401k Plan data: NIELSONS, INC. HEALTH AND WELFARE TRUST plan

NIELSONS, INC. HEALTH AND WELFARE TRUST 401k Plan overview

Plan Name	NIELSONS, INC. HEALTH AND WELFARE TRUST
Plan identification number	501

NIELSONS, INC. HEALTH AND WELFARE TRUST Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Health (other than dental or vision) Life insurance Dental Vision Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

NIELSONS, INC. has sponsored the creation of one or more 401k plans.

Company Name: NIELSONS, INC.

Employer identification number (EIN): 840809283

NAIC Classification: 238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NIELSONS, INC. HEALTH AND WELFARE TRUST

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
501 2019-01-01 MIKE APARICIO 2020-05-19
501 2018-01-01
501 2017-01-01 BRIAN STIERITZ
501 2016-01-01 BRIAN STIERITZ
501 2015-01-01
501 2014-01-01 DAVID SITTON
501 2013-01-01 DAVID SITTON
501 2012-01-01 DAVID SITTON
501 2011-01-01 DAVID SITTON
501 2010-01-01 DAVID SITTON
501 2009-01-01 DAVID SITTON
501 2009-01-01 DAVID SITTON
501 2008-01-01 DAVID SITTON 2010-10-15
501 2007-01-01 DAVID SITTON 2010-10-15
501 2006-01-01 DAVID SITTON 2010-10-15

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed	Name of Company Sponsor	Date Sponsor Signed
501	2019-01-01	MIKE APARICIO	2020-05-19
501	2018-01-01
501	2017-01-01	BRIAN STIERITZ
501	2016-01-01	BRIAN STIERITZ
501	2015-01-01
501	2014-01-01	DAVID SITTON
501	2013-01-01	DAVID SITTON
501	2012-01-01	DAVID SITTON
501	2011-01-01	DAVID SITTON
501	2010-01-01	DAVID SITTON
501	2009-01-01	DAVID SITTON
501	2009-01-01	DAVID SITTON
501	2008-01-01			DAVID SITTON	2010-10-15
501	2007-01-01			DAVID SITTON	2010-10-15
501	2006-01-01			DAVID SITTON	2010-10-15

Plan Statistics for NIELSONS, INC. HEALTH AND WELFARE TRUST

401k plan membership statisitcs for NIELSONS, INC. HEALTH AND WELFARE TRUST

Measure Date Value
2018: NIELSONS, INC. HEALTH AND WELFARE TRUST 2018 401k membership
Total participants, beginning-of-year 2018-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2018-01-01 0
Number of retired or separated participants receiving benefits 2018-01-01 0
Number of other retired or separated participants entitled to future benefits 2018-01-01 0
Total of all active and inactive participants 2018-01-01 0
2017: NIELSONS, INC. HEALTH AND WELFARE TRUST 2017 401k membership
Total participants, beginning-of-year 2017-01-01 0
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
2016: NIELSONS, INC. HEALTH AND WELFARE TRUST 2016 401k membership
Total participants, beginning-of-year 2016-01-01 85
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 0
Number of retired or separated participants receiving benefits 2016-01-01 0
Number of other retired or separated participants entitled to future benefits 2016-01-01 0
Total of all active and inactive participants 2016-01-01 0
2015: NIELSONS, INC. HEALTH AND WELFARE TRUST 2015 401k membership
Total participants, beginning-of-year 2015-01-01 132
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 84
Number of retired or separated participants receiving benefits 2015-01-01 1
Number of other retired or separated participants entitled to future benefits 2015-01-01 0
Total of all active and inactive participants 2015-01-01 85
2014: NIELSONS, INC. HEALTH AND WELFARE TRUST 2014 401k membership
Total participants, beginning-of-year 2014-01-01 80
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 130
Number of retired or separated participants receiving benefits 2014-01-01 2
Number of other retired or separated participants entitled to future benefits 2014-01-01 0
Total of all active and inactive participants 2014-01-01 132
2013: NIELSONS, INC. HEALTH AND WELFARE TRUST 2013 401k membership
Total participants, beginning-of-year 2013-01-01 106
Total number of active participants reported on line 7a of the Form 5500 2013-01-01 76
Total of all active and inactive participants 2013-01-01 76
Total participants 2013-01-01 0
2012: NIELSONS, INC. HEALTH AND WELFARE TRUST 2012 401k membership
Total participants, beginning-of-year 2012-01-01 209
Total number of active participants reported on line 7a of the Form 5500 2012-01-01 106
Total of all active and inactive participants 2012-01-01 106
Total participants 2012-01-01 0
2011: NIELSONS, INC. HEALTH AND WELFARE TRUST 2011 401k membership
Total participants, beginning-of-year 2011-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2011-01-01 209
Total of all active and inactive participants 2011-01-01 209
Total participants 2011-01-01 209
2010: NIELSONS, INC. HEALTH AND WELFARE TRUST 2010 401k membership
Total participants, beginning-of-year 2010-01-01 102
Total number of active participants reported on line 7a of the Form 5500 2010-01-01 91
Total of all active and inactive participants 2010-01-01 91
Total participants 2010-01-01 91
2009: NIELSONS, INC. HEALTH AND WELFARE TRUST 2009 401k membership
Total participants, beginning-of-year 2009-01-01 160
Total number of active participants reported on line 7a of the Form 5500 2009-01-01 102
Total of all active and inactive participants 2009-01-01 102
Total participants 2009-01-01 102
2008: NIELSONS, INC. HEALTH AND WELFARE TRUST 2008 401k membership
Total participants, beginning-of-year 2008-01-01 204
Total number of active participants reported on line 7a of the Form 5500 2008-01-01 160
Total of all active and inactive participants 2008-01-01 160
Total participants 2008-01-01 160
2007: NIELSONS, INC. HEALTH AND WELFARE TRUST 2007 401k membership
Total participants, beginning-of-year 2007-01-01 163
Total number of active participants reported on line 7a of the Form 5500 2007-01-01 204
Total of all active and inactive participants 2007-01-01 204
Total participants 2007-01-01 204
2006: NIELSONS, INC. HEALTH AND WELFARE TRUST 2006 401k membership
Total participants, beginning-of-year 2006-01-01 91
Total number of active participants reported on line 7a of the Form 5500 2006-01-01 163
Total of all active and inactive participants 2006-01-01 163
Total participants 2006-01-01 163

