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THE WASHINGTON BAKERS TRUST WELFARE PLAN 401k Plan overview

Plan NameTHE WASHINGTON BAKERS TRUST WELFARE PLAN
Plan identification number 501

THE WASHINGTON BAKERS TRUST WELFARE PLAN Benefits

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

401k Sponsoring company profile

BOT, WASHINGTON BAKERS TRUST has sponsored the creation of one or more 401k plans.

Company Name:BOT, WASHINGTON BAKERS TRUST
Employer identification number (EIN):916029112
NAIC Classification:311800
NAIC Description: Bakeries and Tortilla Manufacturing

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE WASHINGTON BAKERS TRUST WELFARE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012015-06-01JERRY D'AMBROSIO
5012014-06-01JERRY D'AMBROSIO
5012014-06-01JERRY D'AMBROSIO
5012013-06-01JERRY D'AMBROSIO
5012012-06-01JERRY D'AMBROSIO
5012011-06-01JERRY DAMBROSIO
5012009-06-01ROBERT DAVIS JERRY DAMBROSIO2011-03-14

Plan Statistics for THE WASHINGTON BAKERS TRUST WELFARE PLAN

401k plan membership statisitcs for THE WASHINGTON BAKERS TRUST WELFARE PLAN

Measure Date Value
2015: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2015 401k membership
Total participants, beginning-of-year2015-06-011,387
Total number of active participants reported on line 7a of the Form 55002015-06-010
Number of retired or separated participants receiving benefits2015-06-010
Number of other retired or separated participants entitled to future benefits2015-06-010
Total of all active and inactive participants2015-06-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-06-010
Number of participants with account balances2015-06-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-06-010
Number of employers contributing to the scheme2015-06-010
2014: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2014 401k membership
Total participants, beginning-of-year2014-06-011,370
Total number of active participants reported on line 7a of the Form 55002014-06-011,387
Total of all active and inactive participants2014-06-011,387
Number of employers contributing to the scheme2014-06-0116
2013: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2013 401k membership
Total participants, beginning-of-year2013-06-011,329
Total number of active participants reported on line 7a of the Form 55002013-06-011,370
Total of all active and inactive participants2013-06-011,370
Number of employers contributing to the scheme2013-06-0117
2012: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2012 401k membership
Total participants, beginning-of-year2012-06-011,402
Total number of active participants reported on line 7a of the Form 55002012-06-011,329
Total of all active and inactive participants2012-06-011,329
Number of employers contributing to the scheme2012-06-0118
2011: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2011 401k membership
Total participants, beginning-of-year2011-06-011,470
Total number of active participants reported on line 7a of the Form 55002011-06-011,402
Total of all active and inactive participants2011-06-011,402
Number of employers contributing to the scheme2011-06-0120
2009: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2009 401k membership
Total participants, beginning-of-year2009-06-011,443
Total number of active participants reported on line 7a of the Form 55002009-06-011,463
Number of retired or separated participants receiving benefits2009-06-010
Number of other retired or separated participants entitled to future benefits2009-06-010
Total of all active and inactive participants2009-06-011,463
Number of employers contributing to the scheme2009-06-0114

