to transmit to the plan any participant contributions2015-11-30No
Has the plan failed to provide any benefit when due under the plan2015-11-30No
Contributions received in cash from employer2015-11-30$1,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-11-30$3,001,465
Contract administrator fees2015-11-30$229,866
Liabilities. Value of benefit claims payable at end of year2015-11-30$59,172
Liabilities. Value of benefit claims payable at beginning of year2015-11-30$126,617
Did the plan have assets held for investment2015-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-11-30Yes
Opinion of an independent qualified public accountant for this plan2015-11-30Disclaimer
Accountancy firm name2015-11-30BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN2015-11-30390859910
2014 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-11-30$8,796,931
Total unrealized appreciation/depreciation of assets2014-11-30$8,796,931
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$171,361
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-11-30$76,265
Total income from all sources (including contributions)2014-11-30$12,147,470
Total loss/gain on sale of assets2014-11-30$0
Total of all expenses incurred2014-11-30$3,362,705
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-11-30$3,197,209
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-11-30$3,350,433
Value of total assets at end of year2014-11-30$63,076,257
Value of total assets at beginning of year2014-11-30$54,196,396
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-11-30$165,496
Total interest from all sources2014-11-30$106
Total dividends received (eg from common stock, registered investment company shares)2014-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-11-30No
Was this plan covered by a fidelity bond2014-11-30Yes
Value of fidelity bond cover2014-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2014-11-30No
Contributions received from participants2014-11-30$350,433
Liabilities. Value of operating payables at end of year2014-11-30$44,744
Liabilities. Value of operating payables at beginning of year2014-11-30$54,666
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Value of net income/loss2014-11-30$8,784,765
Value of net assets at end of year (total assets less liabilities)2014-11-30$62,904,896
Value of net assets at beginning of year (total assets less liabilities)2014-11-30$54,120,131
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-11-30No
Were any leases to which the plan was party in default or uncollectible2014-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-11-30$1,096,332
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-11-30$321,547
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-11-30$321,547
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-11-30$106
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2014-11-30$61,979,925
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-11-30$53,874,849
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-11-30Yes
Was there a failure to transmit to the plan any participant contributions2014-11-30No
Has the plan failed to provide any benefit when due under the plan2014-11-30No
Contributions received in cash from employer2014-11-30$3,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-11-30$3,197,209
Contract administrator fees2014-11-30$165,496
Liabilities. Value of benefit claims payable at end of year2014-11-30$126,617
Liabilities. Value of benefit claims payable at beginning of year2014-11-30$21,599
Did the plan have assets held for investment2014-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-11-30Yes
Opinion of an independent qualified public accountant for this plan2014-11-30Disclaimer
Accountancy firm name2014-11-30BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN2014-11-30390859910
2013 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-11-30$12,234,165
Total unrealized appreciation/depreciation of assets2013-11-30$12,234,165
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-11-30$76,265
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-11-30$116,216
Total income from all sources (including contributions)2013-11-30$15,683,353
Total loss/gain on sale of assets2013-11-30$0
Total of all expenses incurred2013-11-30$4,016,229
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-11-30$3,808,675
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-11-30$3,449,163
Value of total assets at end of year2013-11-30$54,196,396
Value of total assets at beginning of year2013-11-30$42,569,223
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-11-30$207,554
Total interest from all sources2013-11-30$25
Total dividends received (eg from common stock, registered investment company shares)2013-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-11-30No
Was this plan covered by a fidelity bond2013-11-30Yes
Value of fidelity bond cover2013-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2013-11-30No