Measure	Date	Value
2018: NIELSONS, INC. HEALTH AND WELFARE TRUST 2018 401k membership
Total participants, beginning-of-year	2018-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2018-01-01	0
Number of retired or separated participants receiving benefits	2018-01-01	0
Number of other retired or separated participants entitled to future benefits	2018-01-01	0
Total of all active and inactive participants	2018-01-01	0
2017: NIELSONS, INC. HEALTH AND WELFARE TRUST 2017 401k membership
Total participants, beginning-of-year	2017-01-01	0
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
2016: NIELSONS, INC. HEALTH AND WELFARE TRUST 2016 401k membership
Total participants, beginning-of-year	2016-01-01	85
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	0
Number of retired or separated participants receiving benefits	2016-01-01	0
Number of other retired or separated participants entitled to future benefits	2016-01-01	0
Total of all active and inactive participants	2016-01-01	0
2015: NIELSONS, INC. HEALTH AND WELFARE TRUST 2015 401k membership
Total participants, beginning-of-year	2015-01-01	132
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	84
Number of retired or separated participants receiving benefits	2015-01-01	1
Number of other retired or separated participants entitled to future benefits	2015-01-01	0
Total of all active and inactive participants	2015-01-01	85
2014: NIELSONS, INC. HEALTH AND WELFARE TRUST 2014 401k membership
Total participants, beginning-of-year	2014-01-01	80
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	130
Number of retired or separated participants receiving benefits	2014-01-01	2
Number of other retired or separated participants entitled to future benefits	2014-01-01	0
Total of all active and inactive participants	2014-01-01	132
2013: NIELSONS, INC. HEALTH AND WELFARE TRUST 2013 401k membership
Total participants, beginning-of-year	2013-01-01	106
Total number of active participants reported on line 7a of the Form 5500	2013-01-01	76
Total of all active and inactive participants	2013-01-01	76
Total participants	2013-01-01	0
2012: NIELSONS, INC. HEALTH AND WELFARE TRUST 2012 401k membership
Total participants, beginning-of-year	2012-01-01	209
Total number of active participants reported on line 7a of the Form 5500	2012-01-01	106
Total of all active and inactive participants	2012-01-01	106
Total participants	2012-01-01	0
2011: NIELSONS, INC. HEALTH AND WELFARE TRUST 2011 401k membership
Total participants, beginning-of-year	2011-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2011-01-01	209
Total of all active and inactive participants	2011-01-01	209
Total participants	2011-01-01	209
2010: NIELSONS, INC. HEALTH AND WELFARE TRUST 2010 401k membership
Total participants, beginning-of-year	2010-01-01	102
Total number of active participants reported on line 7a of the Form 5500	2010-01-01	91
Total of all active and inactive participants	2010-01-01	91
Total participants	2010-01-01	91
2009: NIELSONS, INC. HEALTH AND WELFARE TRUST 2009 401k membership
Total participants, beginning-of-year	2009-01-01	160
Total number of active participants reported on line 7a of the Form 5500	2009-01-01	102
Total of all active and inactive participants	2009-01-01	102
Total participants	2009-01-01	102
2008: NIELSONS, INC. HEALTH AND WELFARE TRUST 2008 401k membership
Total participants, beginning-of-year	2008-01-01	204
Total number of active participants reported on line 7a of the Form 5500	2008-01-01	160
Total of all active and inactive participants	2008-01-01	160
Total participants	2008-01-01	160
2007: NIELSONS, INC. HEALTH AND WELFARE TRUST 2007 401k membership
Total participants, beginning-of-year	2007-01-01	163
Total number of active participants reported on line 7a of the Form 5500	2007-01-01	204
Total of all active and inactive participants	2007-01-01	204
Total participants	2007-01-01	204
2006: NIELSONS, INC. HEALTH AND WELFARE TRUST 2006 401k membership
Total participants, beginning-of-year	2006-01-01	91
Total number of active participants reported on line 7a of the Form 5500	2006-01-01	163
Total of all active and inactive participants	2006-01-01	163
Total participants	2006-01-01	163

