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DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 401k Plan overview

Plan NameDEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN
Plan identification number 501

DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN Benefits

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

401k Sponsoring company profile

DEVINEY CONSTRUCTION COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name:DEVINEY CONSTRUCTION COMPANY, INC.
Employer identification number (EIN):640758906
NAIC Classification:238900

Additional information about DEVINEY CONSTRUCTION COMPANY, INC.

Jurisdiction of Incorporation: Texas Secretary of State
Incorporation Date: 1996-03-25
Company Identification Number: 0010930806
Legal Registered Office Address: PO BOX 6717

JACKSON
United States of America (USA)
39282

More information about DEVINEY CONSTRUCTION COMPANY, INC.

Form 5500 Filing Information

Submission information for form 5500 for 401k plan DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012021-07-01
5012020-07-01
5012019-07-01
5012018-07-01
5012017-07-01DANA DEVINEY
5012016-07-01DANA DEVINEY
5012015-07-01DANA DEVINEY DANA DEVINEY2017-01-17
5012014-07-01DANA LOMAX
5012013-07-01DANA LOMAX
5012012-07-01DANA LOMAX
5012011-07-01DANA DEVINEY LOMAX
5012009-07-01DANA LOMAX

Plan Statistics for DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN

401k plan membership statisitcs for DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN

Measure Date Value
2021: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2021 401k membership
Total participants, beginning-of-year2021-07-01167
Total number of active participants reported on line 7a of the Form 55002021-07-01115
Number of retired or separated participants receiving benefits2021-07-01115
Number of other retired or separated participants entitled to future benefits2021-07-010
Total of all active and inactive participants2021-07-01230
2020: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2020 401k membership
Total participants, beginning-of-year2020-07-01186
Total number of active participants reported on line 7a of the Form 55002020-07-01167
Number of retired or separated participants receiving benefits2020-07-01167
Number of other retired or separated participants entitled to future benefits2020-07-010
Total of all active and inactive participants2020-07-01334
2019: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2019 401k membership
Total participants, beginning-of-year2019-07-01223
Total number of active participants reported on line 7a of the Form 55002019-07-01186
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 participants2019-07-01186
2018: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2018 401k membership
Total participants, beginning-of-year2018-07-01222
Total number of active participants reported on line 7a of the Form 55002018-07-01223
Number of retired or separated participants receiving benefits2018-07-011
Number of other retired or separated participants entitled to future benefits2018-07-010
Total of all active and inactive participants2018-07-01224
2017: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2017 401k membership
Total participants, beginning-of-year2017-07-01204
Total number of active participants reported on line 7a of the Form 55002017-07-01266
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 participants2017-07-01266
2016: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2016 401k membership
Total participants, beginning-of-year2016-07-01204
Total number of active participants reported on line 7a of the Form 55002016-07-01241
Number of retired or separated participants receiving benefits2016-07-014
Number of other retired or separated participants entitled to future benefits2016-07-010
Total of all active and inactive participants2016-07-01245
2015: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2015 401k membership
Total participants, beginning-of-year2015-07-01213
Total number of active participants reported on line 7a of the Form 55002015-07-01239
Number of retired or separated participants receiving benefits2015-07-011
Number of other retired or separated participants entitled to future benefits2015-07-010
Total of all active and inactive participants2015-07-01240
2014: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2014 401k membership
Total participants, beginning-of-year2014-07-01157
Total number of active participants reported on line 7a of the Form 55002014-07-01215
Number of retired or separated participants receiving benefits2014-07-011
Number of other retired or separated participants entitled to future benefits2014-07-010
Total of all active and inactive participants2014-07-01216
2013: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2013 401k membership
Total participants, beginning-of-year2013-07-01163
Total number of active participants reported on line 7a of the Form 55002013-07-01167
Number of retired or separated participants receiving benefits2013-07-015
Number of other retired or separated participants entitled to future benefits2013-07-010
Total of all active and inactive participants2013-07-01172
2012: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2012 401k membership
Total participants, beginning-of-year2012-07-01136
Total number of active participants reported on line 7a of the Form 55002012-07-01142
Number of retired or separated participants receiving benefits2012-07-011
Number of other retired or separated participants entitled to future benefits2012-07-010
Total of all active and inactive participants2012-07-01143
2011: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2011 401k membership
Total participants, beginning-of-year2011-07-01151
Total number of active participants reported on line 7a of the Form 55002011-07-01144
Number of retired or separated participants receiving benefits2011-07-010
Number of other retired or separated participants entitled to future benefits2011-07-010
Total of all active and inactive participants2011-07-01144
2009: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2009 401k membership
Total participants, beginning-of-year2009-07-01136
Total number of active participants reported on line 7a of the Form 55002009-07-01147
Number of retired or separated participants receiving benefits2009-07-011
Number of other retired or separated participants entitled to future benefits2009-07-010
Total of all active and inactive participants2009-07-01148

