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SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS 401k Plan overview

Plan NameSAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS
Plan identification number 501

SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Death benefits (include travel accident but not life insurance)
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that will not file a Form 5500 for next plan year pursuant to 29 CFR 2520.104-20.
  • Unfunded, fully insured, or combination unfunded/insured welfare plan that stopped filing form 5500s in an earlier plan year pursuant to 29 CFR 2520.104-20.

401k Sponsoring company profile

SAYBROOK LOGISTICS ACQUISITION LLC has sponsored the creation of one or more 401k plans.

Company Name:SAYBROOK LOGISTICS ACQUISITION LLC
Employer identification number (EIN):453049540
NAIC Classification:484110
NAIC Description:General Freight Trucking, Local

Additional information about SAYBROOK LOGISTICS ACQUISITION LLC

Jurisdiction of Incorporation: State of Delaware Division of Corporations
Incorporation Date:
Company Identification Number: 5026302

More information about SAYBROOK LOGISTICS ACQUISITION LLC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012019-07-01
5012017-07-01UNDINE SCHWARZ
5012016-07-01UNDINE SCHWARZ UNDINE SCHWARZ2018-01-30

Plan Statistics for SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS

401k plan membership statisitcs for SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS

Measure Date Value
2019: SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS 2019 401k membership
Total participants, beginning-of-year2019-07-01113
Total number of active participants reported on line 7a of the Form 55002019-07-0193
Number of retired or separated participants receiving benefits2019-07-010
Number of other retired or separated participants entitled to future benefits2019-07-010
Total of all active and inactive participants2019-07-0193
2017: SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS 2017 401k membership
Total participants, beginning-of-year2017-07-01103
Total number of active participants reported on line 7a of the Form 55002017-07-0188
Number of retired or separated participants receiving benefits2017-07-010
Number of other retired or separated participants entitled to future benefits2017-07-010
Total of all active and inactive participants2017-07-0188
2016: SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS 2016 401k membership
Total participants, beginning-of-year2016-07-01139
Total number of active participants reported on line 7a of the Form 55002016-07-01103
Number of retired or separated participants receiving benefits2016-07-010
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01103
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-07-010
Total participants2016-07-01103
Number of participants with account balances2016-07-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-07-010