Financial Data on THE WASHINGTON BAKERS TRUST WELFARE PLAN

Measure Date Value
2016 : THE WASHINGTON BAKERS TRUST WELFARE PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-05-31$0
Total transfer of assets from this plan2016-05-31$11,112
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-05-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-05-31$262,347
Total income from all sources (including contributions)2016-05-31$1,166
Total loss/gain on sale of assets2016-05-31$0
Total of all expenses incurred2016-05-31$856,735
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-05-31$842,984
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-05-31$0
Value of total assets at end of year2016-05-31$0
Value of total assets at beginning of year2016-05-31$1,129,028
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-05-31$13,751
Total interest from all sources2016-05-31$0
Total dividends received (eg from common stock, registered investment company shares)2016-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-05-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2016-05-31$949,775
Administrative expenses professional fees incurred2016-05-31$7,593
Was this plan covered by a fidelity bond2016-05-31No
If this is an individual account plan, was there a blackout period2016-05-31No
Were there any nonexempt tranactions with any party-in-interest2016-05-31No
Value of other receiveables (less allowance for doubtful accounts) at end of year2016-05-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2016-05-31$26,314
Other income not declared elsewhere2016-05-31$1,166
Administrative expenses (other) incurred2016-05-31$5,968
Liabilities. Value of operating payables at end of year2016-05-31$0
Liabilities. Value of operating payables at beginning of year2016-05-31$72,347
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-05-31No
Value of net income/loss2016-05-31$-855,569
Value of net assets at end of year (total assets less liabilities)2016-05-31$0
Value of net assets at beginning of year (total assets less liabilities)2016-05-31$866,681
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-05-31No
Were any leases to which the plan was party in default or uncollectible2016-05-31No
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-05-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-05-31$1,008,554
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-05-31$1,008,554
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-05-31No
Was there a failure to transmit to the plan any participant contributions2016-05-31No
Has the plan failed to provide any benefit when due under the plan2016-05-31No
Employer contributions (assets) at end of year2016-05-31$0
Employer contributions (assets) at beginning of year2016-05-31$94,160
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-05-31$842,984
Contract administrator fees2016-05-31$190
Liabilities. Value of benefit claims payable at end of year2016-05-31$0
Liabilities. Value of benefit claims payable at beginning of year2016-05-31$190,000
Did the plan have assets held for investment2016-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-05-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-05-31No
Opinion of an independent qualified public accountant for this plan2016-05-31Unqualified
Accountancy firm name2016-05-31ANASTASI, MOORE & MARTIN, PLLC
Accountancy firm EIN2016-05-31208149084
2015 : THE WASHINGTON BAKERS TRUST WELFARE PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-05-31$-40,119
Total unrealized appreciation/depreciation of assets2015-05-31$-40,119
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-05-31$262,347
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-05-31$1,590,757
Total income from all sources (including contributions)2015-05-31$9,920,197
Total loss/gain on sale of assets2015-05-31$26,736
Total of all expenses incurred2015-05-31$12,358,052
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-05-31$11,751,399
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-05-31$9,854,420
Value of total assets at end of year2015-05-31$1,129,028
Value of total assets at beginning of year2015-05-31$4,895,293
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-05-31$606,653
Total interest from all sources2015-05-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-05-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2015-05-31$0
Administrative expenses professional fees incurred2015-05-31$165,244
Was this plan covered by a fidelity bond2015-05-31Yes
Value of fidelity bond cover2015-05-31$500,000
If this is an individual account plan, was there a blackout period2015-05-31No
Were there any nonexempt tranactions with any party-in-interest2015-05-31No
Contributions received from participants2015-05-31$44,190
Participant contributions at beginning of year2015-05-31$9,910
Value of other receiveables (less allowance for doubtful accounts) at end of year2015-05-31$26,314
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2015-05-31$423,690
