TRUSTEES OF PRINTING INDUSTRIES has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS
401k plan membership statisitcs for PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS
| Measure | Date | Value |
|---|
| 2020: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2020 401k membership |
|---|
| Total participants, beginning-of-year | 2020-06-01 | 24 |
| Total of all active and inactive participants | 2020-06-01 | 0 |
| Total participants | 2020-06-01 | 0 |
| Number of employers contributing to the scheme | 2020-06-01 | 0 |
| 2019: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2019 401k membership |
|---|
| Total participants, beginning-of-year | 2019-06-01 | 10 |
| Total number of active participants reported on line 7a of the Form 5500 | 2019-06-01 | 24 |
| Total of all active and inactive participants | 2019-06-01 | 24 |
| Total participants | 2019-06-01 | 24 |
| Number of participants with account balances | 2019-06-01 | 0 |
| Number of employers contributing to the scheme | 2019-06-01 | 0 |
| 2018: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2018 401k membership |
|---|
| Total participants, beginning-of-year | 2018-06-01 | 11 |
| Total number of active participants reported on line 7a of the Form 5500 | 2018-06-01 | 10 |
| Total of all active and inactive participants | 2018-06-01 | 10 |
| Total participants | 2018-06-01 | 10 |
| Number of employers contributing to the scheme | 2018-06-01 | 0 |
| 2017: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2017 401k membership |
|---|
| Total participants, beginning-of-year | 2017-06-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2017-06-01 | 11 |
| Total of all active and inactive participants | 2017-06-01 | 11 |
| Total participants | 2017-06-01 | 11 |
| Number of employers contributing to the scheme | 2017-06-01 | 0 |
| 2016: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2016 401k membership |
|---|
| Total participants, beginning-of-year | 2016-06-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2016-06-01 | 13 |
| Total of all active and inactive participants | 2016-06-01 | 13 |
| Total participants | 2016-06-01 | 13 |
| Number of employers contributing to the scheme | 2016-06-01 | 0 |
| 2015: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2015 401k membership |
|---|
| Total participants, beginning-of-year | 2015-06-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2015-06-01 | 14 |
| Total of all active and inactive participants | 2015-06-01 | 14 |
| Total participants | 2015-06-01 | 0 |
| Number of employers contributing to the scheme | 2015-06-01 | 0 |
| 2014: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2014 401k membership |
|---|
| Total participants, beginning-of-year | 2014-06-01 | 0 |
| Total number of active participants reported on line 7a of the Form 5500 | 2014-06-01 | 14 |
| Total of all active and inactive participants | 2014-06-01 | 14 |
| Total participants | 2014-06-01 | 0 |
| Number of employers contributing to the scheme | 2014-06-01 | 0 |
| 2013: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2013 401k membership |
|---|
| Total participants, beginning-of-year | 2013-06-01 | 18 |
| Total number of active participants reported on line 7a of the Form 5500 | 2013-06-01 | 17 |
| Total of all active and inactive participants | 2013-06-01 | 17 |
| Total participants | 2013-06-01 | 0 |
| Number of employers contributing to the scheme | 2013-06-01 | 0 |
| 2012: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2012 401k membership |
|---|
| Total participants, beginning-of-year | 2012-06-01 | 19 |
| Total number of active participants reported on line 7a of the Form 5500 | 2012-06-01 | 18 |
| Total of all active and inactive participants | 2012-06-01 | 18 |
| Total participants | 2012-06-01 | 0 |
| 2011: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2011 401k membership |
|---|
| Total participants, beginning-of-year | 2011-06-01 | 19 |
| Total number of active participants reported on line 7a of the Form 5500 | 2011-06-01 | 19 |
| Total of all active and inactive participants | 2011-06-01 | 19 |
| Total participants | 2011-06-01 | 19 |
| 2010: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2010 401k membership |
|---|
| Total participants, beginning-of-year | 2010-06-01 | 23 |
| Total number of active participants reported on line 7a of the Form 5500 | 2010-06-01 | 19 |