Financial Data on NIELSONS, INC. HEALTH AND WELFARE TRUST

Measure	Date	Value
2018 : NIELSONS, INC. HEALTH AND WELFARE TRUST 2018 401k financial data
Total unrealized appreciation/depreciation of assets	2018-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2018-12-31	$2,457
Total income from all sources (including contributions)	2018-12-31	$37,908
Total loss/gain on sale of assets	2018-12-31	$0
Total of all expenses incurred	2018-12-31	$28,252
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-12-31	$0
Value of total assets at end of year	2018-12-31	$1,799,366
Value of total assets at beginning of year	2018-12-31	$1,792,167
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-12-31	$28,252
Total interest from all sources	2018-12-31	$11,867
Total dividends received (eg from common stock, registered investment company shares)	2018-12-31	$18,845
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-12-31	Yes
Total dividends received from registered investment company shares (eg mutual funds)	2018-12-31	$18,845
Administrative expenses professional fees incurred	2018-12-31	$20,863
Was this plan covered by a fidelity bond	2018-12-31	Yes
Value of fidelity bond cover	2018-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2018-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2018-12-31	No
Administrative expenses (other) incurred	2018-12-31	$84
Liabilities. Value of operating payables at end of year	2018-12-31	$0
Liabilities. Value of operating payables at beginning of year	2018-12-31	$2,457
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Value of net income/loss	2018-12-31	$9,656
Value of net assets at end of year (total assets less liabilities)	2018-12-31	$1,799,366
Value of net assets at beginning of year (total assets less liabilities)	2018-12-31	$1,789,710
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-12-31	No
Were any leases to which the plan was party in default or uncollectible	2018-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2018-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2018-12-31	$1,411,314
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2018-12-31	$1,799,366
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2018-12-31	$380,853
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2018-12-31	$380,853
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2018-12-31	$11,867
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2018-12-31	$7,196
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-12-31	Yes
Was there a failure to transmit to the plan any participant contributions	2018-12-31	No
Has the plan failed to provide any benefit when due under the plan	2018-12-31	No
Contract administrator fees	2018-12-31	$7,305
Did the plan have assets held for investment	2018-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-12-31	No
Opinion of an independent qualified public accountant for this plan	2018-12-31	Unqualified
Accountancy firm name	2018-12-31	RUBINBROWN LLP
Accountancy firm EIN	2018-12-31	430765316
2017 : NIELSONS, INC. HEALTH AND WELFARE TRUST 2017 401k financial data
Total unrealized appreciation/depreciation of assets	2017-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$2,457
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2017-12-31	$2,457
Total income from all sources (including contributions)	2017-12-31	$163,705
Total loss/gain on sale of assets	2017-12-31	$0
Total of all expenses incurred	2017-12-31	$26,748
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-12-31	$0
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-12-31	$0
Value of total assets at end of year	2017-12-31	$1,792,167
Value of total assets at beginning of year	2017-12-31	$1,655,210
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-12-31	$26,748
Total interest from all sources	2017-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2017-12-31	$35,192
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-12-31	Yes
Total dividends received from registered investment company shares (eg mutual funds)	2017-12-31	$35,192
Administrative expenses professional fees incurred	2017-12-31	$18,400
Was this plan covered by a fidelity bond	2017-12-31	Yes
Value of fidelity bond cover	2017-12-31	$1,000,000
If this is an individual account plan, was there a blackout period	2017-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2017-12-31	No
Administrative expenses (other) incurred	2017-12-31	$58
Liabilities. Value of operating payables at end of year	2017-12-31	$2,457
Liabilities. Value of operating payables at beginning of year	2017-12-31	$2,457
Total non interest bearing cash at end of year	2017-12-31	$0
Total non interest bearing cash at beginning of year	2017-12-31	$1,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Value of net income/loss	2017-12-31	$136,957
Value of net assets at end of year (total assets less liabilities)	2017-12-31	$1,789,710
Value of net assets at beginning of year (total assets less liabilities)	2017-12-31	$1,652,753
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-12-31	No
Were any leases to which the plan was party in default or uncollectible	2017-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2017-12-31	$1,411,314
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2017-12-31	$1,270,323
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2017-12-31	$380,853
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2017-12-31	$334,603
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2017-12-31	$334,603
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2017-12-31	$128,513
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-12-31	No
Was there a failure to transmit to the plan any participant contributions	2017-12-31	No
Has the plan failed to provide any benefit when due under the plan	2017-12-31	No
Employer contributions (assets) at end of year	2017-12-31	$0
Employer contributions (assets) at beginning of year	2017-12-31	$49,284
Contract administrator fees	2017-12-31	$8,290
Did the plan have assets held for investment	2017-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-12-31	No
Opinion of an independent qualified public accountant for this plan	2017-12-31	Unqualified
Accountancy firm name	2017-12-31	RUBINBROWN LLP
Accountancy firm EIN	2017-12-31	430765316
2016 : NIELSONS, INC. HEALTH AND WELFARE TRUST 2016 401k financial data
Total unrealized appreciation/depreciation of assets	2016-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$2,457
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2016-12-31	$66,171
Total income from all sources (including contributions)	2016-12-31	$59,056
Total loss/gain on sale of assets	2016-12-31	$0
Total of all expenses incurred	2016-12-31	$69,124
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-12-31	$19,906
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-12-31	$1,187
Value of total assets at end of year	2016-12-31	$1,655,210
Value of total assets at beginning of year	2016-12-31	$1,728,992
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-12-31	$49,218
Total interest from all sources	2016-12-31	$0
Total dividends received (eg from common stock, registered investment company shares)	2016-12-31	$37,233
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-12-31	Yes