Other income not declared elsewhere2015-05-31$54,170
Administrative expenses (other) incurred2015-05-31$43,861
Liabilities. Value of operating payables at end of year2015-05-31$72,347
Liabilities. Value of operating payables at beginning of year2015-05-31$111,757
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-05-31No
Value of net income/loss2015-05-31$-2,437,855
Value of net assets at end of year (total assets less liabilities)2015-05-31$866,681
Value of net assets at beginning of year (total assets less liabilities)2015-05-31$3,304,536
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-05-31No
Were any leases to which the plan was party in default or uncollectible2015-05-31No
Investment advisory and management fees2015-05-31$16,859
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-05-31$5,511
Value of interest in common/collective trusts at beginning of year2015-05-31$2,895,334
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-05-31$1,008,554
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-05-31$299,732
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-05-31$299,732
Expenses. Payments to insurance carriers foe the provision of benefits2015-05-31$1,081,296
Net investment gain or loss from common/collective trusts2015-05-31$24,990
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-05-31Yes
Was there a failure to transmit to the plan any participant contributions2015-05-31No
Has the plan failed to provide any benefit when due under the plan2015-05-31No
Contributions received in cash from employer2015-05-31$9,810,230
Employer contributions (assets) at end of year2015-05-31$94,160
Employer contributions (assets) at beginning of year2015-05-31$1,261,116
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-05-31$10,670,103
Contract administrator fees2015-05-31$380,689
Liabilities. Value of benefit claims payable at end of year2015-05-31$190,000
Liabilities. Value of benefit claims payable at beginning of year2015-05-31$1,479,000
Did the plan have assets held for investment2015-05-31No
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-05-31No
Aggregate proceeds on sale of assets2015-05-31$2,906,938
Aggregate carrying amount (costs) on sale of assets2015-05-31$2,880,202
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-05-31No
Opinion of an independent qualified public accountant for this plan2015-05-31Unqualified
Accountancy firm name2015-05-31ANASTASI, MOORE & MARTIN, PLLC
Accountancy firm EIN2015-05-31208149084
2014 : THE WASHINGTON BAKERS TRUST WELFARE PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-05-31$-34,601
Total unrealized appreciation/depreciation of assets2014-05-31$-34,601
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-05-31$1,590,757
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-05-31$1,983,156
Total income from all sources (including contributions)2014-05-31$14,294,149
Total loss/gain on sale of assets2014-05-31$17,032
Total of all expenses incurred2014-05-31$15,301,804
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-05-31$14,541,123
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-05-31$14,120,680
Value of total assets at end of year2014-05-31$4,895,293
Value of total assets at beginning of year2014-05-31$6,295,347
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-05-31$760,681
Total interest from all sources2014-05-31$0
Total dividends received (eg from common stock, registered investment company shares)2014-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-05-31No
Administrative expenses professional fees incurred2014-05-31$194,149
Was this plan covered by a fidelity bond2014-05-31Yes
Value of fidelity bond cover2014-05-31$500,000
If this is an individual account plan, was there a blackout period2014-05-31No
Were there any nonexempt tranactions with any party-in-interest2014-05-31No
Contributions received from participants2014-05-31$163,020
Participant contributions at end of year2014-05-31$9,910
Participant contributions at beginning of year2014-05-31$9,159
Value of other receiveables (less allowance for doubtful accounts) at end of year2014-05-31$423,690
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2014-05-31$121,883
Other income not declared elsewhere2014-05-31$122,772
Administrative expenses (other) incurred2014-05-31$57,927
Liabilities. Value of operating payables at end of year2014-05-31$111,757
Liabilities. Value of operating payables at beginning of year2014-05-31$116,156
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-05-31No
Value of net income/loss2014-05-31$-1,007,655
Value of net assets at end of year (total assets less liabilities)2014-05-31$3,304,536
Value of net assets at beginning of year (total assets less liabilities)2014-05-31$4,312,191
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-05-31No
Were any leases to which the plan was party in default or uncollectible2014-05-31No
Investment advisory and management fees2014-05-31$27,669
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-05-31$5,511
