CEMENT MASONS - EMPLOYERS TRUST has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN
401k plan membership statisitcs for CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN
| Measure | Date | Value |
|---|
| 2023 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2023 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2023-12-31 | $116,750 |
| Total unrealized appreciation/depreciation of assets | 2023-12-31 | $116,750 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $3,979,237 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2023-12-31 | $3,678,824 |
| Total income from all sources (including contributions) | 2023-12-31 | $10,023,732 |
| Total loss/gain on sale of assets | 2023-12-31 | $9,062 |
| Total of all expenses incurred | 2023-12-31 | $9,693,763 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2023-12-31 | $9,212,253 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2023-12-31 | $8,254,230 |
| Value of total assets at end of year | 2023-12-31 | $8,813,848 |
| Value of total assets at beginning of year | 2023-12-31 | $8,183,466 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2023-12-31 | $481,510 |
| Total interest from all sources | 2023-12-31 | $139,259 |
| Total dividends received (eg from common stock, registered investment company shares) | 2023-12-31 | $38,583 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2023-12-31 | No |
| Total dividends received from registered investment company shares (eg mutual funds) | 2023-12-31 | $38,583 |
| Was this plan covered by a fidelity bond | 2023-12-31 | No |
| If this is an individual account plan, was there a blackout period | 2023-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2023-12-31 | No |
| Contributions received from participants | 2023-12-31 | $308,129 |
| Participant contributions at end of year | 2023-12-31 | $18,890 |
| Participant contributions at beginning of year | 2023-12-31 | $24,632 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2023-12-31 | $501,193 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2023-12-31 | $52,540 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2023-12-31 | $3,179,087 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2023-12-31 | $2,953,687 |
| Other income not declared elsewhere | 2023-12-31 | $1,216,418 |
| Administrative expenses (other) incurred | 2023-12-31 | $69,769 |
| Liabilities. Value of operating payables at end of year | 2023-12-31 | $176,319 |
| Liabilities. Value of operating payables at beginning of year | 2023-12-31 | $145,811 |
| Total non interest bearing cash at end of year | 2023-12-31 | $392,422 |
| Total non interest bearing cash at beginning of year | 2023-12-31 | $270,076 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2023-12-31 | No |
| Value of net income/loss | 2023-12-31 | $329,969 |
| Value of net assets at end of year (total assets less liabilities) | 2023-12-31 | $4,834,611 |
| Value of net assets at beginning of year (total assets less liabilities) | 2023-12-31 | $4,504,642 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2023-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2023-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2023-12-31 | No |
| Investment advisory and management fees | 2023-12-31 | $21,209 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2023-12-31 | $2,091,094 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2023-12-31 | $2,018,458 |
| Value of interest in pooled separate accounts at end of year | 2023-12-31 | $0 |
| Income. Interest from US Government securities | 2023-12-31 | $56,480 |
| Income. Interest from corporate debt instruments | 2023-12-31 | $70,427 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2023-12-31 | $303,538 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2023-12-31 | $94,382 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2023-12-31 | $94,382 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2023-12-31 | $12,352 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2023-12-31 | $2,489,594 |
| Asset value of US Government securities at end of year | 2023-12-31 | $2,908,864 |
| Asset value of US Government securities at beginning of year | 2023-12-31 | $2,608,608 |
| Net investment gain/loss from registered investment companies (e.g. mutual funds) | 2023-12-31 | $249,430 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2023-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2023-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2023-12-31 | No |
| Contributions received in cash from employer | 2023-12-31 | $7,946,101 |
| Employer contributions (assets) at end of year | 2023-12-31 | $639,439 |
| Employer contributions (assets) at beginning of year | 2023-12-31 | $688,863 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2023-12-31 | $6,722,659 |
| Asset. Corporate debt instrument debt (other) at end of year | 2023-12-31 | $1,958,408 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2023-12-31 | $2,425,907 |
| Contract administrator fees | 2023-12-31 | $300,600 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2023-12-31 | No |
| Liabilities. Value of benefit claims payable at end of year | 2023-12-31 | $623,831 |
| Liabilities. Value of benefit claims payable at beginning of year | 2023-12-31 | $579,326 |
| Did the plan have assets held for investment | 2023-12-31 | 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 | 2023-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2023-12-31 | No |
| Aggregate proceeds on sale of assets | 2023-12-31 | $1,058,037 |
| Aggregate carrying amount (costs) on sale of assets | 2023-12-31 | $1,048,975 |
| Opinion of an independent qualified public accountant for this plan | 2023-12-31 | Unqualified |
| Accountancy firm name | 2023-12-31 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2023-12-31 | 930809066 |
| 2022 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2022 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2022-12-31 | $-78,379 |
| Total unrealized appreciation/depreciation of assets | 2022-12-31 | $-78,379 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $3,678,824 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-12-31 | $3,753,791 |
| Total income from all sources (including contributions) | 2022-12-31 | $7,159,387 |
| Total loss/gain on sale of assets | 2022-12-31 | $-765,984 |