Financial Data on DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN

Measure Date Value
2022 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2022 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$51,308
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-06-30$38,111
Total income from all sources (including contributions)2022-06-30$1,125,602
Total of all expenses incurred2022-06-30$1,143,556
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-06-30$1,085,511
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-06-30$1,125,602
Value of total assets at end of year2022-06-30$8,912
Value of total assets at beginning of year2022-06-30$13,669
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-06-30$58,045
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-06-30No
Was this plan covered by a fidelity bond2022-06-30No
If this is an individual account plan, was there a blackout period2022-06-30No
Were there any nonexempt tranactions with any party-in-interest2022-06-30No
Contributions received from participants2022-06-30$325,973
Total non interest bearing cash at end of year2022-06-30$8,912
Total non interest bearing cash at beginning of year2022-06-30$13,669
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Value of net income/loss2022-06-30$-17,954
Value of net assets at end of year (total assets less liabilities)2022-06-30$-42,396
Value of net assets at beginning of year (total assets less liabilities)2022-06-30$-24,442
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2022-06-30No
Were any leases to which the plan was party in default or uncollectible2022-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2022-06-30$356,410
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-06-30No
Was there a failure to transmit to the plan any participant contributions2022-06-30No
Has the plan failed to provide any benefit when due under the plan2022-06-30No
Contributions received in cash from employer2022-06-30$799,629
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-06-30$729,101
Contract administrator fees2022-06-30$58,045
Liabilities. Value of benefit claims payable at end of year2022-06-30$51,308
Liabilities. Value of benefit claims payable at beginning of year2022-06-30$38,111
Did the plan have assets held for investment2022-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-06-30No
Opinion of an independent qualified public accountant for this plan2022-06-30Disclaimer
Accountancy firm name2022-06-30WILLIAMS, WEISS, HESTER & CO., PLLC
Accountancy firm EIN2022-06-30640317418
2021 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2021 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$38,111
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2021-06-30$36,296
Total income from all sources (including contributions)2021-06-30$1,271,708
Total of all expenses incurred2021-06-30$1,354,570
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-06-30$1,309,016
Total contributions o plan (from employers,participants, others, non cash contrinutions)2021-06-30$1,271,708
Value of total assets at end of year2021-06-30$13,669
Value of total assets at beginning of year2021-06-30$94,716
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-06-30$45,554
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-06-30No
Was this plan covered by a fidelity bond2021-06-30No
If this is an individual account plan, was there a blackout period2021-06-30No
Were there any nonexempt tranactions with any party-in-interest2021-06-30No
Contributions received from participants2021-06-30$574,223
Total non interest bearing cash at end of year2021-06-30$13,669
Total non interest bearing cash at beginning of year2021-06-30$94,716
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Value of net income/loss2021-06-30$-82,862
Value of net assets at end of year (total assets less liabilities)2021-06-30$-24,442
Value of net assets at beginning of year (total assets less liabilities)2021-06-30$58,420
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2021-06-30No
Were any leases to which the plan was party in default or uncollectible2021-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2021-06-30$379,899
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-06-30No
Was there a failure to transmit to the plan any participant contributions2021-06-30No
Has the plan failed to provide any benefit when due under the plan2021-06-30No
Contributions received in cash from employer2021-06-30$697,485
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-06-30$929,117
Contract administrator fees2021-06-30$45,554
Liabilities. Value of benefit claims payable at end of year2021-06-30$38,111
Liabilities. Value of benefit claims payable at beginning of year2021-06-30$36,296
Did the plan have assets held for investment2021-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-06-30No
Opinion of an independent qualified public accountant for this plan2021-06-30Disclaimer
Accountancy firm name2021-06-30WILLIAMS, WEISS, HESTER & CO., PLLC
Accountancy firm EIN2021-06-30640317418
2020 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2020 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$36,296
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2020-06-30$54,727
Total income from all sources (including contributions)2020-06-30$1,412,679
Total of all expenses incurred2020-06-30$1,387,162
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-06-30$1,333,499
Total contributions o plan (from employers,participants, others, non cash contrinutions)2020-06-30$1,412,679
Value of total assets at end of year2020-06-30$94,716
Value of total assets at beginning of year2020-06-30$87,630
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-06-30$53,663
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-06-30No
Was this plan covered by a fidelity bond2020-06-30No
If this is an individual account plan, was there a blackout period2020-06-30No
Were there any nonexempt tranactions with any party-in-interest2020-06-30No
Contributions received from participants2020-06-30$552,374