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-05-31$5,506
Value of interest in common/collective trusts at end of year2014-05-31$2,895,334
Value of interest in common/collective trusts at beginning of year2014-05-31$4,496,093
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-05-31$299,732
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-05-31$560,582
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-05-31$560,582
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2014-05-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2014-05-31$1,076,474
Net investment gain or loss from common/collective trusts2014-05-31$68,266
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-05-31Yes
Was there a failure to transmit to the plan any participant contributions2014-05-31No
Has the plan failed to provide any benefit when due under the plan2014-05-31No
Contributions received in cash from employer2014-05-31$13,957,660
Employer contributions (assets) at end of year2014-05-31$1,261,116
Employer contributions (assets) at beginning of year2014-05-31$1,102,124
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-05-31$13,464,649
Contract administrator fees2014-05-31$480,936
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-05-31No
Liabilities. Value of benefit claims payable at end of year2014-05-31$1,479,000
Liabilities. Value of benefit claims payable at beginning of year2014-05-31$1,867,000
Did the plan have assets held for investment2014-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-05-31No
Aggregate proceeds on sale of assets2014-05-31$1,650,000
Aggregate carrying amount (costs) on sale of assets2014-05-31$1,632,968
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-05-31No
Opinion of an independent qualified public accountant for this plan2014-05-31Unqualified
Accountancy firm name2014-05-31ANASTASI, MOORE & MARTIN, PLLC
Accountancy firm EIN2014-05-31208149084
2013 : THE WASHINGTON BAKERS TRUST WELFARE PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-05-31$9,223
Total unrealized appreciation/depreciation of assets2013-05-31$9,223
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-05-31$1,983,156
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-05-31$1,480,021
Total income from all sources (including contributions)2013-05-31$13,051,184
Total loss/gain on sale of assets2013-05-31$0
Total of all expenses incurred2013-05-31$14,375,057
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-05-31$13,637,565
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-05-31$12,898,330
Value of total assets at end of year2013-05-31$6,295,347
Value of total assets at beginning of year2013-05-31$7,116,085
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-05-31$737,492
Total interest from all sources2013-05-31$0
Total dividends received (eg from common stock, registered investment company shares)2013-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-05-31No
Administrative expenses professional fees incurred2013-05-31$166,546
Was this plan covered by a fidelity bond2013-05-31Yes
Value of fidelity bond cover2013-05-31$500,000
If this is an individual account plan, was there a blackout period2013-05-31No
Were there any nonexempt tranactions with any party-in-interest2013-05-31No
Contributions received from participants2013-05-31$145,436
Participant contributions at end of year2013-05-31$9,159
Participant contributions at beginning of year2013-05-31$13,075
Value of other receiveables (less allowance for doubtful accounts) at end of year2013-05-31$121,883
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2013-05-31$41,002
Other income not declared elsewhere2013-05-31$76,934
Administrative expenses (other) incurred2013-05-31$59,931
Liabilities. Value of operating payables at end of year2013-05-31$116,156
Liabilities. Value of operating payables at beginning of year2013-05-31$103,021
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-05-31No
Value of net income/loss2013-05-31$-1,323,873
Value of net assets at end of year (total assets less liabilities)2013-05-31$4,312,191
Value of net assets at beginning of year (total assets less liabilities)2013-05-31$5,636,064
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-05-31No
Were any leases to which the plan was party in default or uncollectible2013-05-31No
Investment advisory and management fees2013-05-31$29,808
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-05-31$5,506
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-05-31$5,501
Value of interest in common/collective trusts at end of year2013-05-31$4,496,093
Value of interest in common/collective trusts at beginning of year2013-05-31$4,422,223
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-05-31$560,582
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-05-31$1,539,678
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-05-31$1,539,678
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2013-05-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2013-05-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2013-05-31$1,034,032