| Total of all expenses incurred | 2022-12-31 | $7,874,230 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-12-31 | $7,416,333 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-12-31 | $7,832,512 |
| Value of total assets at end of year | 2022-12-31 | $8,183,466 |
| Value of total assets at beginning of year | 2022-12-31 | $8,973,276 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-12-31 | $457,897 |
| Total interest from all sources | 2022-12-31 | $104,058 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-12-31 | $38,369 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-12-31 | No |
| Administrative expenses professional fees incurred | 2022-12-31 | $107,950 |
| Was this plan covered by a fidelity bond | 2022-12-31 | Yes |
| Value of fidelity bond cover | 2022-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2022-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2022-12-31 | No |
| Contributions received from participants | 2022-12-31 | $358,394 |
| Participant contributions at end of year | 2022-12-31 | $24,632 |
| Participant contributions at beginning of year | 2022-12-31 | $27,806 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2022-12-31 | $52,540 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-12-31 | $363,002 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-12-31 | $2,953,687 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2022-12-31 | $3,070,214 |
| Other income not declared elsewhere | 2022-12-31 | $28,811 |
| Administrative expenses (other) incurred | 2022-12-31 | $39,501 |
| Liabilities. Value of operating payables at end of year | 2022-12-31 | $145,811 |
| Liabilities. Value of operating payables at beginning of year | 2022-12-31 | $195,071 |
| Total non interest bearing cash at end of year | 2022-12-31 | $270,076 |
| Total non interest bearing cash at beginning of year | 2022-12-31 | $1,312,551 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-12-31 | No |
| Value of net income/loss | 2022-12-31 | $-714,843 |
| Value of net assets at end of year (total assets less liabilities) | 2022-12-31 | $4,504,642 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-12-31 | $5,219,485 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-12-31 | No |
| Investment advisory and management fees | 2022-12-31 | $21,846 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-12-31 | $2,018,458 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-12-31 | $698,788 |
| Value of interest in pooled separate accounts at end of year | 2022-12-31 | $0 |
| Income. Interest from US Government securities | 2022-12-31 | $38,867 |
| Income. Interest from corporate debt instruments | 2022-12-31 | $61,434 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-12-31 | $94,382 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-12-31 | $215,917 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-12-31 | $215,917 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-12-31 | $3,757 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-12-31 | $2,322,494 |
| Asset value of US Government securities at end of year | 2022-12-31 | $2,608,608 |
| Asset value of US Government securities at beginning of year | 2022-12-31 | $1,925,721 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-12-31 | No |
| Contributions received in cash from employer | 2022-12-31 | $7,474,118 |
| Employer contributions (assets) at end of year | 2022-12-31 | $688,863 |
| Employer contributions (assets) at beginning of year | 2022-12-31 | $657,326 |
| Income. Dividends from common stock | 2022-12-31 | $38,369 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-12-31 | $5,093,839 |
| Asset. Corporate debt instrument debt (other) at end of year | 2022-12-31 | $2,425,907 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2022-12-31 | $1,759,458 |
| Contract administrator fees | 2022-12-31 | $288,600 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2022-12-31 | No |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2022-12-31 | $2,012,707 |
| Liabilities. Value of benefit claims payable at end of year | 2022-12-31 | $579,326 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-12-31 | $488,506 |
| Did the plan have assets held for investment | 2022-12-31 | 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 | 2022-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-12-31 | No |
| Aggregate proceeds on sale of assets | 2022-12-31 | $3,961,319 |
| Aggregate carrying amount (costs) on sale of assets | 2022-12-31 | $4,727,303 |
| Opinion of an independent qualified public accountant for this plan | 2022-12-31 | Unqualified |
| Accountancy firm name | 2022-12-31 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2022-12-31 | 930809066 |
| 2021 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2021 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2021-12-31 | $93,243 |
| Total unrealized appreciation/depreciation of assets | 2021-12-31 | $93,243 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $3,753,791 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-12-31 | $3,688,480 |
| Total income from all sources (including contributions) | 2021-12-31 | $9,257,437 |
| Total loss/gain on sale of assets | 2021-12-31 | $195,281 |
| Total of all expenses incurred | 2021-12-31 | $9,096,664 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-12-31 | $8,647,085 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-12-31 | $8,099,351 |
| Value of total assets at end of year | 2021-12-31 | $8,973,276 |
| Value of total assets at beginning of year | 2021-12-31 | $8,747,192 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-12-31 | $449,579 |
| Total interest from all sources | 2021-12-31 | $88,094 |
| Total dividends received (eg from common stock, registered investment company shares) | 2021-12-31 | $22,110 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-12-31 | No |
| Administrative expenses professional fees incurred | 2021-12-31 | $105,940 |
| Was this plan covered by a fidelity bond | 2021-12-31 | Yes |
| Value of fidelity bond cover | 2021-12-31 | $5,000,000 |
| If this is an individual account plan, was there a blackout period | 2021-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2021-12-31 | No |
| Contributions received from participants | 2021-12-31 | $387,400 |
| Participant contributions at end of year | 2021-12-31 | $27,806 |