| Total of all active and inactive participants | 2010-06-01 | 19 |
| Total participants | 2010-06-01 | 19 |
| 2009: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2009 401k membership |
|---|
| Total participants, beginning-of-year | 2009-06-01 | 26 |
| Total number of active participants reported on line 7a of the Form 5500 | 2009-06-01 | 23 |
| Total of all active and inactive participants | 2009-06-01 | 23 |
| Total participants | 2009-06-01 | 23 |
| Measure | Date | Value |
|---|
| 2021 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2021 401k financial data |
|---|
| Expenses. Total of all expenses incurred | 2021-05-31 | $1,429 |
| Total plan assets at end of year | 2021-05-31 | $0 |
| Total plan assets at beginning of year | 2021-05-31 | $1,429 |
| Expenses. Other expenses not covered elsewhere | 2021-05-31 | $1,429 |
| Net income (gross income less expenses) | 2021-05-31 | $-1,429 |
| Net plan assets at end of year (total assets less liabilities) | 2021-05-31 | $0 |
| Net plan assets at beginning of year (total assets less liabilities) | 2021-05-31 | $1,429 |
| 2020 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2020 401k financial data |
|---|
| Total income from all sources | 2020-05-31 | $91,253 |
| Expenses. Total of all expenses incurred | 2020-05-31 | $92,945 |
| Benefits paid (including direct rollovers) | 2020-05-31 | $89,965 |
| Total plan assets at end of year | 2020-05-31 | $1,429 |
| Total plan assets at beginning of year | 2020-05-31 | $3,121 |
| Expenses. Other expenses not covered elsewhere | 2020-05-31 | $2,980 |
| Net income (gross income less expenses) | 2020-05-31 | $-1,692 |
| Net plan assets at end of year (total assets less liabilities) | 2020-05-31 | $1,429 |
| Net plan assets at beginning of year (total assets less liabilities) | 2020-05-31 | $3,121 |
| Total contributions received or receivable from employer(s) | 2020-05-31 | $91,253 |
| 2019 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2019 401k financial data |
|---|
| Total plan liabilities at beginning of year | 2019-05-31 | $75 |
| Total income from all sources | 2019-05-31 | $77,496 |
| Expenses. Total of all expenses incurred | 2019-05-31 | $79,296 |
| Benefits paid (including direct rollovers) | 2019-05-31 | $77,496 |
| Total plan assets at end of year | 2019-05-31 | $3,121 |
| Total plan assets at beginning of year | 2019-05-31 | $4,996 |
| Expenses. Other expenses not covered elsewhere | 2019-05-31 | $1,800 |
| Net income (gross income less expenses) | 2019-05-31 | $-1,800 |
| Net plan assets at end of year (total assets less liabilities) | 2019-05-31 | $3,121 |
| Net plan assets at beginning of year (total assets less liabilities) | 2019-05-31 | $4,921 |
| Total contributions received or receivable from employer(s) | 2019-05-31 | $77,496 |
| 2018 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2018 401k financial data |
|---|
| Total plan liabilities at end of year | 2018-05-30 | $75 |
| Total plan liabilities at beginning of year | 2018-05-30 | $160 |
| Total income from all sources | 2018-05-30 | $75,561 |
| Expenses. Total of all expenses incurred | 2018-05-30 | $79,482 |
| Benefits paid (including direct rollovers) | 2018-05-30 | $68,604 |
| Total plan assets at end of year | 2018-05-30 | $4,996 |
| Total plan assets at beginning of year | 2018-05-30 | $9,002 |
| Expenses. Other expenses not covered elsewhere | 2018-05-30 | $10,878 |
| Net income (gross income less expenses) | 2018-05-30 | $-3,921 |
| Net plan assets at end of year (total assets less liabilities) | 2018-05-30 | $4,921 |
| Net plan assets at beginning of year (total assets less liabilities) | 2018-05-30 | $8,842 |
| Total contributions received or receivable from employer(s) | 2018-05-30 | $75,561 |
| 2017 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2017 401k financial data |
|---|
| Total plan liabilities at end of year | 2017-05-31 | $160 |
| Total plan liabilities at beginning of year | 2017-05-31 | $3,116 |
| Total income from all sources | 2017-05-31 | $96,332 |
| Expenses. Total of all expenses incurred | 2017-05-31 | $96,244 |
| Benefits paid (including direct rollovers) | 2017-05-31 | $85,547 |
| Total plan assets at end of year | 2017-05-31 | $9,002 |
| Total plan assets at beginning of year | 2017-05-31 | $11,870 |