Contributions received from participants2013-11-30$449,163
Liabilities. Value of operating payables at end of year2013-11-30$54,666
Liabilities. Value of operating payables at beginning of year2013-11-30$116,833
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-11-30No
Value of net income/loss2013-11-30$11,667,124
Value of net assets at end of year (total assets less liabilities)2013-11-30$54,120,131
Value of net assets at beginning of year (total assets less liabilities)2013-11-30$42,453,007
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-11-30No
Were any leases to which the plan was party in default or uncollectible2013-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-11-30$321,547
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-11-30$568,249
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-11-30$568,249
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-11-30$25
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-11-30$53,874,849
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-11-30$42,000,974
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-11-30Yes
Was there a failure to transmit to the plan any participant contributions2013-11-30No
Has the plan failed to provide any benefit when due under the plan2013-11-30No
Contributions received in cash from employer2013-11-30$3,000,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-11-30$3,808,675
Contract administrator fees2013-11-30$207,554
Liabilities. Value of benefit claims payable at end of year2013-11-30$21,599
Liabilities. Value of benefit claims payable at beginning of year2013-11-30$-617
Did the plan have assets held for investment2013-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-11-30Yes
Opinion of an independent qualified public accountant for this plan2013-11-30Disclaimer
Accountancy firm name2013-11-30BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN2013-11-30390859910
2012 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-11-30$5,610,167
Total unrealized appreciation/depreciation of assets2012-11-30$5,610,167
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-11-30$116,216
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-11-30$121,445
Total income from all sources (including contributions)2012-11-30$9,190,659
Total loss/gain on sale of assets2012-11-30$0
Total of all expenses incurred2012-11-30$4,259,007
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-11-30$4,033,626
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-11-30$3,580,492
Value of total assets at end of year2012-11-30$42,569,223
Value of total assets at beginning of year2012-11-30$37,642,800
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-11-30$225,381
Total interest from all sources2012-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2012-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-11-30No
Was this plan covered by a fidelity bond2012-11-30Yes
Value of fidelity bond cover2012-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2012-11-30No
Contributions received from participants2012-11-30$580,492
Liabilities. Value of operating payables at end of year2012-11-30$116,833
Liabilities. Value of operating payables at beginning of year2012-11-30$134,883
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-11-30No
Value of net income/loss2012-11-30$4,931,652
Value of net assets at end of year (total assets less liabilities)2012-11-30$42,453,007
Value of net assets at beginning of year (total assets less liabilities)2012-11-30$37,521,355
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-11-30No
Were any leases to which the plan was party in default or uncollectible2012-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-11-30$568,249
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-11-30$574,665
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-11-30$574,665
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2012-11-30$42,000,974
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2012-11-30$36,714,792
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-11-30Yes
Was there a failure to transmit to the plan any participant contributions2012-11-30No
Has the plan failed to provide any benefit when due under the plan2012-11-30No
Contributions received in cash from employer2012-11-30$3,000,000
Employer contributions (assets) at beginning of year2012-11-30$353,343
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-11-30$4,033,626
Contract administrator fees2012-11-30$225,381
Liabilities. Value of benefit claims payable at end of year2012-11-30$-617
Liabilities. Value of benefit claims payable at beginning of year2012-11-30$-13,438
Did the plan have assets held for investment2012-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-11-30Yes
Opinion of an independent qualified public accountant for this plan2012-11-30Disclaimer
Accountancy firm name2012-11-30BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN2012-11-30390859910
2011 : H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-11-30$2,485,641