Total non interest bearing cash at end of year2020-06-30$94,716
Total non interest bearing cash at beginning of year2020-06-30$87,630
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Value of net income/loss2020-06-30$25,517
Value of net assets at end of year (total assets less liabilities)2020-06-30$58,420
Value of net assets at beginning of year (total assets less liabilities)2020-06-30$32,903
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2020-06-30No
Were any leases to which the plan was party in default or uncollectible2020-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2020-06-30$556,730
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-06-30No
Was there a failure to transmit to the plan any participant contributions2020-06-30No
Has the plan failed to provide any benefit when due under the plan2020-06-30No
Contributions received in cash from employer2020-06-30$860,305
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-06-30$776,769
Contract administrator fees2020-06-30$53,663
Liabilities. Value of benefit claims payable at end of year2020-06-30$36,296
Liabilities. Value of benefit claims payable at beginning of year2020-06-30$54,727
Did the plan have assets held for investment2020-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2020-06-30Yes
Opinion of an independent qualified public accountant for this plan2020-06-30Disclaimer
Accountancy firm name2020-06-30WILLIAMS, WEISS, HESTER & CO., PLLC
Accountancy firm EIN2020-06-30640317418
2019 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2019 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$54,727
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2019-06-30$17,762
Total income from all sources (including contributions)2019-06-30$1,292,825
Total of all expenses incurred2019-06-30$1,328,705
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-06-30$1,182,653
Total contributions o plan (from employers,participants, others, non cash contrinutions)2019-06-30$1,292,825
Value of total assets at end of year2019-06-30$87,630
Value of total assets at beginning of year2019-06-30$86,545
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-06-30$146,052
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-06-30No
Was this plan covered by a fidelity bond2019-06-30Yes
Value of fidelity bond cover2019-06-30$1,000,000
If this is an individual account plan, was there a blackout period2019-06-30No
Were there any nonexempt tranactions with any party-in-interest2019-06-30No
Contributions received from participants2019-06-30$576,221
Total non interest bearing cash at end of year2019-06-30$87,630
Total non interest bearing cash at beginning of year2019-06-30$86,545
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Value of net income/loss2019-06-30$-35,880
Value of net assets at end of year (total assets less liabilities)2019-06-30$32,903
Value of net assets at beginning of year (total assets less liabilities)2019-06-30$68,783
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2019-06-30No
Were any leases to which the plan was party in default or uncollectible2019-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2019-06-30$545,490
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-06-30No
Was there a failure to transmit to the plan any participant contributions2019-06-30No
Has the plan failed to provide any benefit when due under the plan2019-06-30No
Contributions received in cash from employer2019-06-30$716,604
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-06-30$637,163
Contract administrator fees2019-06-30$146,052
Liabilities. Value of benefit claims payable at end of year2019-06-30$54,727
Liabilities. Value of benefit claims payable at beginning of year2019-06-30$17,762
Did the plan have assets held for investment2019-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-06-30Yes
Opinion of an independent qualified public accountant for this plan2019-06-30Disclaimer
Accountancy firm name2019-06-30WILLIAMS, WEISS, HESTER & CO., PLLC
Accountancy firm EIN2019-06-30640317418
2018 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$17,762
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-06-30$230,017
Total income from all sources (including contributions)2018-06-30$1,358,416
Total loss/gain on sale of assets2018-06-30$0
Total of all expenses incurred2018-06-30$1,376,638
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-06-30$675,665
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-06-30$1,358,416
Value of total assets at end of year2018-06-30$86,545
Value of total assets at beginning of year2018-06-30$317,022
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-06-30$700,973
Total interest from all sources2018-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2018-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-06-30No
Administrative expenses professional fees incurred2018-06-30$163,999
Was this plan covered by a fidelity bond2018-06-30Yes
Value of fidelity bond cover2018-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2018-06-30No
Contributions received from participants2018-06-30$588,877
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2018-06-30$675,665
Administrative expenses (other) incurred2018-06-30$536,974
Total non interest bearing cash at end of year2018-06-30$86,545
Total non interest bearing cash at beginning of year2018-06-30$317,022
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Value of net income/loss2018-06-30$-18,222
Value of net assets at end of year (total assets less liabilities)2018-06-30$68,783
Value of net assets at beginning of year (total assets less liabilities)2018-06-30$87,005
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2018-06-30No
Were any leases to which the plan was party in default or uncollectible2018-06-30No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-06-30No
Was there a failure to transmit to the plan any participant contributions2018-06-30No
Has the plan failed to provide any benefit when due under the plan2018-06-30No