Financial Data on SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS

Measure Date Value
2017 : SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS 2017 401k financial data
Unrealized appreciation/depreciation of real estate assets2017-06-30$0
Unrealized appreciation/depreciation of other (non real estate) assets2017-06-30$0
Total unrealized appreciation/depreciation of assets2017-06-30$0
Total transfer of assets to this plan2017-06-30$0
Total transfer of assets from this plan2017-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$0
Expenses. Interest paid2017-06-30$0
Amount of participant contributions which was failed to transmit to the plan within the time period described in 29 CFR 251.3-1022017-06-30$0
Total income from all sources (including contributions)2017-06-30$642,916
Total loss/gain on sale of assets2017-06-30$0
Total of all expenses incurred2017-06-30$642,916
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$642,916
Expenses. Certain deemed distributions of participant loans2017-06-30$0
Value of total corrective distributions2017-06-30$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$642,916
Value of total assets at end of year2017-06-30$0
Value of total assets at beginning of year2017-06-30$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$0
Total income from rents2017-06-30$0
Total interest from all sources2017-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2017-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-06-30No
Total dividends received from registered investment company shares (eg mutual funds)2017-06-30$0
Assets. Real estate other than employer real property at end of year2017-06-30$0
Assets. Real estate other than employer real property at beginning of year2017-06-30$0
Administrative expenses professional fees incurred2017-06-30$0
Assets. Corporate prefeered stocks other than exployer securities at end of year2017-06-30$0
Assets. Corporate prefeered stocks other than exployer securities at beginning of year2017-06-30$0
Was this plan covered by a fidelity bond2017-06-30No
If this is an individual account plan, was there a blackout period2017-06-30No
Were there any nonexempt tranactions with any party-in-interest2017-06-30No
Contributions received from participants2017-06-30$0
Participant contributions at end of year2017-06-30$0
Participant contributions at beginning of year2017-06-30$0
Participant contributions at end of year2017-06-30$0
Participant contributions at beginning of year2017-06-30$0
Assets. Other investments not covered elsewhere at end of year2017-06-30$0
Assets. Other investments not covered elsewhere at beginning of year2017-06-30$0
Income. Received or receivable in cash from other sources (including rollovers)2017-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-06-30$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-06-30$0
Assets. Loans (other than to participants) at end of year2017-06-30$0
Assets. Loans (other than to participants) at beginning of year2017-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2017-06-30$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-06-30$0
Other income not declared elsewhere2017-06-30$0
Administrative expenses (other) incurred2017-06-30$0
Liabilities. Value of operating payables at end of year2017-06-30$0
Liabilities. Value of operating payables at beginning of year2017-06-30$0
Total non interest bearing cash at end of year2017-06-30$0
Total non interest bearing cash at beginning of year2017-06-30$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Income. Non cash contributions2017-06-30$0
Value of net income/loss2017-06-30$0
Value of net assets at end of year (total assets less liabilities)2017-06-30$0
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2017-06-30No
Were any leases to which the plan was party in default or uncollectible2017-06-30No
Assets. partnership/joint venture interests at end of year2017-06-30$0
Assets. partnership/joint venture interests at beginning of year2017-06-30$0
Investment advisory and management fees2017-06-30$0
Value of interest in registered invesment companies (eg mutual funds) at end of year2017-06-30$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-06-30$0
Value of interest in pooled separate accounts at end of year2017-06-30$0
Value of interest in pooled separate accounts at beginning of year2017-06-30$0
Interest on participant loans2017-06-30$0
Income. Interest from loans (other than to participants)2017-06-30$0
Interest earned on other investments2017-06-30$0
Income. Interest from US Government securities2017-06-30$0
Income. Interest from corporate debt instruments2017-06-30$0
Value of interest in master investment trust accounts at end of year2017-06-30$0
Value of interest in master investment trust accounts at beginning of year2017-06-30$0
Value of interest in common/collective trusts at end of year2017-06-30$0
Value of interest in common/collective trusts at beginning of year2017-06-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-06-30$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-06-30$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-06-30$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-06-30$0
Assets. Value of investments in 103.12 investment entities at end of year2017-06-30$0
Assets. Value of investments in 103.12 investment entities at beginning of year2017-06-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-06-30$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-06-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2017-06-30$642,916
Asset value of US Government securities at end of year2017-06-30$0
Asset value of US Government securities at beginning of year2017-06-30$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-06-30$0
Net investment gain/loss from pooled separate accounts2017-06-30$0
Net investment gain or loss from common/collective trusts2017-06-30$0
Net gain/loss from 103.12 investment entities2017-06-30$0
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-06-30No
Was there a failure to transmit to the plan any participant contributions2017-06-30No
Has the plan failed to provide any benefit when due under the plan2017-06-30No
Assets. Invements in employer securities at end of year2017-06-30$0
Assets. Invements in employer securities at beginning of year2017-06-30$0
Assets. Value of employer real property at end of year2017-06-30$0
Assets. Value of employer real property at beginning of year2017-06-30$0
Contributions received in cash from employer2017-06-30$642,916
Employer contributions (assets) at end of year2017-06-30$0
Employer contributions (assets) at beginning of year2017-06-30$0
Income. Dividends from preferred stock2017-06-30$0
Income. Dividends from common stock2017-06-30$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-06-30$0
Asset. Corporate debt instrument preferred debt at end of year2017-06-30$0
Asset. Corporate debt instrument preferred debt at beginning of year2017-06-30$0
Asset. Corporate debt instrument debt (other) at end of year2017-06-30$0
Asset. Corporate debt instrument debt (other) at beginning of year2017-06-30$0
Contract administrator fees2017-06-30$0
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-06-30No
Assets. Corporate common stocks other than exployer securities at end of year2017-06-30$0
Assets. Corporate common stocks other than exployer securities at beginning of year2017-06-30$0
Liabilities. Value of benefit claims payable at end of year2017-06-30$0
Liabilities. Value of benefit claims payable at beginning of year2017-06-30$0
Assets. Value of buildings and other operty used in plan operation at end of year2017-06-30$0
Assets. Value of buildings and other operty used in plan operation at beginning of year2017-06-30$0
Did the plan have assets held for investment2017-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-06-30No
Aggregate proceeds on sale of assets2017-06-30$0
Aggregate carrying amount (costs) on sale of assets2017-06-30$0
Liabilities. Value of acquisition indebtedness at end of year2017-06-30$0
Liabilities. Value of acquisition indebtedness at beginning of year2017-06-30$0