Total unrealized appreciation/depreciation of assets2011-11-30$2,485,641
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-11-30$121,445
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-11-30$180,398
Total income from all sources (including contributions)2011-11-30$6,580,282
Total loss/gain on sale of assets2011-11-30$0
Total of all expenses incurred2011-11-30$4,157,693
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-11-30$3,897,532
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-11-30$4,094,641
Value of total assets at end of year2011-11-30$37,642,800
Value of total assets at beginning of year2011-11-30$35,279,164
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-11-30$260,161
Total interest from all sources2011-11-30$0
Total dividends received (eg from common stock, registered investment company shares)2011-11-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-11-30No
Administrative expenses professional fees incurred2011-11-30$49,919
Was this plan covered by a fidelity bond2011-11-30Yes
Value of fidelity bond cover2011-11-30$10,000,000
Were there any nonexempt tranactions with any party-in-interest2011-11-30No
Contributions received from participants2011-11-30$594,505
Liabilities. Value of operating payables at end of year2011-11-30$134,883
Liabilities. Value of operating payables at beginning of year2011-11-30$155,848
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-11-30No
Value of net income/loss2011-11-30$2,422,589
Value of net assets at end of year (total assets less liabilities)2011-11-30$37,521,355
Value of net assets at beginning of year (total assets less liabilities)2011-11-30$35,098,766
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-11-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-11-30No
Were any leases to which the plan was party in default or uncollectible2011-11-30No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-11-30$574,665
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-11-30$680,233
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-11-30$680,233
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2011-11-30$36,714,792
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-11-30$34,598,931
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-11-30Yes
Was there a failure to transmit to the plan any participant contributions2011-11-30No
Has the plan failed to provide any benefit when due under the plan2011-11-30No
Contributions received in cash from employer2011-11-30$3,500,136
Employer contributions (assets) at end of year2011-11-30$353,343
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-11-30$3,897,532
Contract administrator fees2011-11-30$210,242
Liabilities. Value of benefit claims payable at end of year2011-11-30$-13,438
Liabilities. Value of benefit claims payable at beginning of year2011-11-30$24,550
Did the plan have assets held for investment2011-11-30Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-11-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-11-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-11-30Yes
Opinion of an independent qualified public accountant for this plan2011-11-30Disclaimer
Accountancy firm name2011-11-30BAKER TILLY VIRCHOW KRAUSE, LLP
Accountancy firm EIN2011-11-30390859910

Form 5500 Responses for H. B. FULLER COMPANY RETIREE MEDICAL PLAN

2021: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2021 form 5500 responses
2021-12-01Type of plan entitySingle employer plan
2021-12-01Submission has been amendedNo
2021-12-01This submission is the final filingNo
2021-12-01This return/report is a short plan year return/report (less than 12 months)No
2021-12-01Plan is a collectively bargained planNo
2021-12-01Plan funding arrangement – InsuranceYes
2021-12-01Plan funding arrangement – TrustYes
2021-12-01Plan benefit arrangement – InsuranceYes
2021-12-01Plan benefit arrangement - TrustYes
2020: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2020 form 5500 responses
2020-12-01Type of plan entitySingle employer plan
2020-12-01Submission has been amendedNo
2020-12-01This submission is the final filingNo
2020-12-01This return/report is a short plan year return/report (less than 12 months)No
2020-12-01Plan is a collectively bargained planNo
2020-12-01Plan funding arrangement – InsuranceYes
2020-12-01Plan funding arrangement – TrustYes
2020-12-01Plan benefit arrangement – InsuranceYes
2020-12-01Plan benefit arrangement - TrustYes
2019: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2019 form 5500 responses
2019-12-01Type of plan entitySingle employer plan
2019-12-01Submission has been amendedNo
2019-12-01This submission is the final filingNo
2019-12-01This return/report is a short plan year return/report (less than 12 months)No
2019-12-01Plan is a collectively bargained planNo
2019-12-01Plan funding arrangement – InsuranceYes
2019-12-01Plan funding arrangement – TrustYes
2019-12-01Plan benefit arrangement – InsuranceYes
2019-12-01Plan benefit arrangement - TrustYes