Total dividends received from registered investment company shares (eg mutual funds)	2016-12-31	$37,233
Administrative expenses professional fees incurred	2016-12-31	$31,218
Was this plan covered by a fidelity bond	2016-12-31	Yes
Value of fidelity bond cover	2016-12-31	$500,000
If this is an individual account plan, was there a blackout period	2016-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2016-12-31	No
Contributions received from participants	2016-12-31	$1,187
Participant contributions at end of year	2016-12-31	$0
Participant contributions at beginning of year	2016-12-31	$6,086
Liabilities. Value of operating payables at end of year	2016-12-31	$2,457
Liabilities. Value of operating payables at beginning of year	2016-12-31	$2,866
Total non interest bearing cash at end of year	2016-12-31	$1,000
Total non interest bearing cash at beginning of year	2016-12-31	$22,684
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Value of net income/loss	2016-12-31	$-10,068
Value of net assets at end of year (total assets less liabilities)	2016-12-31	$1,652,753
Value of net assets at beginning of year (total assets less liabilities)	2016-12-31	$1,662,821
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-12-31	No
Were any leases to which the plan was party in default or uncollectible	2016-12-31	No
Value of interest in registered invesment companies (eg mutual funds) at end of year	2016-12-31	$1,270,323
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2016-12-31	$1,249,687
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2016-12-31	$334,603
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2016-12-31	$343,724
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2016-12-31	$343,724
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2016-12-31	$20,636
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-12-31	No
Was there a failure to transmit to the plan any participant contributions	2016-12-31	No
Has the plan failed to provide any benefit when due under the plan	2016-12-31	No
Employer contributions (assets) at end of year	2016-12-31	$49,284
Employer contributions (assets) at beginning of year	2016-12-31	$106,811
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2016-12-31	$19,906
Contract administrator fees	2016-12-31	$18,000
Liabilities. Value of benefit claims payable at end of year	2016-12-31	$0
Liabilities. Value of benefit claims payable at beginning of year	2016-12-31	$63,305
Did the plan have assets held for investment	2016-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-12-31	No
Opinion of an independent qualified public accountant for this plan	2016-12-31	Unqualified
Accountancy firm name	2016-12-31	RUBINBROWN LLP
Accountancy firm EIN	2016-12-31	430765316
2015 : NIELSONS, INC. HEALTH AND WELFARE TRUST 2015 401k financial data
Total unrealized appreciation/depreciation of assets	2015-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$66,171
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2015-12-31	$94,592
Total income from all sources (including contributions)	2015-12-31	$365,731
Total loss/gain on sale of assets	2015-12-31	$0
Total of all expenses incurred	2015-12-31	$566,832
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-12-31	$437,641
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-12-31	$396,961
Value of total assets at end of year	2015-12-31	$1,728,992
Value of total assets at beginning of year	2015-12-31	$1,958,514
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-12-31	$129,191
Total interest from all sources	2015-12-31	$110
Total dividends received (eg from common stock, registered investment company shares)	2015-12-31	$24,427
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-12-31	Yes
Total dividends received from registered investment company shares (eg mutual funds)	2015-12-31	$24,427
Administrative expenses professional fees incurred	2015-12-31	$21,460
Was this plan covered by a fidelity bond	2015-12-31	Yes
Value of fidelity bond cover	2015-12-31	$500,000
If this is an individual account plan, was there a blackout period	2015-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2015-12-31	No
Contributions received from participants	2015-12-31	$140,349
Participant contributions at end of year	2015-12-31	$6,086
Participant contributions at beginning of year	2015-12-31	$10,640
Administrative expenses (other) incurred	2015-12-31	$312
Liabilities. Value of operating payables at end of year	2015-12-31	$2,866
Liabilities. Value of operating payables at beginning of year	2015-12-31	$67,993
Total non interest bearing cash at end of year	2015-12-31	$22,684
Total non interest bearing cash at beginning of year	2015-12-31	$64,621
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Value of net income/loss	2015-12-31	$-201,101
Value of net assets at end of year (total assets less liabilities)	2015-12-31	$1,662,821
Value of net assets at beginning of year (total assets less liabilities)	2015-12-31	$1,863,922
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-12-31	No
Were any leases to which the plan was party in default or uncollectible	2015-12-31	No
Investment advisory and management fees	2015-12-31	$0
Value of interest in registered invesment companies (eg mutual funds) at end of year	2015-12-31	$1,249,687
Value of interest in registered invesment companies (eg mutual funds) at beginning of year	2015-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2015-12-31	$343,724
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2015-12-31	$1,863,925
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2015-12-31	$1,863,925
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2015-12-31	$110
Net investment gain/loss from registered investment companies (e.g. mutual funds)	2015-12-31	$-55,767
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-12-31	No
Was there a failure to transmit to the plan any participant contributions	2015-12-31	No
Has the plan failed to provide any benefit when due under the plan	2015-12-31	No
Contributions received in cash from employer	2015-12-31	$256,612
Employer contributions (assets) at end of year	2015-12-31	$106,811
Employer contributions (assets) at beginning of year	2015-12-31	$19,328
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-12-31	$437,641
Contract administrator fees	2015-12-31	$107,419
Liabilities. Value of benefit claims payable at end of year	2015-12-31	$63,305
Liabilities. Value of benefit claims payable at beginning of year	2015-12-31	$26,599
Did the plan have assets held for investment	2015-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-12-31	No
Opinion of an independent qualified public accountant for this plan	2015-12-31	Unqualified
Accountancy firm name	2015-12-31	RUBINBROWN LLP
Accountancy firm EIN	2015-12-31	430765316
2014 : NIELSONS, INC. HEALTH AND WELFARE TRUST 2014 401k financial data
Total unrealized appreciation/depreciation of assets	2014-12-31	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$94,592
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2014-12-31	$19,798
Total income from all sources (including contributions)	2014-12-31	$434,789
Total loss/gain on sale of assets	2014-12-31	$0
Total of all expenses incurred	2014-12-31	$608,758
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-12-31	$455,769