Contributions received in cash from employer2018-06-30$769,539
Liabilities. Value of benefit claims payable at end of year2018-06-30$17,762
Liabilities. Value of benefit claims payable at beginning of year2018-06-30$230,017
Did the plan have assets held for investment2018-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-06-30No
Opinion of an independent qualified public accountant for this plan2018-06-30Unqualified
Accountancy firm name2018-06-30WILLIAMS, WEISS, HESTER AND CO.
Accountancy firm EIN2018-06-30640317418
2017 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$230,017
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-06-30$86,011
Total income from all sources (including contributions)2017-06-30$2,312,633
Total loss/gain on sale of assets2017-06-30$0
Total of all expenses incurred2017-06-30$2,248,233
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-06-30$1,467,602
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-06-30$2,312,633
Value of total assets at end of year2017-06-30$317,022
Value of total assets at beginning of year2017-06-30$108,616
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-06-30$780,631
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
Was this plan covered by a fidelity bond2017-06-30Yes
Value of fidelity bond cover2017-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2017-06-30No
Contributions received from participants2017-06-30$584,083
Administrative expenses (other) incurred2017-06-30$681,920
Total non interest bearing cash at end of year2017-06-30$317,022
Total non interest bearing cash at beginning of year2017-06-30$108,616
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
Value of net income/loss2017-06-30$64,400
Value of net assets at end of year (total assets less liabilities)2017-06-30$87,005
Value of net assets at beginning of year (total assets less liabilities)2017-06-30$22,605
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
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
Contributions received in cash from employer2017-06-30$1,728,550
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-06-30$1,467,602
Contract administrator fees2017-06-30$98,711
Liabilities. Value of benefit claims payable at end of year2017-06-30$230,017
Liabilities. Value of benefit claims payable at beginning of year2017-06-30$86,011
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
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-06-30No
Opinion of an independent qualified public accountant for this plan2017-06-30Unqualified
Accountancy firm name2017-06-30WILLIAMS, WEISS, HESTER AND CO.
Accountancy firm EIN2017-06-30640317418
2016 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$86,011
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-06-30$294,156
Total income from all sources (including contributions)2016-06-30$2,174,592
Total loss/gain on sale of assets2016-06-30$0
Total of all expenses incurred2016-06-30$2,172,108
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-06-30$1,489,394
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-06-30$2,174,592
Value of total assets at end of year2016-06-30$108,616
Value of total assets at beginning of year2016-06-30$314,277
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-06-30$682,714
Total interest from all sources2016-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2016-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-06-30No
Administrative expenses professional fees incurred2016-06-30$145,391
Was this plan covered by a fidelity bond2016-06-30Yes
Value of fidelity bond cover2016-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2016-06-30No
Contributions received from participants2016-06-30$584,294
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2016-06-30$1,489,394
Administrative expenses (other) incurred2016-06-30$537,323
Total non interest bearing cash at end of year2016-06-30$108,616
Total non interest bearing cash at beginning of year2016-06-30$314,277
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Value of net income/loss2016-06-30$2,484
Value of net assets at end of year (total assets less liabilities)2016-06-30$22,605
Value of net assets at beginning of year (total assets less liabilities)2016-06-30$20,121
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2016-06-30No
Were any leases to which the plan was party in default or uncollectible2016-06-30No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-06-30No
Was there a failure to transmit to the plan any participant contributions2016-06-30No
Has the plan failed to provide any benefit when due under the plan2016-06-30No
Contributions received in cash from employer2016-06-30$1,590,298
Liabilities. Value of benefit claims payable at end of year2016-06-30$86,011
Liabilities. Value of benefit claims payable at beginning of year2016-06-30$294,156
Did the plan have assets held for investment2016-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-06-30No
Opinion of an independent qualified public accountant for this plan2016-06-30Unqualified
Accountancy firm name2016-06-30WILLIAMS, WEISS, HESTER AND CO
Accountancy firm EIN2016-06-30640317418
2015 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$294,156
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-06-30$127,059
Total income from all sources (including contributions)2015-06-30$2,293,875
Total loss/gain on sale of assets2015-06-30$0
Total of all expenses incurred2015-06-30$2,171,533
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-06-30$1,582,731
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-06-30$2,293,875
Value of total assets at end of year2015-06-30$314,277
Value of total assets at beginning of year2015-06-30$24,838
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-06-30$588,802
Total interest from all sources2015-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2015-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-06-30No
Administrative expenses professional fees incurred2015-06-30$63,119
Was this plan covered by a fidelity bond2015-06-30Yes