Form 5500 Responses for SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS

2019: SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Submission has been amendedNo
2019-07-01This submission is the final filingNo
2019-07-01This return/report is a short plan year return/report (less than 12 months)No
2019-07-01Plan is a collectively bargained planNo
2019-07-01Plan funding arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – InsuranceYes
2017: SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS 2017 form 5500 responses
2017-07-01Type of plan entitySingle employer plan
2017-07-01Submission has been amendedNo
2017-07-01This submission is the final filingNo
2017-07-01This return/report is a short plan year return/report (less than 12 months)No
2017-07-01Plan is a collectively bargained planNo
2017-07-01Plan funding arrangement – InsuranceYes
2017-07-01Plan benefit arrangement – InsuranceYes
2016: SAYBROOK LOGISTICS ACQUISITION LLC HEALTH BENEFIT PLANS 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
2016-07-01First time form 5500 has been submittedYes
2016-07-01Submission has been amendedNo
2016-07-01This submission is the final filingNo
2016-07-01This return/report is a short plan year return/report (less than 12 months)No
2016-07-01Plan is a collectively bargained planNo
2016-07-01Plan funding arrangement – InsuranceYes
2016-07-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract number141560
Policy instance 1
Insurance contract or identification number141560
Number of Individuals Covered2
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $895
Total amount of fees paid to insurance companyUSD $3,301
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 $18,143
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $895
Amount paid for insurance broker fees3301
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number233559
Policy instance 2
Insurance contract or identification number233559
Number of Individuals Covered29
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $10,779
Total amount of fees paid to insurance companyUSD $310
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 $180,091
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,779
Amount paid for insurance broker fees310
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number528901
Policy instance 3
Insurance contract or identification number528901
Number of Individuals Covered83
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $8,706
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, ACCIDENT AND CANCER
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 $65,804
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,706
Insurance broker organization code?3
AETNA HEALTH, INC. (National Association of Insurance Commissioners NAIC id number: 00000 )
Policy contract number141560HNO
Policy instance 4
Insurance contract or identification number141560HNO
Number of Individuals Covered70
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of commissions paid to insurance brokerUSD $17,343
Total amount of fees paid to insurance companyUSD $0
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 $356,879
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,343
Insurance broker organization code?3
THE GUARDIAN LIFE INSURANCE COMPANY OF AMERICA (National Association of Insurance Commissioners NAIC id number: 64246 )
Policy contract number528901
Policy instance 1
Insurance contract or identification number528901
Number of Individuals Covered73
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $7,028
Total amount of fees paid to insurance companyUSD $0
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 BenefitYes
Vision Insurance Welfare BenefitYes
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D, ACCIDENT AND CANCER
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 $48,123
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CALIFORNIA PHYSICIANS SERVICE (National Association of Insurance Commissioners NAIC id number: 47732 )
Policy contract numberW0063914
Policy instance 2
Insurance contract or identification numberW0063914
Number of Individuals Covered56
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $17,852
Total amount of fees paid to insurance companyUSD $0
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 $341,590
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 )
Policy contract number233559
Policy instance 3
Insurance contract or identification number233559
Number of Individuals Covered31
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $8,154
Total amount of fees paid to insurance companyUSD $617
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 $137,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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