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-12-31	$434,600
Value of total assets at end of year	2014-12-31	$1,958,514
Value of total assets at beginning of year	2014-12-31	$2,057,689
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-12-31	$152,989
Total interest from all sources	2014-12-31	$189
Total dividends received (eg from common stock, registered investment company shares)	2014-12-31	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-12-31	No
Administrative expenses professional fees incurred	2014-12-31	$84,939
Was this plan covered by a fidelity bond	2014-12-31	Yes
Value of fidelity bond cover	2014-12-31	$500,000
If this is an individual account plan, was there a blackout period	2014-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2014-12-31	No
Contributions received from participants	2014-12-31	$123,842
Participant contributions at end of year	2014-12-31	$10,640
Participant contributions at beginning of year	2014-12-31	$5,906
Administrative expenses (other) incurred	2014-12-31	$283
Liabilities. Value of operating payables at end of year	2014-12-31	$67,993
Liabilities. Value of operating payables at beginning of year	2014-12-31	$16,492
Total non interest bearing cash at end of year	2014-12-31	$64,621
Total non interest bearing cash at beginning of year	2014-12-31	$96,514
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Value of net income/loss	2014-12-31	$-173,969
Value of net assets at end of year (total assets less liabilities)	2014-12-31	$1,863,922
Value of net assets at beginning of year (total assets less liabilities)	2014-12-31	$2,037,891
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-12-31	No
Were any leases to which the plan was party in default or uncollectible	2014-12-31	No
Value of interest in common/collective trusts at end of year	2014-12-31	$0
Value of interest in common/collective trusts at beginning of year	2014-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2014-12-31	$1,863,925
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2014-12-31	$1,933,362
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2014-12-31	$1,933,362
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2014-12-31	$189
Expenses. Payments to insurance carriers foe the provision of benefits	2014-12-31	$47,368
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-12-31	No
Was there a failure to transmit to the plan any participant contributions	2014-12-31	No
Has the plan failed to provide any benefit when due under the plan	2014-12-31	No
Contributions received in cash from employer	2014-12-31	$310,758
Employer contributions (assets) at end of year	2014-12-31	$19,328
Employer contributions (assets) at beginning of year	2014-12-31	$21,907
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-12-31	$408,401
Contract administrator fees	2014-12-31	$67,767
Liabilities. Value of benefit claims payable at end of year	2014-12-31	$26,599
Liabilities. Value of benefit claims payable at beginning of year	2014-12-31	$3,306
Did the plan have assets held for investment	2014-12-31	No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-12-31	No
Opinion of an independent qualified public accountant for this plan	2014-12-31	Unqualified
Accountancy firm name	2014-12-31	RUBINBROWN LLP
Accountancy firm EIN	2014-12-31	430765316
2013 : NIELSONS, INC. HEALTH AND WELFARE TRUST 2013 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$19,798
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-12-31	$8,045
Total income from all sources (including contributions)	2013-12-31	$436,420
Total of all expenses incurred	2013-12-31	$470,079
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-12-31	$414,147
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-12-31	$436,227
Value of total assets at end of year	2013-12-31	$2,057,689
Value of total assets at beginning of year	2013-12-31	$2,079,595
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-12-31	$55,932
Total interest from all sources	2013-12-31	$193
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-12-31	No
Administrative expenses professional fees incurred	2013-12-31	$37,778
Was this plan covered by a fidelity bond	2013-12-31	Yes
Value of fidelity bond cover	2013-12-31	$500,000
If this is an individual account plan, was there a blackout period	2013-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2013-12-31	No
Contributions received from participants	2013-12-31	$120,227
Participant contributions at end of year	2013-12-31	$5,906
Participant contributions at beginning of year	2013-12-31	$11,645
Administrative expenses (other) incurred	2013-12-31	$154
Liabilities. Value of operating payables at end of year	2013-12-31	$16,492
Total non interest bearing cash at end of year	2013-12-31	$96,514
Total non interest bearing cash at beginning of year	2013-12-31	$90,312
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Value of net income/loss	2013-12-31	$-33,659
Value of net assets at end of year (total assets less liabilities)	2013-12-31	$2,037,891
Value of net assets at beginning of year (total assets less liabilities)	2013-12-31	$2,071,550
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-12-31	No
Were any leases to which the plan was party in default or uncollectible	2013-12-31	No
Value of interest in common/collective trusts at end of year	2013-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2013-12-31	$1,933,362
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2013-12-31	$1,952,022
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2013-12-31	$1,952,022
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2013-12-31	$193
Expenses. Payments to insurance carriers foe the provision of benefits	2013-12-31	$414,147
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-12-31	No
Was there a failure to transmit to the plan any participant contributions	2013-12-31	Yes
Has the plan failed to provide any benefit when due under the plan	2013-12-31	No
Contributions received in cash from employer	2013-12-31	$316,000
Employer contributions (assets) at end of year	2013-12-31	$21,907
Employer contributions (assets) at beginning of year	2013-12-31	$25,616
Contract administrator fees	2013-12-31	$18,000
Liabilities. Value of benefit claims payable at end of year	2013-12-31	$3,306
Liabilities. Value of benefit claims payable at beginning of year	2013-12-31	$8,045
Did the plan have assets held for investment	2013-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-12-31	No
Opinion of an independent qualified public accountant for this plan	2013-12-31	Unqualified
Accountancy firm name	2013-12-31	FREDRICKZINK & ASSOCIATES, PC
Accountancy firm EIN	2013-12-31	841073179
2012 : NIELSONS, INC. HEALTH AND WELFARE TRUST 2012 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$8,045
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2012-12-31	$15,353
Total income from all sources (including contributions)	2012-12-31	$747,796
Total of all expenses incurred	2012-12-31	$629,321
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2012-12-31	$594,815
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2012-12-31	$747,601
Value of total assets at end of year	2012-12-31	$2,079,595
Value of total assets at beginning of year	2012-12-31	$1,968,428
Total of administrative expenses incurred including professional, contract, advisory and management fees	2012-12-31	$34,506