Value of fidelity bond cover2015-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2015-06-30No
Contributions received from participants2015-06-30$565,325
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2015-06-30$1,582,731
Administrative expenses (other) incurred2015-06-30$525,683
Total non interest bearing cash at end of year2015-06-30$314,277
Total non interest bearing cash at beginning of year2015-06-30$24,838
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Value of net income/loss2015-06-30$122,342
Value of net assets at end of year (total assets less liabilities)2015-06-30$20,121
Value of net assets at beginning of year (total assets less liabilities)2015-06-30$-102,221
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2015-06-30No
Were any leases to which the plan was party in default or uncollectible2015-06-30No
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-06-30No
Was there a failure to transmit to the plan any participant contributions2015-06-30No
Has the plan failed to provide any benefit when due under the plan2015-06-30No
Contributions received in cash from employer2015-06-30$1,728,550
Liabilities. Value of benefit claims payable at end of year2015-06-30$294,156
Liabilities. Value of benefit claims payable at beginning of year2015-06-30$127,059
Did the plan have assets held for investment2015-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-06-30No
Opinion of an independent qualified public accountant for this plan2015-06-30Unqualified
Accountancy firm name2015-06-30WILLIAMS, WEISS, HESTER AND CO
Accountancy firm EIN2015-06-30640317418
2014 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$127,059
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-06-30$205,341
Total income from all sources (including contributions)2014-06-30$2,337,338
Total loss/gain on sale of assets2014-06-30$0
Total of all expenses incurred2014-06-30$2,253,964
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-06-30$2,210,942
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-06-30$2,337,338
Value of total assets at end of year2014-06-30$24,838
Value of total assets at beginning of year2014-06-30$19,746
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-06-30$43,022
Total interest from all sources2014-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2014-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-06-30No
Administrative expenses professional fees incurred2014-06-30$43,022
Was this plan covered by a fidelity bond2014-06-30Yes
Value of fidelity bond cover2014-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2014-06-30No
Contributions received from participants2014-06-30$408,611
Total non interest bearing cash at end of year2014-06-30$24,838
Total non interest bearing cash at beginning of year2014-06-30$19,746
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Value of net income/loss2014-06-30$83,374
Value of net assets at end of year (total assets less liabilities)2014-06-30$-102,221
Value of net assets at beginning of year (total assets less liabilities)2014-06-30$-185,595
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2014-06-30No
Were any leases to which the plan was party in default or uncollectible2014-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2014-06-30$295,074
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-06-30No
Was there a failure to transmit to the plan any participant contributions2014-06-30No
Has the plan failed to provide any benefit when due under the plan2014-06-30No
Contributions received in cash from employer2014-06-30$1,928,727
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-06-30$1,915,868
Liabilities. Value of benefit claims payable at end of year2014-06-30$127,059
Liabilities. Value of benefit claims payable at beginning of year2014-06-30$205,341
Did the plan have assets held for investment2014-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-06-30No
Opinion of an independent qualified public accountant for this plan2014-06-30Unqualified
Accountancy firm name2014-06-30WILLIAMS, WEISS HESTER & CO
Accountancy firm EIN2014-06-30640317418
2013 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$205,341
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-06-30$101,683
Total income from all sources (including contributions)2013-06-30$1,434,934
Total loss/gain on sale of assets2013-06-30$0
Total of all expenses incurred2013-06-30$1,535,061
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-06-30$1,498,055
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-06-30$1,434,934
Value of total assets at end of year2013-06-30$19,746
Value of total assets at beginning of year2013-06-30$16,215
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-06-30$37,006
Total interest from all sources2013-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2013-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-06-30No
Administrative expenses professional fees incurred2013-06-30$37,006
Was this plan covered by a fidelity bond2013-06-30Yes
Value of fidelity bond cover2013-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2013-06-30No
Contributions received from participants2013-06-30$317,184
Total non interest bearing cash at end of year2013-06-30$19,746
Total non interest bearing cash at beginning of year2013-06-30$16,215
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Value of net income/loss2013-06-30$-100,127
Value of net assets at end of year (total assets less liabilities)2013-06-30$-185,595
Value of net assets at beginning of year (total assets less liabilities)2013-06-30$-85,468
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2013-06-30No
Were any leases to which the plan was party in default or uncollectible2013-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2013-06-30$227,537
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-06-30No
Was there a failure to transmit to the plan any participant contributions2013-06-30No
Has the plan failed to provide any benefit when due under the plan2013-06-30No