Net investment gain or loss from common/collective trusts2013-05-31$66,697
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-05-31No
Was there a failure to transmit to the plan any participant contributions2013-05-31No
Has the plan failed to provide any benefit when due under the plan2013-05-31No
Contributions received in cash from employer2013-05-31$12,752,894
Employer contributions (assets) at end of year2013-05-31$1,102,124
Employer contributions (assets) at beginning of year2013-05-31$1,094,606
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-05-31$12,603,533
Contract administrator fees2013-05-31$481,207
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-05-31No
Liabilities. Value of benefit claims payable at end of year2013-05-31$1,867,000
Liabilities. Value of benefit claims payable at beginning of year2013-05-31$1,377,000
Did the plan have assets held for investment2013-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-05-31No
Aggregate proceeds on sale of assets2013-05-31$0
Aggregate carrying amount (costs) on sale of assets2013-05-31$0
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-05-31No
Opinion of an independent qualified public accountant for this plan2013-05-31Unqualified
Accountancy firm name2013-05-31ANASTASI, MOORE & MARTIN, PLLC
Accountancy firm EIN2013-05-31208149084
2012 : THE WASHINGTON BAKERS TRUST WELFARE PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-05-31$-23,637
Total unrealized appreciation/depreciation of assets2012-05-31$-23,637
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-05-31$1,480,021
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-05-31$1,040,300
Total income from all sources (including contributions)2012-05-31$13,423,470
Total loss/gain on sale of assets2012-05-31$316
Total of all expenses incurred2012-05-31$14,076,971
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-05-31$13,357,963
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-05-31$13,295,895
Value of total assets at end of year2012-05-31$7,116,085
Value of total assets at beginning of year2012-05-31$7,329,865
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-05-31$719,008
Total interest from all sources2012-05-31$0
Total dividends received (eg from common stock, registered investment company shares)2012-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-05-31No
Administrative expenses professional fees incurred2012-05-31$187,724
Was this plan covered by a fidelity bond2012-05-31Yes
Value of fidelity bond cover2012-05-31$500,000
If this is an individual account plan, was there a blackout period2012-05-31No
Were there any nonexempt tranactions with any party-in-interest2012-05-31No
Contributions received from participants2012-05-31$13,075
Participant contributions at end of year2012-05-31$13,075
Participant contributions at beginning of year2012-05-31$17,573
Value of other receiveables (less allowance for doubtful accounts) at end of year2012-05-31$41,002
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2012-05-31$57,005
Other income not declared elsewhere2012-05-31$59,617
Administrative expenses (other) incurred2012-05-31$49,272
Liabilities. Value of operating payables at end of year2012-05-31$103,021
Liabilities. Value of operating payables at beginning of year2012-05-31$145,300
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Value of net income/loss2012-05-31$-653,501
Value of net assets at end of year (total assets less liabilities)2012-05-31$5,636,064
Value of net assets at beginning of year (total assets less liabilities)2012-05-31$6,289,565
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-05-31No
Were any leases to which the plan was party in default or uncollectible2012-05-31No
Investment advisory and management fees2012-05-31$28,001
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-05-31$5,501
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-05-31$0
Value of interest in common/collective trusts at end of year2012-05-31$4,422,223
Value of interest in common/collective trusts at beginning of year2012-05-31$4,362,486
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-05-31$1,539,678
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-05-31$1,786,668
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-05-31$1,786,668
Expenses. Payments to insurance carriers foe the provision of benefits2012-05-31$1,022,349
Net investment gain or loss from common/collective trusts2012-05-31$91,279
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-05-31No
Was there a failure to transmit to the plan any participant contributions2012-05-31No
Has the plan failed to provide any benefit when due under the plan2012-05-31No
Contributions received in cash from employer2012-05-31$13,282,820
Employer contributions (assets) at end of year2012-05-31$1,094,606
Employer contributions (assets) at beginning of year2012-05-31$1,106,133
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-05-31$12,335,614
