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MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 401k Plan overview

Plan NameMEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES
Plan identification number 502

MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Other welfare benefit cover

401k Sponsoring company profile

AMERICAN CAPITAL, LTD. has sponsored the creation of one or more 401k plans.

Company Name:AMERICAN CAPITAL, LTD.
Employer identification number (EIN):521451377
NAIC Classification:523110
NAIC Description:Investment Banking and Securities Dealing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5022017-01-01
5022016-01-01
5022015-01-01
5022014-01-01
5022013-01-01DANA SMITH, SVP HR AND CHRO
5022012-01-01DOUG LWIN
5022011-01-01DOUG LWIN
5022009-01-01DOUG LWIN
5022009-01-01DOUG LWIN

Plan Statistics for MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES

401k plan membership statisitcs for MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES

Measure Date Value
2017: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2017 401k membership
Total participants, beginning-of-year2017-01-01526
Total number of active participants reported on line 7a of the Form 55002017-01-010
Number of retired or separated participants receiving benefits2017-01-010
Total of all active and inactive participants2017-01-010
2016: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2016 401k membership
Total participants, beginning-of-year2016-01-011,569
Total number of active participants reported on line 7a of the Form 55002016-01-01512
Number of retired or separated participants receiving benefits2016-01-0114
Total of all active and inactive participants2016-01-01526
2015: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2015 401k membership
Total participants, beginning-of-year2015-01-011,454
Total number of active participants reported on line 7a of the Form 55002015-01-011,523
Number of retired or separated participants receiving benefits2015-01-0146
Total of all active and inactive participants2015-01-011,569
2014: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2014 401k membership
Total participants, beginning-of-year2014-01-011,471
Total number of active participants reported on line 7a of the Form 55002014-01-011,445
Number of retired or separated participants receiving benefits2014-01-019
Total of all active and inactive participants2014-01-011,454
2013: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2013 401k membership
Total participants, beginning-of-year2013-01-011,477
Total number of active participants reported on line 7a of the Form 55002013-01-011,445
Number of retired or separated participants receiving benefits2013-01-0126
Total of all active and inactive participants2013-01-011,471
2012: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2012 401k membership
Total participants, beginning-of-year2012-01-01902
Total number of active participants reported on line 7a of the Form 55002012-01-011,442
Number of retired or separated participants receiving benefits2012-01-0135
Total of all active and inactive participants2012-01-011,477
2011: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2011 401k membership
Total participants, beginning-of-year2011-01-01696
Total number of active participants reported on line 7a of the Form 55002011-01-01873
Number of retired or separated participants receiving benefits2011-01-0129
Total of all active and inactive participants2011-01-01902
2009: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2009 401k membership
Total participants, beginning-of-year2009-01-01492
Total number of active participants reported on line 7a of the Form 55002009-01-01319
Number of retired or separated participants receiving benefits2009-01-0130
Total of all active and inactive participants2009-01-01349
Total participants2009-01-01349