2018: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2018 form 5500 responses
2018-12-01Type of plan entitySingle employer plan
2018-12-01Submission has been amendedNo
2018-12-01This submission is the final filingNo
2018-12-01This return/report is a short plan year return/report (less than 12 months)No
2018-12-01Plan is a collectively bargained planNo
2018-12-01Plan funding arrangement – InsuranceYes
2018-12-01Plan funding arrangement – TrustYes
2018-12-01Plan benefit arrangement – InsuranceYes
2018-12-01Plan benefit arrangement - TrustYes
2017: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2017 form 5500 responses
2017-12-01Type of plan entitySingle employer plan
2017-12-01Submission has been amendedNo
2017-12-01This submission is the final filingNo
2017-12-01This return/report is a short plan year return/report (less than 12 months)No
2017-12-01Plan is a collectively bargained planNo
2017-12-01Plan funding arrangement – InsuranceYes
2017-12-01Plan funding arrangement – TrustYes
2017-12-01Plan benefit arrangement – InsuranceYes
2017-12-01Plan benefit arrangement - TrustYes
2016: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2016 form 5500 responses
2016-12-01Type of plan entitySingle employer plan
2016-12-01Submission has been amendedNo
2016-12-01This submission is the final filingNo
2016-12-01This return/report is a short plan year return/report (less than 12 months)No
2016-12-01Plan is a collectively bargained planNo
2016-12-01Plan funding arrangement – InsuranceYes
2016-12-01Plan funding arrangement – TrustYes
2016-12-01Plan benefit arrangement – InsuranceYes
2016-12-01Plan benefit arrangement - TrustYes
2015: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2015 form 5500 responses
2015-12-01Type of plan entitySingle employer plan
2015-12-01Submission has been amendedYes
2015-12-01This submission is the final filingNo
2015-12-01This return/report is a short plan year return/report (less than 12 months)No
2015-12-01Plan is a collectively bargained planNo
2015-12-01Plan funding arrangement – InsuranceYes
2015-12-01Plan funding arrangement – TrustYes
2015-12-01Plan benefit arrangement – InsuranceYes
2015-12-01Plan benefit arrangement - TrustYes
2014: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2014 form 5500 responses
2014-12-01Type of plan entitySingle employer plan
2014-12-01Submission has been amendedNo
2014-12-01This submission is the final filingNo
2014-12-01This return/report is a short plan year return/report (less than 12 months)No
2014-12-01Plan is a collectively bargained planNo
2014-12-01Plan funding arrangement – InsuranceYes
2014-12-01Plan funding arrangement – TrustYes
2014-12-01Plan benefit arrangement – InsuranceYes
2014-12-01Plan benefit arrangement - TrustYes
2013: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2013 form 5500 responses
2013-12-01Type of plan entitySingle employer plan
2013-12-01Submission has been amendedNo
2013-12-01This submission is the final filingNo
2013-12-01This return/report is a short plan year return/report (less than 12 months)No
2013-12-01Plan is a collectively bargained planNo
2013-12-01Plan funding arrangement – InsuranceYes
2013-12-01Plan funding arrangement – TrustYes
2013-12-01Plan benefit arrangement – InsuranceYes
2013-12-01Plan benefit arrangement - TrustYes
2012: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2012 form 5500 responses
2012-12-01Type of plan entitySingle employer plan
2012-12-01Submission has been amendedNo
2012-12-01This submission is the final filingNo
2012-12-01This return/report is a short plan year return/report (less than 12 months)No
2012-12-01Plan is a collectively bargained planNo
2012-12-01Plan funding arrangement – InsuranceYes
2012-12-01Plan funding arrangement – TrustYes
2012-12-01Plan benefit arrangement – InsuranceYes
2012-12-01Plan benefit arrangement - TrustYes
2011: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2011 form 5500 responses
2011-12-01Type of plan entitySingle employer plan
2011-12-01Submission has been amendedNo
2011-12-01This submission is the final filingNo
2011-12-01This return/report is a short plan year return/report (less than 12 months)No
2011-12-01Plan is a collectively bargained planNo
2011-12-01Plan funding arrangement – InsuranceYes
2011-12-01Plan funding arrangement – TrustYes
2011-12-01Plan benefit arrangement – InsuranceYes
2011-12-01Plan benefit arrangement - TrustYes
2010: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2010 form 5500 responses
2010-12-01Type of plan entitySingle employer plan
2010-12-01Submission has been amendedYes
2010-12-01This submission is the final filingNo
2010-12-01This return/report is a short plan year return/report (less than 12 months)No
2010-12-01Plan is a collectively bargained planNo
2010-12-01Plan funding arrangement – InsuranceYes
2010-12-01Plan funding arrangement – TrustYes
2010-12-01Plan benefit arrangement – InsuranceYes
2010-12-01Plan benefit arrangement - TrustYes