Total interest from all sources	2012-12-31	$195
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2012-12-31	No
Administrative expenses professional fees incurred	2012-12-31	$16,484
Was this plan covered by a fidelity bond	2012-12-31	No
Were there any nonexempt tranactions with any party-in-interest	2012-12-31	No
Contributions received from participants	2012-12-31	$133,726
Participant contributions at end of year	2012-12-31	$11,645
Participant contributions at beginning of year	2012-12-31	$17,977
Administrative expenses (other) incurred	2012-12-31	$22
Total non interest bearing cash at end of year	2012-12-31	$90,312
Total non interest bearing cash at beginning of year	2012-12-31	$46,080
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Value of net income/loss	2012-12-31	$118,475
Value of net assets at end of year (total assets less liabilities)	2012-12-31	$2,071,550
Value of net assets at beginning of year (total assets less liabilities)	2012-12-31	$1,953,075
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2012-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2012-12-31	No
Were any leases to which the plan was party in default or uncollectible	2012-12-31	No
Value of interest in common/collective trusts at end of year	2012-12-31	$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2012-12-31	$1,952,022
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2012-12-31	$1,716,861
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2012-12-31	$1,716,861
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2012-12-31	$195
Expenses. Payments to insurance carriers foe the provision of benefits	2012-12-31	$594,815
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2012-12-31	No
Was there a failure to transmit to the plan any participant contributions	2012-12-31	No
Has the plan failed to provide any benefit when due under the plan	2012-12-31	No
Contributions received in cash from employer	2012-12-31	$613,875
Employer contributions (assets) at end of year	2012-12-31	$25,616
Employer contributions (assets) at beginning of year	2012-12-31	$187,510
Contract administrator fees	2012-12-31	$18,000
Liabilities. Value of benefit claims payable at end of year	2012-12-31	$8,045
Liabilities. Value of benefit claims payable at beginning of year	2012-12-31	$15,353
Did the plan have assets held for investment	2012-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2012-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2012-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2012-12-31	No
Opinion of an independent qualified public accountant for this plan	2012-12-31	Unqualified
Accountancy firm name	2012-12-31	FREDRICKZINK & ASSOCIATES, PC
Accountancy firm EIN	2012-12-31	841073179
2011 : NIELSONS, INC. HEALTH AND WELFARE TRUST 2011 401k financial data
Total plan liabilities at end of year	2011-12-31	$15,353
Total plan liabilities at beginning of year	2011-12-31	$14,226
Total income from all sources	2011-12-31	$1,863,725
Expenses. Total of all expenses incurred	2011-12-31	$365,030
Benefits paid (including direct rollovers)	2011-12-31	$327,338
Total plan assets at end of year	2011-12-31	$1,968,428
Total plan assets at beginning of year	2011-12-31	$468,606
Total contributions received or receivable from participants	2011-12-31	$110,112
Expenses. Other expenses not covered elsewhere	2011-12-31	$37,692
Other income received	2011-12-31	$103
Net income (gross income less expenses)	2011-12-31	$1,498,695
Net plan assets at end of year (total assets less liabilities)	2011-12-31	$1,953,075
Net plan assets at beginning of year (total assets less liabilities)	2011-12-31	$454,380
Total contributions received or receivable from employer(s)	2011-12-31	$1,753,510
2010 : NIELSONS, INC. HEALTH AND WELFARE TRUST 2010 401k financial data
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$14,226
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2010-12-31	$284,852
Total income from all sources (including contributions)	2010-12-31	$900,994
Total of all expenses incurred	2010-12-31	$227,858
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2010-12-31	$175,525
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2010-12-31	$900,971
Value of total assets at end of year	2010-12-31	$468,606
Value of total assets at beginning of year	2010-12-31	$66,096
Total of administrative expenses incurred including professional, contract, advisory and management fees	2010-12-31	$52,333
Total interest from all sources	2010-12-31	$23
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2010-12-31	No
Administrative expenses professional fees incurred	2010-12-31	$34,317
Was this plan covered by a fidelity bond	2010-12-31	Yes
Value of fidelity bond cover	2010-12-31	$500,000
Were there any nonexempt tranactions with any party-in-interest	2010-12-31	No
Contributions received from participants	2010-12-31	$58,704
Participant contributions at end of year	2010-12-31	$5,101
Value of other receiveables (less allowance for doubtful accounts) at end of year	2010-12-31	$15,403
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year	2010-12-31	$284,852
Administrative expenses (other) incurred	2010-12-31	$16
Liabilities. Value of operating payables at end of year	2010-12-31	$9,000
Total non interest bearing cash at end of year	2010-12-31	$35,573
Total non interest bearing cash at beginning of year	2010-12-31	$1,319
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Value of net income/loss	2010-12-31	$673,136
Value of net assets at end of year (total assets less liabilities)	2010-12-31	$454,380
Value of net assets at beginning of year (total assets less liabilities)	2010-12-31	$-218,756
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2010-12-31	No
Were any loans by the plan or fixed income obligations due to the plan in default	2010-12-31	No
Were any leases to which the plan was party in default or uncollectible	2010-12-31	No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year	2010-12-31	$364,333
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year	2010-12-31	$64,777
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year	2010-12-31	$64,777
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)	2010-12-31	$23
Expenses. Payments to insurance carriers foe the provision of benefits	2010-12-31	$175,525
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2010-12-31	No
Was there a failure to transmit to the plan any participant contributions	2010-12-31	No
Has the plan failed to provide any benefit when due under the plan	2010-12-31	No
Contributions received in cash from employer	2010-12-31	$842,267
Employer contributions (assets) at end of year	2010-12-31	$48,196
Contract administrator fees	2010-12-31	$18,000
Liabilities. Value of benefit claims payable at end of year	2010-12-31	$5,226
Did the plan have assets held for investment	2010-12-31	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2010-12-31	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2010-12-31	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2010-12-31	No
Opinion of an independent qualified public accountant for this plan	2010-12-31	Unqualified
Accountancy firm name	2010-12-31	FREDRICKZINK & ASSOCIATES, PC
Accountancy firm EIN	2010-12-31	841073179