Financial Data on MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES

Measure Date Value
2017 : MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2017 401k financial data
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-07-21$634,173
Total income from all sources (including contributions)2017-07-21$20,875
Total of all expenses incurred2017-07-21$462,979
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-07-21$374,088
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-07-21$20,428
Value of total assets at end of year2017-07-21$0
Value of total assets at beginning of year2017-07-21$1,076,277
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-07-21$88,891
Total interest from all sources2017-07-21$447
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-07-21Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2017-07-21$0
Administrative expenses professional fees incurred2017-07-21$77,062
Was this plan covered by a fidelity bond2017-07-21Yes
Value of fidelity bond cover2017-07-21$3,000,000
If this is an individual account plan, was there a blackout period2017-07-21No
Were there any nonexempt tranactions with any party-in-interest2017-07-21No
Contributions received from participants2017-07-21$20,428
Participant contributions at end of year2017-07-21$0
Participant contributions at beginning of year2017-07-21$67,904
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2017-07-21$20,822
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2017-07-21$17,171
Administrative expenses (other) incurred2017-07-21$6,075
Liabilities. Value of operating payables at beginning of year2017-07-21$5,135
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-07-21No
Value of net income/loss2017-07-21$-442,104
Value of net assets at end of year (total assets less liabilities)2017-07-21$0
Value of net assets at beginning of year (total assets less liabilities)2017-07-21$442,104
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-07-21No
Were any loans by the plan or fixed income obligations due to the plan in default2017-07-21No
Were any leases to which the plan was party in default or uncollectible2017-07-21No
Investment advisory and management fees2017-07-21$5,754
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-07-21$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-07-21$704,000
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-07-21$704,000
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-07-21$447
Expenses. Payments to insurance carriers foe the provision of benefits2017-07-21$15,780
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-07-21No
Was there a failure to transmit to the plan any participant contributions2017-07-21No
Has the plan failed to provide any benefit when due under the plan2017-07-21No
Employer contributions (assets) at end of year2017-07-21$0
Employer contributions (assets) at beginning of year2017-07-21$283,551
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-07-21$358,308
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-07-21No
Liabilities. Value of benefit claims payable at beginning of year2017-07-21$611,867
Did the plan have assets held for investment2017-07-21No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-07-21No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-07-21Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-07-21No
Opinion of an independent qualified public accountant for this plan2017-07-21Unqualified
Accountancy firm name2017-07-21NOVAK FRANCELLA, LLC
Accountancy firm EIN2017-07-21611436956
2016 : MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2016 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$634,173
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$2,129,218
Total income from all sources (including contributions)2016-12-31$7,673,253
Total of all expenses incurred2016-12-31$10,387,426
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$9,895,025
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$7,665,277
Value of total assets at end of year2016-12-31$1,076,277
Value of total assets at beginning of year2016-12-31$5,285,495
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$492,401
Total interest from all sources2016-12-31$7,976
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$415,834
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$3,000,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$1,376,726
Participant contributions at end of year2016-12-31$67,904
Participant contributions at beginning of year2016-12-31$39,760
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-12-31$20,822
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-12-31$136,246
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2016-12-31$17,171
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2016-12-31$6,586
Administrative expenses (other) incurred2016-12-31$65,176
Liabilities. Value of operating payables at end of year2016-12-31$5,135
Liabilities. Value of operating payables at beginning of year2016-12-31$5,632
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-2,714,173
Value of net assets at end of year (total assets less liabilities)2016-12-31$442,104
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$3,156,277
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$11,391
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$704,000
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$5,032,679
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$5,032,679
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$7,976
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$269,835
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Contributions received in cash from employer2016-12-31$6,288,551
Employer contributions (assets) at end of year2016-12-31$283,551
Employer contributions (assets) at beginning of year2016-12-31$76,810
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$9,625,190
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Liabilities. Value of benefit claims payable at end of year2016-12-31$611,867
Liabilities. Value of benefit claims payable at beginning of year2016-12-31$2,117,000
Did the plan have assets held for investment2016-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31No
Opinion of an independent qualified public accountant for this plan2016-12-31Unqualified
Accountancy firm name2016-12-31NOVAK FRANCELLA, LLC
Accountancy firm EIN2016-12-31611436956
2015 : MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2015 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$2,129,218
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$1,199,684
Total income from all sources (including contributions)2015-12-31$18,888,717
Total of all expenses incurred2015-12-31$18,749,534
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$17,967,716
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$18,883,218
Value of total assets at end of year2015-12-31$5,285,495
Value of total assets at beginning of year2015-12-31$4,216,778
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$781,818
Total interest from all sources2015-12-31$5,499
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$628,128
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$3,000,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$3,492,849
Participant contributions at end of year2015-12-31$39,760
Participant contributions at beginning of year2015-12-31$58,415
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-12-31$136,246
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-12-31$192,552
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2015-12-31$6,586
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$5,988
Administrative expenses (other) incurred2015-12-31$147,790
Liabilities. Value of operating payables at end of year2015-12-31$5,632
Liabilities. Value of operating payables at beginning of year2015-12-31$17,696
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$139,183
Value of net assets at end of year (total assets less liabilities)2015-12-31$3,156,277
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$3,017,094
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$5,900
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$5,032,679
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$3,653,627
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$3,653,627
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$5,499
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$966,328
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Contributions received in cash from employer2015-12-31$15,390,369
Employer contributions (assets) at end of year2015-12-31$76,810
Employer contributions (assets) at beginning of year2015-12-31$312,184
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$17,001,388
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
Liabilities. Value of benefit claims payable at end of year2015-12-31$2,117,000
Liabilities. Value of benefit claims payable at beginning of year2015-12-31$1,176,000
Did the plan have assets held for investment2015-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31No
Opinion of an independent qualified public accountant for this plan2015-12-31Unqualified
Accountancy firm name2015-12-31NOVAK FRANCELLA, LLC
Accountancy firm EIN2015-12-31611436956
2014 : MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2014 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$1,199,684
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$815,656
Total income from all sources (including contributions)2014-12-31$18,721,659
Total of all expenses incurred2014-12-31$16,675,455
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$16,191,776
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$18,719,799
Value of total assets at end of year2014-12-31$4,216,778
Value of total assets at beginning of year2014-12-31$1,786,546
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$483,679
Total interest from all sources2014-12-31$1,860
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$306,872
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$3,000,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Contributions received from participants2014-12-31$2,727,668
Participant contributions at end of year2014-12-31$58,415
Participant contributions at beginning of year2014-12-31$102,193
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-12-31$192,552
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-12-31$114,864
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$23,684