| Expenses. Other expenses not covered elsewhere | 2017-05-31 | $10,697 |
| Net income (gross income less expenses) | 2017-05-31 | $88 |
| Net plan assets at end of year (total assets less liabilities) | 2017-05-31 | $8,842 |
| Net plan assets at beginning of year (total assets less liabilities) | 2017-05-31 | $8,754 |
| Total contributions received or receivable from employer(s) | 2017-05-31 | $96,332 |
| 2016 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2016 401k financial data |
|---|
| Total plan liabilities at end of year | 2016-05-31 | $3,116 |
| Total plan liabilities at beginning of year | 2016-05-31 | $3,025 |
| Total income from all sources | 2016-05-31 | $109,332 |
| Expenses. Total of all expenses incurred | 2016-05-31 | $111,949 |
| Benefits paid (including direct rollovers) | 2016-05-31 | $101,649 |
| Total plan assets at end of year | 2016-05-31 | $11,870 |
| Total plan assets at beginning of year | 2016-05-31 | $14,396 |
| Expenses. Other expenses not covered elsewhere | 2016-05-31 | $10,300 |
| Net income (gross income less expenses) | 2016-05-31 | $-2,617 |
| Net plan assets at end of year (total assets less liabilities) | 2016-05-31 | $8,754 |
| Net plan assets at beginning of year (total assets less liabilities) | 2016-05-31 | $11,371 |
| Total contributions received or receivable from employer(s) | 2016-05-31 | $109,332 |
| 2015 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2015 401k financial data |
|---|
| Total plan liabilities at end of year | 2015-05-31 | $3,025 |
| Total plan liabilities at beginning of year | 2015-05-31 | $14,575 |
| Total income from all sources | 2015-05-31 | $138,417 |
| Expenses. Total of all expenses incurred | 2015-05-31 | $141,593 |
| Benefits paid (including direct rollovers) | 2015-05-31 | $127,068 |
| Total plan assets at end of year | 2015-05-31 | $14,396 |
| Total plan assets at beginning of year | 2015-05-31 | $29,122 |
| Expenses. Other expenses not covered elsewhere | 2015-05-31 | $14,525 |
| Net income (gross income less expenses) | 2015-05-31 | $-3,176 |
| Net plan assets at end of year (total assets less liabilities) | 2015-05-31 | $11,371 |
| Net plan assets at beginning of year (total assets less liabilities) | 2015-05-31 | $14,547 |
| Total contributions received or receivable from employer(s) | 2015-05-31 | $138,417 |
| 2014 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2014 401k financial data |
|---|
| Total plan liabilities at end of year | 2014-05-31 | $14,575 |
| Total plan liabilities at beginning of year | 2014-05-31 | $14,743 |
| Total income from all sources | 2014-05-31 | $147,237 |
| Expenses. Total of all expenses incurred | 2014-05-31 | $148,603 |
| Benefits paid (including direct rollovers) | 2014-05-31 | $139,793 |
| Total plan assets at end of year | 2014-05-31 | $29,122 |
| Total plan assets at beginning of year | 2014-05-31 | $30,656 |
| Expenses. Other expenses not covered elsewhere | 2014-05-31 | $8,810 |
| Net income (gross income less expenses) | 2014-05-31 | $-1,366 |
| Net plan assets at end of year (total assets less liabilities) | 2014-05-31 | $14,547 |
| Net plan assets at beginning of year (total assets less liabilities) | 2014-05-31 | $15,913 |
| Total contributions received or receivable from employer(s) | 2014-05-31 | $147,237 |
| 2013 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2013 401k financial data |
|---|
| Total plan liabilities at end of year | 2013-05-31 | $14,743 |
| Total plan liabilities at beginning of year | 2013-05-31 | $3,050 |
| Total income from all sources | 2013-05-31 | $170,239 |
| Expenses. Total of all expenses incurred | 2013-05-31 | $172,843 |
| Benefits paid (including direct rollovers) | 2013-05-31 | $160,577 |
| Total plan assets at end of year | 2013-05-31 | $30,656 |
| Total plan assets at beginning of year | 2013-05-31 | $21,567 |
| Expenses. Other expenses not covered elsewhere | 2013-05-31 | $12,266 |
| Other income received | 2013-05-31 | $7 |
| Net income (gross income less expenses) | 2013-05-31 | $-2,604 |
| Net plan assets at end of year (total assets less liabilities) | 2013-05-31 | $15,913 |
| Net plan assets at beginning of year (total assets less liabilities) | 2013-05-31 | $18,517 |
| Total contributions received or receivable from employer(s) | 2013-05-31 | $170,232 |
| 2012 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2012 401k financial data |