Form 5500 Responses for NIELSONS, INC. HEALTH AND WELFARE TRUST

2018: NIELSONS, INC. HEALTH AND WELFARE TRUST 2018 form 5500 responses
2018-01-01	Type of plan entity	Single employer plan
2018-01-01	Submission has been amended	No
2018-01-01	This submission is the final filing	No
2018-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2018-01-01	Plan is a collectively bargained plan	Yes
2018-01-01	Plan funding arrangement – Trust	Yes
2018-01-01	Plan benefit arrangement - Trust	Yes
2017: NIELSONS, INC. HEALTH AND WELFARE TRUST 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	No
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	Yes
2017-01-01	Plan funding arrangement – Trust	Yes
2017-01-01	Plan benefit arrangement - Trust	Yes
2016: NIELSONS, INC. HEALTH AND WELFARE TRUST 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Submission has been amended	No
2016-01-01	This submission is the final filing	No
2016-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2016-01-01	Plan is a collectively bargained plan	Yes
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan funding arrangement – Trust	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement - Trust	Yes
2015: NIELSONS, INC. HEALTH AND WELFARE TRUST 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Submission has been amended	No
2015-01-01	This submission is the final filing	No
2015-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2015-01-01	Plan is a collectively bargained plan	Yes
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan funding arrangement – Trust	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement - Trust	Yes
2014: NIELSONS, INC. HEALTH AND WELFARE TRUST 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Submission has been amended	No
2014-01-01	This submission is the final filing	No
2014-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2014-01-01	Plan is a collectively bargained plan	Yes
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan funding arrangement – Trust	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement - Trust	Yes
2013: NIELSONS, INC. HEALTH AND WELFARE TRUST 2013 form 5500 responses
2013-01-01	Type of plan entity	Single employer plan
2013-01-01	Plan is a collectively bargained plan	Yes
2013-01-01	Plan funding arrangement – Insurance	Yes
2013-01-01	Plan funding arrangement – Trust	Yes
2013-01-01	Plan benefit arrangement – Insurance	Yes
2013-01-01	Plan benefit arrangement - Trust	Yes
2012: NIELSONS, INC. HEALTH AND WELFARE TRUST 2012 form 5500 responses
2012-01-01	Type of plan entity	Single employer plan
2012-01-01	Plan is a collectively bargained plan	Yes
2012-01-01	Plan funding arrangement – Insurance	Yes
2012-01-01	Plan funding arrangement – Trust	Yes
2012-01-01	Plan benefit arrangement – Insurance	Yes
2012-01-01	Plan benefit arrangement - Trust	Yes
2011: NIELSONS, INC. HEALTH AND WELFARE TRUST 2011 form 5500 responses
2011-01-01	Type of plan entity	Single employer plan
2011-01-01	Plan is a collectively bargained plan	Yes
2011-01-01	Plan funding arrangement – Insurance	Yes
2011-01-01	Plan funding arrangement – Trust	Yes
2011-01-01	Plan benefit arrangement – Insurance	Yes
2011-01-01	Plan benefit arrangement - Trust	Yes
2010: NIELSONS, INC. HEALTH AND WELFARE TRUST 2010 form 5500 responses
2010-01-01	Type of plan entity	Single employer plan
2010-01-01	Plan is a collectively bargained plan	Yes
2010-01-01	Plan funding arrangement – Insurance	Yes
2010-01-01	Plan funding arrangement – Trust	Yes
2010-01-01	Plan benefit arrangement – Insurance	Yes
2010-01-01	Plan benefit arrangement - Trust	Yes
2009: NIELSONS, INC. HEALTH AND WELFARE TRUST 2009 form 5500 responses
2009-01-01	Type of plan entity	Single employer plan
2009-01-01	Plan is a collectively bargained plan	Yes
2009-01-01	Plan funding arrangement – Insurance	Yes
2009-01-01	Plan funding arrangement – Trust	Yes
2009-01-01	Plan benefit arrangement – Insurance	Yes
2009-01-01	Plan benefit arrangement - Trust	Yes
2008: NIELSONS, INC. HEALTH AND WELFARE TRUST 2008 form 5500 responses
2008-01-01	Type of plan entity	Single employer plan
2008-01-01	Submission has been amended	No
2008-01-01	This submission is the final filing	No
2008-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2008-01-01	Plan is a collectively bargained plan	Yes
2008-01-01	Plan funding arrangement – Insurance	Yes
2008-01-01	Plan funding arrangement – Trust	Yes
2008-01-01	Plan benefit arrangement – Insurance	Yes
2008-01-01	Plan benefit arrangement - Trust	Yes
2007: NIELSONS, INC. HEALTH AND WELFARE TRUST 2007 form 5500 responses
2007-01-01	Type of plan entity	Single employer plan
2007-01-01	Submission has been amended	Yes
2007-01-01	This submission is the final filing	No
2007-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2007-01-01	Plan is a collectively bargained plan	Yes
2007-01-01	Plan funding arrangement – Insurance	Yes
2007-01-01	Plan funding arrangement – Trust	Yes
2007-01-01	Plan benefit arrangement – Insurance	Yes
2007-01-01	Plan benefit arrangement - Trust	Yes
2006: NIELSONS, INC. HEALTH AND WELFARE TRUST 2006 form 5500 responses
2006-01-01	Type of plan entity	Single employer plan
2006-01-01	Submission has been amended	Yes
2006-01-01	This submission is the final filing	No
2006-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2006-01-01	Plan is a collectively bargained plan	Yes
2006-01-01	Plan funding arrangement – Insurance	Yes
2006-01-01	Plan funding arrangement – Trust	Yes
2006-01-01	Plan benefit arrangement – Insurance	Yes
2006-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12243874

