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RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN 401k Plan overview

Plan NameRAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN
Plan identification number 504

RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Life insurance
  • Dental
  • Vision
  • Temporary disability (accident and sickness)
  • Long-term disability cover
  • Other welfare benefit cover

401k Sponsoring company profile

RAPPAHANNOCK GOODWILL INDUSTRIES, INC. has sponsored the creation of one or more 401k plans.

Company Name:RAPPAHANNOCK GOODWILL INDUSTRIES, INC.
Employer identification number (EIN):540808744
NAIC Classification:624310
NAIC Description:Vocational Rehabilitation Services

Additional information about RAPPAHANNOCK GOODWILL INDUSTRIES, INC.

Jurisdiction of Incorporation: Virginia Secretary of State
Incorporation Date: 1966-10-17
Company Identification Number: 0109965
Legal Registered Office Address: 4701 MARKET ST SUITE A
725 JACKSON ST STE 200
FREDERICKSBURG
United States of America (USA)
22408

More information about RAPPAHANNOCK GOODWILL INDUSTRIES, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5042017-09-01DONALD K. TOLSON2019-06-18
5042017-09-01DONALD K. TOLSON2019-06-04
5042016-09-01DONALD K. TOLSON

Plan Statistics for RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN

401k plan membership statisitcs for RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2017: RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-09-01368
Total number of active participants reported on line 7a of the Form 55002017-09-01383
Number of retired or separated participants receiving benefits2017-09-012
Number of other retired or separated participants entitled to future benefits2017-09-010
Total of all active and inactive participants2017-09-01385
2016: RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-09-01365
Total number of active participants reported on line 7a of the Form 55002016-09-01352
Number of retired or separated participants receiving benefits2016-09-011
Number of other retired or separated participants entitled to future benefits2016-09-010
Total of all active and inactive participants2016-09-01353

Financial Data on RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN

Measure Date Value
2018 : RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-08-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-08-31$176,116
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-08-31$60,105
Total income from all sources (including contributions)2018-08-31$2,218,422
Total loss/gain on sale of assets2018-08-31$0
Total of all expenses incurred2018-08-31$2,226,362
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-08-31$2,013,475
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-08-31$2,212,054
Value of total assets at end of year2018-08-31$739,703
Value of total assets at beginning of year2018-08-31$631,632
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-08-31$212,887
Total interest from all sources2018-08-31$6,368
Total dividends received (eg from common stock, registered investment company shares)2018-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-08-31No
Was this plan covered by a fidelity bond2018-08-31Yes
Value of fidelity bond cover2018-08-31$10,000
Were there any nonexempt tranactions with any party-in-interest2018-08-31No
Administrative expenses (other) incurred2018-08-31$212,887
Liabilities. Value of operating payables at end of year2018-08-31$176,116
Liabilities. Value of operating payables at beginning of year2018-08-31$60,105
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-08-31No
Value of net income/loss2018-08-31$-7,940
Value of net assets at end of year (total assets less liabilities)2018-08-31$563,587
Value of net assets at beginning of year (total assets less liabilities)2018-08-31$571,527
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-08-31No
Were any leases to which the plan was party in default or uncollectible2018-08-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-08-31$739,703
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-08-31$630,431
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-08-31$630,431
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-08-31$6,368
Expenses. Payments to insurance carriers foe the provision of benefits2018-08-31$2,013,475
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-08-31No
Was there a failure to transmit to the plan any participant contributions2018-08-31No
Has the plan failed to provide any benefit when due under the plan2018-08-31No
Contributions received in cash from employer2018-08-31$2,212,054
Employer contributions (assets) at end of year2018-08-31$0
Employer contributions (assets) at beginning of year2018-08-31$1,201
Did the plan have assets held for investment2018-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-08-31No
Opinion of an independent qualified public accountant for this plan2018-08-31Unqualified
Accountancy firm name2018-08-31BAS PARTNERS
Accountancy firm EIN2018-08-31208779390
2017 : RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-08-31$0
Total transfer of assets to this plan2017-08-31$483,722
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-08-31$60,105
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-08-31$0
Total income from all sources (including contributions)2017-08-31$2,299,769
Total loss/gain on sale of assets2017-08-31$0
Total of all expenses incurred2017-08-31$2,211,964
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-08-31$2,040,316
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-08-31$2,298,657
Value of total assets at end of year2017-08-31$631,632
Value of total assets at beginning of year2017-08-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-08-31$171,648
Total interest from all sources2017-08-31$1,112
Total dividends received (eg from common stock, registered investment company shares)2017-08-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-08-31No
Was this plan covered by a fidelity bond2017-08-31Yes
Value of fidelity bond cover2017-08-31$10,000
Were there any nonexempt tranactions with any party-in-interest2017-08-31No
Administrative expenses (other) incurred2017-08-31$171,648
Liabilities. Value of operating payables at end of year2017-08-31$60,105
Liabilities. Value of operating payables at beginning of year2017-08-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-08-31No
Value of net income/loss2017-08-31$87,805
Value of net assets at end of year (total assets less liabilities)2017-08-31$571,527
Value of net assets at beginning of year (total assets less liabilities)2017-08-31$0
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-08-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-08-31No
Were any leases to which the plan was party in default or uncollectible2017-08-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-08-31$630,431
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-08-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-08-31$0
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-08-31$1,112
Expenses. Payments to insurance carriers foe the provision of benefits2017-08-31$1,994,033
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-08-31No
Was there a failure to transmit to the plan any participant contributions2017-08-31No
Has the plan failed to provide any benefit when due under the plan2017-08-31No
Contributions received in cash from employer2017-08-31$2,298,657
Employer contributions (assets) at end of year2017-08-31$1,201
Employer contributions (assets) at beginning of year2017-08-31$0
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-08-31$46,283
Did the plan have assets held for investment2017-08-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-08-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-08-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-08-31No
Opinion of an independent qualified public accountant for this plan2017-08-31Unqualified
Accountancy firm name2017-08-31BAS PARTNERS
Accountancy firm EIN2017-08-31208779390