Contract administrator fees2012-05-31$454,011
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-05-31No
Liabilities. Value of benefit claims payable at end of year2012-05-31$1,377,000
Liabilities. Value of benefit claims payable at beginning of year2012-05-31$895,000
Did the plan have assets held for investment2012-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-05-31No
Aggregate proceeds on sale of assets2012-05-31$5,500
Aggregate carrying amount (costs) on sale of assets2012-05-31$5,184
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-05-31No
Opinion of an independent qualified public accountant for this plan2012-05-31Unqualified
Accountancy firm name2012-05-31ANASTASI & MOORE, PLLC
Accountancy firm EIN2012-05-31208149084
2011 : THE WASHINGTON BAKERS TRUST WELFARE PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-05-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$1,040,300
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-05-31$2,873,847
Total income from all sources (including contributions)2011-05-31$13,263,343
Total loss/gain on sale of assets2011-05-31$0
Total of all expenses incurred2011-05-31$10,269,863
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-05-31$9,531,565
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-05-31$13,051,464
Value of total assets at end of year2011-05-31$7,329,865
Value of total assets at beginning of year2011-05-31$6,169,932
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-05-31$738,298
Total interest from all sources2011-05-31$1,690
Total dividends received (eg from common stock, registered investment company shares)2011-05-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-05-31No
Administrative expenses professional fees incurred2011-05-31$182,824
Was this plan covered by a fidelity bond2011-05-31Yes
Value of fidelity bond cover2011-05-31$500,000
Were there any nonexempt tranactions with any party-in-interest2011-05-31No
Contributions received from participants2011-05-31$159,772
Participant contributions at end of year2011-05-31$17,573
Participant contributions at beginning of year2011-05-31$28,884
Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries)2011-05-31$8,471,716
Value of other receiveables (less allowance for doubtful accounts) at end of year2011-05-31$57,005
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-05-31$201,442
Other income not declared elsewhere2011-05-31$65,520
Administrative expenses (other) incurred2011-05-31$55,723
Liabilities. Value of operating payables at end of year2011-05-31$145,300
Liabilities. Value of operating payables at beginning of year2011-05-31$121,847
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Value of net income/loss2011-05-31$2,993,480
Value of net assets at end of year (total assets less liabilities)2011-05-31$6,289,565
Value of net assets at beginning of year (total assets less liabilities)2011-05-31$3,296,085
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-05-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-05-31No
Were any leases to which the plan was party in default or uncollectible2011-05-31No
Investment advisory and management fees2011-05-31$32,130
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-05-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-05-31$1
Value of interest in common/collective trusts at end of year2011-05-31$4,362,486
Value of interest in common/collective trusts at beginning of year2011-05-31$4,206,279
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-05-31$1,786,668
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-05-31$673,295
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-05-31$673,295
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-05-31$1,690
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2011-05-31$0
Expenses. Payments to insurance carriers foe the provision of benefits2011-05-31$1,059,849
Net investment gain or loss from common/collective trusts2011-05-31$144,669
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-05-31No
Was there a failure to transmit to the plan any participant contributions2011-05-31No
Has the plan failed to provide any benefit when due under the plan2011-05-31No
Contributions received in cash from employer2011-05-31$12,891,692
Employer contributions (assets) at end of year2011-05-31$1,106,133
Employer contributions (assets) at beginning of year2011-05-31$1,060,031
Contract administrator fees2011-05-31$467,621
Liabilities. Value of benefit claims payable at end of year2011-05-31$895,000
Liabilities. Value of benefit claims payable at beginning of year2011-05-31$2,752,000
Did the plan have assets held for investment2011-05-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-05-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-05-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-05-31No
Opinion of an independent qualified public accountant for this plan2011-05-31Unqualified
Accountancy firm name2011-05-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2011-05-31410746749