Policy instance

Insurance contract or identification number	12243874
Number of Individuals Covered	84
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $206
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $11,968
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $206
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

FIRST SYMETRA NATIONAL LIFE INS CO OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 78417 )

Policy contract number

0000

Policy instance

Insurance contract or identification number	0000
Number of Individuals Covered	84
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $4,781
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $31,112
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,781
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

960027/960024

Policy instance

Insurance contract or identification number	960027/960024
Number of Individuals Covered	84
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $105
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
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 Carrier	USD $3,551
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $105
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

960027/960024

Policy instance

Insurance contract or identification number	960027/960024
Number of Individuals Covered	130
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
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 Carrier	USD $8,572
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12243874

Policy instance

Insurance contract or identification number	12243874
Number of Individuals Covered	122
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $186
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	Yes
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $11,300
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $186
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

FIRST SYMETRA NATIONAL LIFE INS CO OF NEW YORK (National Association of Insurance Commissioners NAIC id number: 78417 )

Policy contract number

0000

Policy instance

Insurance contract or identification number	0000
Number of Individuals Covered	128
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,903
Total amount of fees paid to insurance company	USD $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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
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 Carrier	USD $27,496
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,903
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12243874

Policy instance

Insurance contract or identification number	12243874
Number of Individuals Covered	88
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $184
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $184
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

960027/960024

Policy instance

Insurance contract or identification number	960027/960024
Number of Individuals Covered	79
Insurance policy start date	2013-01-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $461
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $461
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

295873

Policy instance

Insurance contract or identification number	295873
Number of Individuals Covered	76
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $13,275
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $13,275
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

9138

Policy instance

Insurance contract or identification number	9138
Number of Individuals Covered	76
Insurance policy start date	2012-10-01
Insurance policy end date	2013-09-30
Total amount of commissions paid to insurance broker	USD $1,569
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,569
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

960027/960024

Policy instance

Insurance contract or identification number	960027/960024
Insurance policy start date	2012-01-01
Insurance policy end date	2012-12-31
Total amount of commissions paid to insurance broker	USD $552
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $552
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

295873

Policy instance

Insurance contract or identification number	295873
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $12,989
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $12,989
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

9138

Policy instance

Insurance contract or identification number	9138
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $1,656
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $1,656
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12243874

Policy instance

Insurance contract or identification number	12243874
Insurance policy start date	2011-10-01
Insurance policy end date	2012-09-30
Total amount of commissions paid to insurance broker	USD $194
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $194
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

9138

Policy instance

Insurance contract or identification number	9138
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $2,156
Dental Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12243874

Policy instance

Insurance contract or identification number	12243874
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $253
Vision Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

960027/960024

Policy instance

Insurance contract or identification number	960027/960024
Insurance policy start date	2011-01-01
Insurance policy end date	2011-12-31
Total amount of commissions paid to insurance broker	USD $803
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

295873

Policy instance

Insurance contract or identification number	295873
Insurance policy start date	2010-10-01
Insurance policy end date	2011-09-30
Total amount of commissions paid to insurance broker	USD $17,734
Health Insurance Welfare Benefit	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

EMPIRE HEALTHCHOICE ASSURANCE, INC. (National Association of Insurance Commissioners NAIC id number: 55093 )

Policy contract number

295873

Policy instance

Insurance contract or identification number	295873
Number of Individuals Covered	86
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $7,320
Health Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $134,792
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $7,320
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 47029 )

Policy contract number

12243874

Policy instance

Insurance contract or identification number	12243874
Number of Individuals Covered	86
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $21
Vision Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $6,465
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $21
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

CIGNA GROUP INSURANCE (National Association of Insurance Commissioners NAIC id number: 64548 )

Policy contract number

960027/960024

Policy instance

Insurance contract or identification number	960027/960024
Number of Individuals Covered	151
Insurance policy start date	2010-01-01
Insurance policy end date	2010-12-31
Total amount of commissions paid to insurance broker	USD $788
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $7,350
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $788
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

DELTA DENTAL OF NJ INC (National Association of Insurance Commissioners NAIC id number: 55085 )

Policy contract number

9138

Policy instance

Insurance contract or identification number	9138
Number of Individuals Covered	86
Insurance policy start date	2009-10-01
Insurance policy end date	2010-09-30
Total amount of commissions paid to insurance broker	USD $906
Dental Insurance Welfare Benefit	Yes
Welfare Benefit Premiums Paid to Carrier	USD $17,883
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $906
Insurance broker organization code?	3
Insurance broker name	CREATIVE BENEFITS, INC.

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Company Name:	NIELSONS, INC.
Employer identification number (EIN):	840809283
NAIC Classification:	238900