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$61,656
Administrative expenses (other) incurred2014-12-31$172,453
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$2,046,204
Value of net assets at end of year (total assets less liabilities)2014-12-31$3,017,094
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$970,890
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$4,354
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$3,653,627
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$1,213,531
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$1,213,531
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$1,860
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$768,250
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Contributions received in cash from employer2014-12-31$15,992,131
Employer contributions (assets) at end of year2014-12-31$312,184
Employer contributions (assets) at beginning of year2014-12-31$355,958
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$15,423,526
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Liabilities. Value of benefit claims payable at end of year2014-12-31$1,176,000
Liabilities. Value of benefit claims payable at beginning of year2014-12-31$754,000
Did the plan have assets held for investment2014-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31No
Opinion of an independent qualified public accountant for this plan2014-12-31Unqualified
Accountancy firm name2014-12-31NOVAK FRANCELLA, LLC
Accountancy firm EIN2014-12-31611436956
2013 : MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$815,656
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$1,138,000
Total income from all sources (including contributions)2013-12-31$16,826,261
Total of all expenses incurred2013-12-31$15,374,233
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$15,116,311
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$15,978,499
Value of total assets at end of year2013-12-31$1,786,546
Value of total assets at beginning of year2013-12-31$656,862
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$257,922
Total interest from all sources2013-12-31$415
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$254,917
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$3,000,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Contributions received from participants2013-12-31$2,551,587
Participant contributions at end of year2013-12-31$102,193
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-12-31$114,864
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$61,656
Other income not declared elsewhere2013-12-31$847,347
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$1,452,028
Value of net assets at end of year (total assets less liabilities)2013-12-31$970,890
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$-481,138
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$3,005
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$1,213,531
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$494,804
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$494,804
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$415
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$674,224
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Contributions received in cash from employer2013-12-31$13,426,912
Employer contributions (assets) at end of year2013-12-31$355,958
Employer contributions (assets) at beginning of year2013-12-31$162,058
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$14,442,087
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Liabilities. Value of benefit claims payable at end of year2013-12-31$754,000
Liabilities. Value of benefit claims payable at beginning of year2013-12-31$1,138,000
Did the plan have assets held for investment2013-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31No
Opinion of an independent qualified public accountant for this plan2013-12-31Unqualified
Accountancy firm name2013-12-31NOVAK FRANCELLA, LLC
Accountancy firm EIN2013-12-31611436956
2012 : MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$1,138,000
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$796,670
Total income from all sources (including contributions)2012-12-31$13,379,410
Total of all expenses incurred2012-12-31$13,337,561
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$13,064,481
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$13,338,371
Value of total assets at end of year2012-12-31$656,862
Value of total assets at beginning of year2012-12-31$273,683
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$273,080
Total interest from all sources2012-12-31$860
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Administrative expenses professional fees incurred2012-12-31$273,080
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$3,000,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Other income not declared elsewhere2012-12-31$40,179
Liabilities. Value of operating payables at end of year2012-12-31$0
Liabilities. Value of operating payables at beginning of year2012-12-31$670
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$41,849
Value of net assets at end of year (total assets less liabilities)2012-12-31$-481,138
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$-522,987
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$494,804
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$172,234
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$172,234
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$860
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$1,083,752
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$13,338,371
Employer contributions (assets) at end of year2012-12-31$162,058
Employer contributions (assets) at beginning of year2012-12-31$101,449
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$11,980,729
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Liabilities. Value of benefit claims payable at end of year2012-12-31$1,138,000
Liabilities. Value of benefit claims payable at beginning of year2012-12-31$796,000
Did the plan have assets held for investment2012-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31No
Opinion of an independent qualified public accountant for this plan2012-12-31Unqualified
Accountancy firm name2012-12-31NOVAK FRANCELLA LLC
Accountancy firm EIN2012-12-31611436956
2011 : MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2011 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$796,670
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$721,575
Total income from all sources (including contributions)2011-12-31$7,751,524
Total of all expenses incurred2011-12-31$7,872,991
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$7,711,353
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$7,621,181
Value of total assets at end of year2011-12-31$273,683
Value of total assets at beginning of year2011-12-31$320,055
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$161,638
Total interest from all sources2011-12-31$520
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Administrative expenses professional fees incurred2011-12-31$161,638
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$10,000,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Other income not declared elsewhere2011-12-31$129,823
Liabilities. Value of operating payables at end of year2011-12-31$670
Liabilities. Value of operating payables at beginning of year2011-12-31$3,575
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-121,467
Value of net assets at end of year (total assets less liabilities)2011-12-31$-522,987
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$-401,520
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$172,234
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$160,868
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$160,868
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$520
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Contributions received in cash from employer2011-12-31$7,621,181
Employer contributions (assets) at end of year2011-12-31$101,449
Employer contributions (assets) at beginning of year2011-12-31$159,187
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$7,711,353
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Liabilities. Value of benefit claims payable at end of year2011-12-31$796,000
Liabilities. Value of benefit claims payable at beginning of year2011-12-31$718,000
Did the plan have assets held for investment2011-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31No
Opinion of an independent qualified public accountant for this plan2011-12-31Unqualified
Accountancy firm name2011-12-31NOVAK FRANCELLA LLC
Accountancy firm EIN2011-12-31611436956
2010 : MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$721,575
Total income from all sources (including contributions)2010-12-31$6,200,428
Total of all expenses incurred2010-12-31$6,601,948
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$6,375,515
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$6,199,444
Value of total assets at end of year2010-12-31$320,055
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$226,433
Total interest from all sources2010-12-31$984
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Administrative expenses professional fees incurred2010-12-31$226,433
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$10,000,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Liabilities. Value of operating payables at end of year2010-12-31$3,575
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-401,520
Value of net assets at end of year (total assets less liabilities)2010-12-31$-401,520
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$160,868
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$984
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Contributions received in cash from employer2010-12-31$6,199,444
Employer contributions (assets) at end of year2010-12-31$159,187
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$6,375,515
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Liabilities. Value of benefit claims payable at end of year2010-12-31$718,000
Did the plan have assets held for investment2010-12-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31No
Opinion of an independent qualified public accountant for this plan2010-12-31Unqualified
Accountancy firm name2010-12-31NOVAK FRANCELLA LLC
Accountancy firm EIN2010-12-31611436956