|---|
| Total plan liabilities at end of year | 2012-05-31 | $3,050 |
| Total plan liabilities at beginning of year | 2012-05-31 | $75 |
| Total income from all sources | 2012-05-31 | $171,152 |
| Expenses. Total of all expenses incurred | 2012-05-31 | $173,953 |
| Benefits paid (including direct rollovers) | 2012-05-31 | $161,649 |
| Total plan assets at end of year | 2012-05-31 | $21,567 |
| Total plan assets at beginning of year | 2012-05-31 | $21,393 |
| Expenses. Other expenses not covered elsewhere | 2012-05-31 | $12,304 |
| Other income received | 2012-05-31 | $11 |
| Net income (gross income less expenses) | 2012-05-31 | $-2,801 |
| Net plan assets at end of year (total assets less liabilities) | 2012-05-31 | $18,517 |
| Net plan assets at beginning of year (total assets less liabilities) | 2012-05-31 | $21,318 |
| Total contributions received or receivable from employer(s) | 2012-05-31 | $171,141 |
| 2011 : PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2011 401k financial data |
|---|
| Total plan liabilities at end of year | 2011-05-31 | $75 |
| Total plan liabilities at beginning of year | 2011-05-31 | $78 |
| Total income from all sources | 2011-05-31 | $173,914 |
| Expenses. Total of all expenses incurred | 2011-05-31 | $241,629 |
| Benefits paid (including direct rollovers) | 2011-05-31 | $220,488 |
| Total plan assets at end of year | 2011-05-31 | $21,393 |
| Total plan assets at beginning of year | 2011-05-31 | $89,111 |
| Value of fidelity bond covering the plan | 2011-05-31 | $400,000 |
| Expenses. Other expenses not covered elsewhere | 2011-05-31 | $21,141 |
| Other income received | 2011-05-31 | $15 |
| Net income (gross income less expenses) | 2011-05-31 | $-67,715 |
| Net plan assets at end of year (total assets less liabilities) | 2011-05-31 | $21,318 |
| Net plan assets at beginning of year (total assets less liabilities) | 2011-05-31 | $89,033 |
| Total contributions received or receivable from employer(s) | 2011-05-31 | $173,899 |
| 2020: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2020 form 5500 responses |
|---|
| 2020-06-01 | Type of plan entity | Multi-employer plan |
| 2020-06-01 | This submission is the final filing | Yes |
| 2020-06-01 | Plan is a collectively bargained plan | Yes |
| 2020-06-01 | Plan funding arrangement – Insurance | Yes |
| 2020-06-01 | Plan funding arrangement – Trust | Yes |
| 2020-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2020-06-01 | Plan benefit arrangement - Trust | Yes |
| 2019: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2019 form 5500 responses |
|---|
| 2019-06-01 | Type of plan entity | Multi-employer plan |
| 2019-06-01 | Plan is a collectively bargained plan | Yes |
| 2019-06-01 | Plan funding arrangement – Insurance | Yes |
| 2019-06-01 | Plan funding arrangement – Trust | Yes |
| 2019-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2019-06-01 | Plan benefit arrangement - Trust | Yes |
| 2018: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2018 form 5500 responses |
|---|
| 2018-06-01 | Type of plan entity | Multi-employer plan |
| 2018-06-01 | Plan is a collectively bargained plan | Yes |
| 2018-06-01 | Plan funding arrangement – Insurance | Yes |
| 2018-06-01 | Plan funding arrangement – Trust | Yes |
| 2018-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2018-06-01 | Plan benefit arrangement - Trust | Yes |
| 2017: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2017 form 5500 responses |
|---|
| 2017-06-01 | Type of plan entity | Multi-employer plan |
| 2017-06-01 | Plan is a collectively bargained plan | Yes |
| 2017-06-01 | Plan funding arrangement – Insurance | Yes |
| 2017-06-01 | Plan funding arrangement – Trust | Yes |
| 2017-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2017-06-01 | Plan benefit arrangement - Trust | Yes |
| 2016: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2016 form 5500 responses |
|---|
| 2016-06-01 | Type of plan entity | Multi-employer plan |
| 2016-06-01 | Plan is a collectively bargained plan | Yes |
| 2016-06-01 | Plan funding arrangement – Insurance | Yes |
| 2016-06-01 | Plan funding arrangement – Trust | Yes |
| 2016-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2016-06-01 | Plan benefit arrangement - Trust | Yes |
| 2015: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2015 form 5500 responses |
|---|