Contributions received in cash from employer2013-06-30$1,117,750
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-06-30$1,270,518
Liabilities. Value of benefit claims payable at end of year2013-06-30$205,341
Liabilities. Value of benefit claims payable at beginning of year2013-06-30$101,683
Did the plan have assets held for investment2013-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-06-30No
Opinion of an independent qualified public accountant for this plan2013-06-30Unqualified
Accountancy firm name2013-06-30WILLIAMS, WEISS HESTER & CO., LLC
Accountancy firm EIN2013-06-30640317418
2012 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$101,683
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-06-30$79,534
Total income from all sources (including contributions)2012-06-30$1,437,718
Total loss/gain on sale of assets2012-06-30$0
Total of all expenses incurred2012-06-30$1,454,960
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-06-30$1,407,654
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-06-30$1,437,718
Value of total assets at end of year2012-06-30$16,215
Value of total assets at beginning of year2012-06-30$11,308
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-06-30$47,306
Total interest from all sources2012-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2012-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-06-30No
Administrative expenses professional fees incurred2012-06-30$47,306
Was this plan covered by a fidelity bond2012-06-30Yes
Value of fidelity bond cover2012-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2012-06-30No
Contributions received from participants2012-06-30$347,578
Total non interest bearing cash at end of year2012-06-30$16,215
Total non interest bearing cash at beginning of year2012-06-30$11,308
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Value of net income/loss2012-06-30$-17,242
Value of net assets at end of year (total assets less liabilities)2012-06-30$-85,468
Value of net assets at beginning of year (total assets less liabilities)2012-06-30$-68,226
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2012-06-30No
Were any leases to which the plan was party in default or uncollectible2012-06-30No
Expenses. Payments to insurance carriers foe the provision of benefits2012-06-30$254,801
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-06-30No
Was there a failure to transmit to the plan any participant contributions2012-06-30No
Has the plan failed to provide any benefit when due under the plan2012-06-30No
Contributions received in cash from employer2012-06-30$1,090,140
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-06-30$1,152,853
Liabilities. Value of benefit claims payable at end of year2012-06-30$101,683
Liabilities. Value of benefit claims payable at beginning of year2012-06-30$79,534
Did the plan have assets held for investment2012-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-06-30No
Opinion of an independent qualified public accountant for this plan2012-06-30Unqualified
Accountancy firm name2012-06-30WILLIAMS, WEISS HESTER & CO., LLC
Accountancy firm EIN2012-06-30640317418
2011 : DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-06-30$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$79,534
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-06-30$170,677
Total income from all sources (including contributions)2011-06-30$851,358
Total loss/gain on sale of assets2011-06-30$0
Total of all expenses incurred2011-06-30$757,206
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-06-30$723,337
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-06-30$851,358
Value of total assets at end of year2011-06-30$11,308
Value of total assets at beginning of year2011-06-30$8,299
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-06-30$33,869
Total interest from all sources2011-06-30$0
Total dividends received (eg from common stock, registered investment company shares)2011-06-30$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-06-30No
Administrative expenses professional fees incurred2011-06-30$33,869
Was this plan covered by a fidelity bond2011-06-30Yes
Value of fidelity bond cover2011-06-30$1,000,000
Were there any nonexempt tranactions with any party-in-interest2011-06-30No
Contributions received from participants2011-06-30$327,722
Total non interest bearing cash at end of year2011-06-30$11,308
Total non interest bearing cash at beginning of year2011-06-30$8,299
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Value of net income/loss2011-06-30$94,152
Value of net assets at end of year (total assets less liabilities)2011-06-30$-68,226
Value of net assets at beginning of year (total assets less liabilities)2011-06-30$-162,378
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-06-30No
Were any loans by the plan or fixed income obligations due to the plan in default2011-06-30No
Were any leases to which the plan was party in default or uncollectible2011-06-30No
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-06-30$0
Expenses. Payments to insurance carriers foe the provision of benefits2011-06-30$229,041
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-06-30No
Was there a failure to transmit to the plan any participant contributions2011-06-30No
Has the plan failed to provide any benefit when due under the plan2011-06-30No
Contributions received in cash from employer2011-06-30$523,636
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-06-30$494,296
Liabilities. Value of benefit claims payable at end of year2011-06-30$79,534
Liabilities. Value of benefit claims payable at beginning of year2011-06-30$170,677
Did the plan have assets held for investment2011-06-30No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-06-30No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-06-30No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-06-30No
Opinion of an independent qualified public accountant for this plan2011-06-30Unqualified
Accountancy firm name2011-06-30WILLIAMS, WEISS, HESTER & CO,LLC
Accountancy firm EIN2011-06-30640317418