Form 5500 Responses for THE WASHINGTON BAKERS TRUST WELFARE PLAN

2015: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2015 form 5500 responses
2015-06-01Type of plan entityMulti-employer plan
2015-06-01Submission has been amendedNo
2015-06-01This submission is the final filingYes
2015-06-01This return/report is a short plan year return/report (less than 12 months)No
2015-06-01Plan is a collectively bargained planYes
2015-06-01Plan funding arrangement – TrustYes
2015-06-01Plan benefit arrangement - TrustYes
2014: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2014 form 5500 responses
2014-06-01Type of plan entityMulti-employer plan
2014-06-01Submission has been amendedYes
2014-06-01This submission is the final filingNo
2014-06-01This return/report is a short plan year return/report (less than 12 months)No
2014-06-01Plan is a collectively bargained planYes
2014-06-01Plan funding arrangement – TrustYes
2014-06-01Plan benefit arrangement – InsuranceYes
2014-06-01Plan benefit arrangement - TrustYes
2013: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2013 form 5500 responses
2013-06-01Type of plan entityMulti-employer plan
2013-06-01Submission has been amendedNo
2013-06-01This submission is the final filingNo
2013-06-01This return/report is a short plan year return/report (less than 12 months)No
2013-06-01Plan is a collectively bargained planYes
2013-06-01Plan funding arrangement – TrustYes
2013-06-01Plan benefit arrangement – InsuranceYes
2013-06-01Plan benefit arrangement - TrustYes
2012: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2012 form 5500 responses
2012-06-01Type of plan entityMulti-employer plan
2012-06-01Submission has been amendedNo
2012-06-01This submission is the final filingNo
2012-06-01This return/report is a short plan year return/report (less than 12 months)No
2012-06-01Plan is a collectively bargained planYes
2012-06-01Plan funding arrangement – TrustYes
2012-06-01Plan benefit arrangement – InsuranceYes
2012-06-01Plan benefit arrangement - TrustYes
2011: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2011 form 5500 responses
2011-06-01Type of plan entityMulti-employer plan
2011-06-01Submission has been amendedNo
2011-06-01This submission is the final filingNo
2011-06-01This return/report is a short plan year return/report (less than 12 months)No
2011-06-01Plan is a collectively bargained planYes
2011-06-01Plan funding arrangement – TrustYes
2011-06-01Plan benefit arrangement – InsuranceYes
2011-06-01Plan benefit arrangement - TrustYes
2009: THE WASHINGTON BAKERS TRUST WELFARE PLAN 2009 form 5500 responses
2009-06-01Type of plan entityMulti-employer plan
2009-06-01Submission has been amendedNo
2009-06-01This submission is the final filingNo
2009-06-01This return/report is a short plan year return/report (less than 12 months)No
2009-06-01Plan is a collectively bargained planYes
2009-06-01Plan funding arrangement – TrustYes
2009-06-01Plan benefit arrangement – InsuranceYes
2009-06-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOO55V6
Policy instance 2
Insurance contract or identification numberGOOO55V6
Number of Individuals Covered1380
Insurance policy start date2014-06-01
Insurance policy end date2015-02-01
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $3,239
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 )
Policy contract numberWA-400054-9999
Policy instance 3
Insurance contract or identification numberWA-400054-9999
Number of Individuals Covered1387
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $853,662
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract numberWA202/Z106
Policy instance 1
Insurance contract or identification numberWA202/Z106
Number of Individuals Covered429
Insurance policy start date2014-06-01
Insurance policy end date2015-01-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract numberZ106/WA202
Policy instance 1
Insurance contract or identification numberZ106/WA202
Number of Individuals Covered430
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOO55V6
Policy instance 2
Insurance contract or identification numberGOOO55V6
Number of Individuals Covered1353
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,665
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 )
Policy contract numberWA-400054-9999
Policy instance 3
Insurance contract or identification numberWA-400054-9999
Number of Individuals Covered1387
Insurance policy start date2013-06-01
Insurance policy end date2014-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $807,884
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract numberZ106/WA202
Policy instance 1
Insurance contract or identification numberZ106/WA202
Number of Individuals Covered448
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 )
Policy contract numberWA-400054-9999
Policy instance 3
Insurance contract or identification numberWA-400054-9999
Number of Individuals Covered1323
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $700,381
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOO55V6
Policy instance 2
Insurance contract or identification numberGOOO55V6
Number of Individuals Covered1278
Insurance policy start date2012-06-01
Insurance policy end date2013-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,698
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
LIFEWISE ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 94188 )
Policy contract numberWA-400054-9999
Policy instance 1
Insurance contract or identification numberWA-400054-9999
Number of Individuals Covered1410
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $674,221
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOO55V6
Policy instance 2
Insurance contract or identification numberGOOO55V6
Number of Individuals Covered1381
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedAD&D
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $4,906
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract numberZ106
Policy instance 3
Insurance contract or identification numberZ106
Number of Individuals Covered464
Insurance policy start date2011-06-01
Insurance policy end date2012-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WILLAMETTE DENTAL OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 47050 )
Policy contract numberZ106
Policy instance 1
Insurance contract or identification numberZ106
Number of Individuals Covered436
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitYes
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGOOO55V6
Policy instance 2
Insurance contract or identification numberGOOO55V6
Number of Individuals Covered1395
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Welfare Benefit Premiums Paid to CarrierUSD $723,660
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG00055V6
Policy instance 3
Insurance contract or identification numberG00055V6
Number of Individuals Covered1367
Insurance policy start date2010-06-01
Insurance policy end date2011-05-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH AND 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 CarrierUSD $4,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?Yes

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