| 2015-06-01 | Type of plan entity | Multi-employer plan |
| 2015-06-01 | Plan is a collectively bargained plan | Yes |
| 2015-06-01 | Plan funding arrangement – Insurance | Yes |
| 2015-06-01 | Plan funding arrangement – Trust | Yes |
| 2015-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2015-06-01 | Plan benefit arrangement - Trust | Yes |
| 2014: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2014 form 5500 responses |
|---|
| 2014-06-01 | Type of plan entity | Multi-employer plan |
| 2014-06-01 | Plan is a collectively bargained plan | Yes |
| 2014-06-01 | Plan funding arrangement – Insurance | Yes |
| 2014-06-01 | Plan funding arrangement – Trust | Yes |
| 2014-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2014-06-01 | Plan benefit arrangement - Trust | Yes |
| 2013: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2013 form 5500 responses |
|---|
| 2013-06-01 | Type of plan entity | Multi-employer plan |
| 2013-06-01 | Plan is a collectively bargained plan | Yes |
| 2013-06-01 | Plan funding arrangement – Insurance | Yes |
| 2013-06-01 | Plan funding arrangement – Trust | Yes |
| 2013-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2013-06-01 | Plan benefit arrangement - Trust | Yes |
| 2012: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2012 form 5500 responses |
|---|
| 2012-06-01 | Type of plan entity | Multi-employer plan |
| 2012-06-01 | Plan is a collectively bargained plan | Yes |
| 2012-06-01 | Plan funding arrangement – Trust | Yes |
| 2012-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2012-06-01 | Plan benefit arrangement - Trust | Yes |
| 2011: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2011 form 5500 responses |
|---|
| 2011-06-01 | Type of plan entity | Multi-employer plan |
| 2011-06-01 | Plan is a collectively bargained plan | Yes |
| 2011-06-01 | Plan funding arrangement – Trust | Yes |
| 2011-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2011-06-01 | Plan benefit arrangement - Trust | Yes |
| 2010: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2010 form 5500 responses |
|---|
| 2010-06-01 | Type of plan entity | Multi-employer plan |
| 2010-06-01 | Plan is a collectively bargained plan | Yes |
| 2010-06-01 | Plan funding arrangement – Trust | Yes |
| 2010-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2010-06-01 | Plan benefit arrangement - Trust | Yes |
| 2009: PRINTING INDUSTRIES MOUNTAIN STATES INSURANCE TRUS 2009 form 5500 responses |
|---|
| 2009-06-01 | Type of plan entity | Multi-employer plan |
| 2009-06-01 | Plan is a collectively bargained plan | Yes |
| 2009-06-01 | Plan funding arrangement – Trust | Yes |
| 2009-06-01 | Plan benefit arrangement – Insurance | Yes |
| 2009-06-01 | Plan benefit arrangement - Trust | Yes |
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 1 |
| Insurance contract or identification number | 160 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2020-02-01 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 3 |
| Insurance contract or identification number | 695203 | | Insurance policy start date | 2020-06-01 | | Insurance policy end date | 2020-06-30 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Insurance policy start date | 2020-02-01 | | Insurance policy end date | 2020-02-01 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 3 |
| Insurance contract or identification number | 695203 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2019-06-01 | | Insurance policy end date | 2020-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 1 |
| Insurance contract or identification number | 160 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2019-02-01 | | Insurance policy end date | 2020-01-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 1 |
| Insurance contract or identification number | 160 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $68,774 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2018-02-01 | | Insurance policy end date | 2019-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,096 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 3 |
| Insurance contract or identification number | 695203 | | Number of Individuals Covered | 10 | | Insurance policy start date | 2018-06-01 | | Insurance policy end date | 2019-05-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,626 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 1 |