Form 5500 Responses for DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN

2021: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2021 form 5500 responses
2021-07-01Type of plan entitySingle employer plan
2021-07-01Plan funding arrangement – TrustYes
2021-07-01Plan benefit arrangement – InsuranceYes
2021-07-01Plan benefit arrangement – General assets of the sponsorYes
2020: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2020 form 5500 responses
2020-07-01Type of plan entitySingle employer plan
2020-07-01Plan funding arrangement – TrustYes
2020-07-01Plan benefit arrangement – InsuranceYes
2020-07-01Plan benefit arrangement – General assets of the sponsorYes
2019: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2019 form 5500 responses
2019-07-01Type of plan entitySingle employer plan
2019-07-01Plan funding arrangement – TrustYes
2019-07-01Plan benefit arrangement – InsuranceYes
2019-07-01Plan benefit arrangement – General assets of the sponsorYes
2018: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2018 form 5500 responses
2018-07-01Type of plan entitySingle employer plan
2018-07-01Plan funding arrangement – TrustYes
2018-07-01Plan benefit arrangement – InsuranceYes
2018-07-01Plan benefit arrangement – General assets of the sponsorYes
2017: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 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 – TrustYes
2017-07-01Plan benefit arrangement – InsuranceYes
2017-07-01Plan benefit arrangement - TrustYes
2017-07-01Plan benefit arrangement – General assets of the sponsorYes
2016: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2016 form 5500 responses
2016-07-01Type of plan entitySingle employer plan
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 – TrustYes
2016-07-01Plan benefit arrangement – InsuranceYes
2016-07-01Plan benefit arrangement - TrustYes
2016-07-01Plan benefit arrangement – General assets of the sponsorYes
2015: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2015 form 5500 responses
2015-07-01Type of plan entitySingle employer plan
2015-07-01Submission has been amendedNo
2015-07-01This submission is the final filingNo
2015-07-01This return/report is a short plan year return/report (less than 12 months)No
2015-07-01Plan is a collectively bargained planNo
2015-07-01Plan funding arrangement – TrustYes
2015-07-01Plan benefit arrangement – InsuranceYes
2015-07-01Plan benefit arrangement - TrustYes
2015-07-01Plan benefit arrangement – General assets of the sponsorYes
2014: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2014 form 5500 responses
2014-07-01Type of plan entitySingle employer plan
2014-07-01Submission has been amendedNo
2014-07-01This submission is the final filingNo
2014-07-01This return/report is a short plan year return/report (less than 12 months)No
2014-07-01Plan is a collectively bargained planNo
2014-07-01Plan funding arrangement – TrustYes
2014-07-01Plan benefit arrangement – InsuranceYes
2014-07-01Plan benefit arrangement - TrustYes
2014-07-01Plan benefit arrangement – General assets of the sponsorYes
2013: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2013 form 5500 responses
2013-07-01Type of plan entitySingle employer plan
2013-07-01Submission has been amendedNo
2013-07-01This submission is the final filingNo
2013-07-01This return/report is a short plan year return/report (less than 12 months)No
2013-07-01Plan is a collectively bargained planNo
2013-07-01Plan funding arrangement – TrustYes
2013-07-01Plan benefit arrangement – InsuranceYes
2013-07-01Plan benefit arrangement - TrustYes
2013-07-01Plan benefit arrangement – General assets of the sponsorYes
2012: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2012 form 5500 responses
2012-07-01Type of plan entitySingle employer plan
2012-07-01Submission has been amendedNo
2012-07-01This submission is the final filingNo
2012-07-01This return/report is a short plan year return/report (less than 12 months)No
2012-07-01Plan is a collectively bargained planNo
2012-07-01Plan funding arrangement – TrustYes
2012-07-01Plan benefit arrangement – InsuranceYes
2012-07-01Plan benefit arrangement - TrustYes
2012-07-01Plan benefit arrangement – General assets of the sponsorYes
2011: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2011 form 5500 responses
2011-07-01Type of plan entitySingle employer plan
2011-07-01Submission has been amendedNo
2011-07-01This submission is the final filingNo
2011-07-01This return/report is a short plan year return/report (less than 12 months)No
2011-07-01Plan is a collectively bargained planNo
2011-07-01Plan funding arrangement – TrustYes
2011-07-01Plan benefit arrangement – InsuranceYes
2011-07-01Plan benefit arrangement - TrustYes
2011-07-01Plan benefit arrangement – General assets of the sponsorYes
2009: DEVINEY CONSTRUCTION CO., EMPLOYEE MEDICAL BENEFITS PLAN 2009 form 5500 responses
2009-07-01Type of plan entitySingle employer plan
2009-07-01Submission has been amendedNo
2009-07-01This submission is the final filingNo
2009-07-01This return/report is a short plan year return/report (less than 12 months)No
2009-07-01Plan is a collectively bargained planNo
2009-07-01Plan funding arrangement – TrustYes
2009-07-01Plan benefit arrangement – InsuranceYes
2009-07-01Plan benefit arrangement - TrustYes
2009-07-01Plan benefit arrangement – General assets of the sponsorYes