2009: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2009 form 5500 responses
2009-12-01Type of plan entitySingle employer plan
2009-12-01Submission has been amendedNo
2009-12-01This submission is the final filingNo
2009-12-01This return/report is a short plan year return/report (less than 12 months)No
2009-12-01Plan is a collectively bargained planNo
2009-12-01Plan funding arrangement – InsuranceYes
2009-12-01Plan funding arrangement – TrustYes
2009-12-01Plan benefit arrangement – InsuranceYes
2009-12-01Plan benefit arrangement - TrustYes
2008: H. B. FULLER COMPANY RETIREE MEDICAL PLAN 2008 form 5500 responses
2008-12-01Type of plan entitySingle employer plan
2008-12-01Submission has been amendedNo
2008-12-01This submission is the final filingNo
2008-12-01This return/report is a short plan year return/report (less than 12 months)No
2008-12-01Plan is a collectively bargained planNo

Insurance Providers Used on plan

BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract number258036
Policy instance 2
Insurance contract or identification number258036
Number of Individuals Covered35
Insurance policy start date2021-12-01
Insurance policy end date2022-11-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $302,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number61064
Policy instance 1
Insurance contract or identification number61064
Number of Individuals Covered393
Insurance policy start date2021-08-03
Insurance policy end date2022-08-02
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract number258036
Policy instance 2
Insurance contract or identification number258036
Number of Individuals Covered36
Insurance policy start date2020-12-01
Insurance policy end date2021-11-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $558,511
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number61064
Policy instance 1
Insurance contract or identification number61064
Number of Individuals Covered419
Insurance policy start date2020-08-03
Insurance policy end date2021-08-02
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract number258036
Policy instance 2
Insurance contract or identification number258036
Number of Individuals Covered39
Insurance policy start date2019-12-01
Insurance policy end date2020-11-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $418,337
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number61064
Policy instance 1
Insurance contract or identification number61064
Number of Individuals Covered419
Insurance policy start date2019-08-03
Insurance policy end date2020-08-02
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
BCBSM, INC. DBA BLUE CROSS AND BLUE SHIELD OF MINNESOTA (National Association of Insurance Commissioners NAIC id number: 55026 )
Policy contract number258036
Policy instance 2
Insurance contract or identification number258036
Number of Individuals Covered35
Insurance policy start date2019-01-01
Insurance policy end date2019-11-30
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitYes
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $527,635
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number61064
Policy instance 1
Insurance contract or identification number61064
Number of Individuals Covered406
Insurance policy start date2018-08-03
Insurance policy end date2019-08-02
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number61064
Policy instance 1
Insurance contract or identification number61064
Number of Individuals Covered433
Insurance policy start date2017-08-03
Insurance policy end date2018-08-02
Are there contracts with allocated funds for individual policies?0
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number61064
Policy instance 1
Insurance contract or identification number61064
Number of Individuals Covered630
Insurance policy start date2014-08-03
Insurance policy end date2015-08-02
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number91064
Policy instance 1
Insurance contract or identification number91064
Number of Individuals Covered455
Insurance policy start date2013-08-03
Insurance policy end date2014-08-02
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number91064
Policy instance 1
Insurance contract or identification number91064
Number of Individuals Covered458
Insurance policy start date2012-08-03
Insurance policy end date2013-08-02
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number91064
Policy instance 1
Insurance contract or identification number91064
Number of Individuals Covered464
Insurance policy start date2011-08-03
Insurance policy end date2012-08-02
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MASSACHUSETTS MUTUAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65935 )
Policy contract number91064
Policy instance 1
Insurance contract or identification number91064
Number of Individuals Covered592
Insurance policy start date2010-08-03
Insurance policy end date2011-08-02
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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