Form 5500 Responses for MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES

2017: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01This submission is the final filingYes
2017-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: MEDICAL PLAN FOR EMPLOYEES OF AMERICAN CAPITAL LTD. & PARTICIPATING COMPANIES 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedYes
2009-01-01Plan funding arrangement – InsuranceYes
2009-01-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number66815
Policy instance 1
Insurance contract or identification number66815
Number of Individuals Covered2830
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-012380-000
Policy instance 2
Insurance contract or identification number16-012380-000
Number of Individuals Covered1521
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $39,402
Welfare Benefit Premiums Paid to CarrierUSD $1,026,778
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees39402
Additional information about fees paid to insurance brokerVOLUME BONUS
Insurance broker organization code?3
Insurance broker nameWILLIS OF NEW YORK, INC.
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number66815
Policy instance 1
Insurance contract or identification number66815
Number of Individuals Covered2650
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-012380-000
Policy instance 2
Insurance contract or identification number16-012380-000
Number of Individuals Covered1444
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $32,641
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $845,106
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees32641
Additional information about fees paid to insurance brokerGROUP VOLUME BONUS
Insurance broker organization code?3
Insurance broker nameWILLIS OF NEW YORK, INC.
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number66815
Policy instance 1
Insurance contract or identification number66815
Number of Individuals Covered2637
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SYMETRA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68608 )
Policy contract number16-012380-000
Policy instance 2
Insurance contract or identification number16-012380-000
Number of Individuals Covered1390
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $733,023
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211891
Policy instance 1
Insurance contract or identification number211891
Number of Individuals Covered1442
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $1,117,903
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number66815
Policy instance 2
Insurance contract or identification number66815
Number of Individuals Covered3560
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211891
Policy instance 1
Insurance contract or identification number211891
Number of Individuals Covered902
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $624,310
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
GHMSI (National Association of Insurance Commissioners NAIC id number: 53007 )
Policy contract number66815
Policy instance 2
Insurance contract or identification number66815
Number of Individuals Covered2369
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract number211891
Policy instance 1
Insurance contract or identification number211891
Number of Individuals Covered696
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $491,706
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
CAREFIRST BLUECROSS BLUESHIELD (National Association of Insurance Commissioners NAIC id number: 47058 )
Policy contract number66815
Policy instance 2
Insurance contract or identification number66815
Number of Individuals Covered1929
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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