| Insurance contract or identification number | 160 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $59,359 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2017-02-01 | | Insurance policy end date | 2018-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,349 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 3 |
| Insurance contract or identification number | 695203 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2017-06-01 | | Insurance policy end date | 2018-05-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,897 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 3 |
| Insurance contract or identification number | 695203 | | Insurance policy start date | 2015-06-01 | | Insurance policy end date | 2016-05-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,018 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $2,631 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 1 |
| Insurance contract or identification number | 160 | | Insurance policy start date | 2015-02-01 | | Insurance policy end date | 2016-01-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $90,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 3 |
| Insurance contract or identification number | 695203 | | Insurance policy start date | 2014-06-01 | | Insurance policy end date | 2015-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 1 |
| Insurance contract or identification number | 160 | | Insurance policy start date | 2014-02-01 | | Insurance policy end date | 2015-01-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 3 |
| Insurance contract or identification number | 695203 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2013-06-01 | | Insurance policy end date | 2014-05-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,376 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,398 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 1 |
| Insurance contract or identification number | 160 | | Number of Individuals Covered | 17 | | Insurance policy start date | 2013-02-01 | | Insurance policy end date | 2014-01-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $126,018 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 1 |
| Insurance contract or identification number | 695203 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2013-05-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 3 |
| Insurance contract or identification number | 160 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2012-02-01 | | Insurance policy end date | 2013-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 3 |
| Insurance contract or identification number | 160 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $149,600 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Insurance policy start date | 2011-02-01 | | Insurance policy end date | 2012-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,005 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 1 |
| Insurance contract or identification number | 695203 | | Insurance policy start date | 2011-06-01 | | Insurance policy end date | 2012-05-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,857 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER PERMANENTE (National Association of Insurance Commissioners NAIC id number: 95669 ) |
| Policy contract number | 160 |
| Policy instance | 3 |
| Insurance contract or identification number | 160 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $164,132 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HARTFORD LIFE (National Association of Insurance Commissioners NAIC id number: 68608 ) |
| Policy contract number | 01-013724-00 |
| Policy instance | 2 |
| Insurance contract or identification number | 01-013724-00 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2010-02-01 | | Insurance policy end date | 2011-01-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $3,644 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL (National Association of Insurance Commissioners NAIC id number: 11011 ) |
| Policy contract number | 695203 |
| Policy instance | 1 |
| Insurance contract or identification number | 695203 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2010-06-01 | | Insurance policy end date | 2011-05-31 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $8,420 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