Insurance Providers Used on plan

SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberEXRK
Policy instance 1
Insurance contract or identification numberEXRK
Number of Individuals Covered115
Insurance policy start date2022-07-01
Insurance policy end date2023-06-30
Total amount of commissions paid to insurance brokerUSD $125,947
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $125,947
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberEXRK
Policy instance 1
Insurance contract or identification numberEXRK
Number of Individuals Covered164
Insurance policy start date2021-07-01
Insurance policy end date2022-06-30
Total amount of commissions paid to insurance brokerUSD $356,410
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $356,410
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
SUN LIFE ASSURANCE COMPANY OF CANADA (National Association of Insurance Commissioners NAIC id number: 80802 )
Policy contract numberEXRK
Policy instance 1
Insurance contract or identification numberEXRK
Number of Individuals Covered164
Insurance policy start date2020-07-01
Insurance policy end date2021-06-30
Total amount of fees paid to insurance companyUSD $17,961
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees17961
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberEXRK
Policy instance 1
Insurance contract or identification numberEXRK
Number of Individuals Covered185
Insurance policy start date2019-07-01
Insurance policy end date2020-06-30
Total amount of fees paid to insurance companyUSD $22,176
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees22176
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract numberEXRK
Policy instance 1
Insurance contract or identification numberEXRK
Number of Individuals Covered208
Insurance policy start date2018-07-01
Insurance policy end date2019-06-30
Total amount of fees paid to insurance companyUSD $25,394
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees25394
Additional information about fees paid to insurance brokerSERVICE FEE
Insurance broker organization code?3
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFMH910454
Policy instance 1
Insurance contract or identification numberFMH910454
Number of Individuals Covered298
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $2,619
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 $13,094
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,619
Insurance broker organization code?3
Insurance broker nameHEALTHSMART BENEFIT SOLUTIONS
RELIASTAR LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67105 )
Policy contract number70170 0
Policy instance 2
Insurance contract or identification number70170 0
Number of Individuals Covered222
Insurance policy start date2017-07-01
Insurance policy end date2018-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $25,016
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 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 $500,324
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees25016
Additional information about fees paid to insurance brokerSERVICE FEES
Insurance broker organization code?3
Insurance broker nameSBR SERVICES LLC
TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )
Policy contract numberTMG101019
Policy instance 2
Insurance contract or identification numberTMG101019
Number of Individuals Covered210
Insurance policy start date2015-07-01
Insurance policy end date2016-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $52,690
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare 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 $454,725
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees48173
Additional information about fees paid to insurance brokerFEES PAID
Insurance broker organization code?3
Insurance broker nameDW VAN DYKE AND CO
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFMH910455
Policy instance 1
Insurance contract or identification numberFMH910455
Number of Individuals Covered276
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $1,996
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $9,982
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,996
Insurance broker organization code?3
Insurance broker nameHEALTHSMART BENEFIT SOLUTIONS
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number1041 2014
Policy instance 2
Insurance contract or identification number1041 2014
Number of Individuals Covered193
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare 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 $446,830
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFMH910455
Policy instance 1
Insurance contract or identification numberFMH910455
Number of Individuals Covered348
Insurance policy start date2014-07-01
Insurance policy end date2015-06-30
Total amount of commissions paid to insurance brokerUSD $4,871
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $24,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,871
Insurance broker organization code?3
Insurance broker nameHEALTHSMART BENEFIT SOLUTIONS
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number11041-01S 01A
Policy instance 2
Insurance contract or identification number11041-01S 01A
Number of Individuals Covered165
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare 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 $250,018
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFMH910455
Policy instance 1
Insurance contract or identification numberFMH910455
Number of Individuals Covered358
Insurance policy start date2013-07-01
Insurance policy end date2014-06-30
Total amount of commissions paid to insurance brokerUSD $4,915
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $24,573
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,915
Insurance broker organization code?3
Insurance broker nameHEALTHSMART BENEFIT SOLUTIONS
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFMH910455
Policy instance 1
Insurance contract or identification numberFMH910455
Number of Individuals Covered348
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $4,856
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $24,280
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,856
Insurance broker organization code?3
Insurance broker nameHEALTHSMART BENEFIT SOLUTIONS
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number11041-01S 01A
Policy instance 2
Insurance contract or identification number11041-01S 01A
Number of Individuals Covered135
Insurance policy start date2012-07-01
Insurance policy end date2013-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare 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 $194,357
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
PAN-AMERICAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 67539 )
Policy contract number11041-01S 01A
Policy instance 2
Insurance contract or identification number11041-01S 01A
Number of Individuals Covered133
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare 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 $217,131
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFMH910455
Policy instance 1
Insurance contract or identification numberFMH910455
Number of Individuals Covered373
Insurance policy start date2011-07-01
Insurance policy end date2012-06-30
Total amount of commissions paid to insurance brokerUSD $4,987
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $24,935
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
FEDERAL INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 20281 )
Policy contract numberGW19960576901S
Policy instance 1
Insurance contract or identification numberGW19960576901S
Number of Individuals Covered162
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare 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 $198,316
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 )
Policy contract numberFMH910455
Policy instance 2
Insurance contract or identification numberFMH910455
Number of Individuals Covered397
Insurance policy start date2010-07-01
Insurance policy end date2011-06-30
Total amount of commissions paid to insurance brokerUSD $4,383
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
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 $21,914
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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