Form 5500 Responses for RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN

2017: RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN 2017 form 5500 responses
2017-09-01Type of plan entitySingle employer plan
2017-09-01Submission has been amendedYes
2017-09-01This submission is the final filingNo
2017-09-01This return/report is a short plan year return/report (less than 12 months)No
2017-09-01Plan is a collectively bargained planNo
2017-09-01Plan funding arrangement – InsuranceYes
2017-09-01Plan funding arrangement – TrustYes
2017-09-01Plan benefit arrangement – InsuranceYes
2017-09-01Plan benefit arrangement - TrustYes
2016: RAPPAHANNOCK GOODWILL INDUSTRIES, INC. HEALTH AND WELFARE BENEFIT PLAN 2016 form 5500 responses
2016-09-01Type of plan entitySingle employer plan
2016-09-01First time form 5500 has been submittedYes
2016-09-01Submission has been amendedNo
2016-09-01This submission is the final filingNo
2016-09-01This return/report is a short plan year return/report (less than 12 months)No
2016-09-01Plan is a collectively bargained planNo
2016-09-01Plan funding arrangement – InsuranceYes
2016-09-01Plan funding arrangement – TrustYes
2016-09-01Plan benefit arrangement – InsuranceYes
2016-09-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract numberTCAD0147F
Policy instance 2
Insurance contract or identification numberTCAD0147F
Number of Individuals Covered152
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $18,151
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $125,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 73288 )
Policy contract number621370
Policy instance 8
Insurance contract or identification number621370
Number of Individuals Covered99
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $182
Total amount of fees paid to insurance companyUSD $8
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 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 $8,208
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
HUMANA (National Association of Insurance Commissioners NAIC id number: 70580 )
Policy contract number621370
Policy instance 7
Insurance contract or identification number621370
Number of Individuals Covered83
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $780
Total amount of fees paid to insurance companyUSD $7
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 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 $28,487
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
EYEMED VISION CARE (National Association of Insurance Commissioners NAIC id number: 71870 )
Policy contract number10019191001
Policy instance 6
Insurance contract or identification number10019191001
Number of Individuals Covered153
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $1,082
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 BenefitNo
Vision Insurance Welfare BenefitYes
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 $11,976
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSLI600077
Policy instance 5
Insurance contract or identification numberSLI600077
Number of Individuals Covered186
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $2,360
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $15,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD603371
Policy instance 4
Insurance contract or identification numberSGD603371
Number of Individuals Covered87
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $959
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitYes
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 $6,389
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )
Policy contract numberSGD603370
Policy instance 3
Insurance contract or identification numberSGD603370
Number of Individuals Covered87
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $3,120
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitYes
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 $20,800
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract numberTCA0147F
Policy instance 2
Insurance contract or identification numberTCA0147F
Number of Individuals Covered152
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $18,151
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 BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitYes
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
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 $125,773
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
AETNA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60054 )
Policy contract numberGP-020500
Policy instance 1
Insurance contract or identification numberGP-020500
Number of Individuals Covered144
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $42,838
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 BenefitYes
Vision Insurance Welfare BenefitYes
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 $737,542
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
KAISER FOUNDATION HEALTH PLANS OF MID-ATLANTIC (National Association of Insurance Commissioners NAIC id number: 95639 )
Policy contract number23890
Policy instance 9
Insurance contract or identification number23890
Number of Individuals Covered154
Insurance policy start date2017-09-01
Insurance policy end date2018-08-31
Total amount of commissions paid to insurance brokerUSD $58,047
Total amount of fees paid to insurance companyUSD $12,838
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 $889,751
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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