| Participant contributions at beginning of year | 2021-12-31 | $27,052 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-12-31 | $363,002 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2021-12-31 | $399,562 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2021-12-31 | $3,070,214 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2021-12-31 | $2,941,844 |
| Other income not declared elsewhere | 2021-12-31 | $759,358 |
| Administrative expenses (other) incurred | 2021-12-31 | $32,252 |
| Liabilities. Value of operating payables at end of year | 2021-12-31 | $195,071 |
| Liabilities. Value of operating payables at beginning of year | 2021-12-31 | $233,203 |
| Total non interest bearing cash at end of year | 2021-12-31 | $1,312,551 |
| Total non interest bearing cash at beginning of year | 2021-12-31 | $1,420,767 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-12-31 | No |
| Value of net income/loss | 2021-12-31 | $160,773 |
| Value of net assets at end of year (total assets less liabilities) | 2021-12-31 | $5,219,485 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-12-31 | $5,058,712 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-12-31 | No |
| Investment advisory and management fees | 2021-12-31 | $22,787 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-12-31 | $698,788 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-12-31 | $657,333 |
| Value of interest in pooled separate accounts at end of year | 2021-12-31 | $0 |
| Income. Interest from US Government securities | 2021-12-31 | $36,539 |
| Income. Interest from corporate debt instruments | 2021-12-31 | $51,520 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-12-31 | $215,917 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-12-31 | $245,889 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-12-31 | $245,889 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-12-31 | $35 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-12-31 | $2,654,456 |
| Asset value of US Government securities at end of year | 2021-12-31 | $1,925,721 |
| Asset value of US Government securities at beginning of year | 2021-12-31 | $1,788,715 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2021-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-12-31 | No |
| Contributions received in cash from employer | 2021-12-31 | $7,711,951 |
| Employer contributions (assets) at end of year | 2021-12-31 | $657,326 |
| Employer contributions (assets) at beginning of year | 2021-12-31 | $682,427 |
| Income. Dividends from common stock | 2021-12-31 | $22,110 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-12-31 | $5,992,629 |
| Asset. Corporate debt instrument debt (other) at end of year | 2021-12-31 | $1,759,458 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2021-12-31 | $1,643,170 |
| Contract administrator fees | 2021-12-31 | $288,600 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2021-12-31 | No |
| Assets. Corporate common stocks other than exployer securities at end of year | 2021-12-31 | $2,012,707 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2021-12-31 | $1,882,277 |
| Liabilities. Value of benefit claims payable at end of year | 2021-12-31 | $488,506 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-12-31 | $513,433 |
| Did the plan have assets held for investment | 2021-12-31 | 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 | 2021-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-12-31 | No |
| Aggregate proceeds on sale of assets | 2021-12-31 | $1,856,435 |
| Aggregate carrying amount (costs) on sale of assets | 2021-12-31 | $1,661,154 |
| Opinion of an independent qualified public accountant for this plan | 2021-12-31 | Unqualified |
| Accountancy firm name | 2021-12-31 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2021-12-31 | 930809066 |
| 2020 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2020 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2020-12-31 | $647,209 |
| Total unrealized appreciation/depreciation of assets | 2020-12-31 | $647,209 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $3,688,480 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-12-31 | $3,404,768 |
| Total income from all sources (including contributions) | 2020-12-31 | $9,494,506 |
| Total loss/gain on sale of assets | 2020-12-31 | $3,946 |
| Total of all expenses incurred | 2020-12-31 | $8,153,813 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-12-31 | $7,705,356 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-12-31 | $8,289,486 |
| Value of total assets at end of year | 2020-12-31 | $8,747,192 |
| Value of total assets at beginning of year | 2020-12-31 | $7,122,787 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-12-31 | $448,457 |
| Total interest from all sources | 2020-12-31 | $81,753 |
| Total dividends received (eg from common stock, registered investment company shares) | 2020-12-31 | $28,254 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-12-31 | No |
| Administrative expenses professional fees incurred | 2020-12-31 | $121,445 |
| Was this plan covered by a fidelity bond | 2020-12-31 | Yes |
| Value of fidelity bond cover | 2020-12-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2020-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2020-12-31 | No |
| Contributions received from participants | 2020-12-31 | $365,469 |
| Participant contributions at end of year | 2020-12-31 | $27,052 |
| Participant contributions at beginning of year | 2020-12-31 | $29,989 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2020-12-31 | $399,562 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2020-12-31 | $78,486 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2020-12-31 | $2,941,844 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2020-12-31 | $2,775,853 |
| Other income not declared elsewhere | 2020-12-31 | $443,858 |
| Administrative expenses (other) incurred | 2020-12-31 | $31,423 |
| Liabilities. Value of operating payables at end of year | 2020-12-31 | $233,203 |
| Liabilities. Value of operating payables at beginning of year | 2020-12-31 | $109,409 |
| Total non interest bearing cash at end of year | 2020-12-31 | $1,420,767 |
| Total non interest bearing cash at beginning of year | 2020-12-31 | $933,234 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-12-31 | No |
| Value of net income/loss | 2020-12-31 | $1,340,693 |
| Value of net assets at end of year (total assets less liabilities) | 2020-12-31 | $5,058,712 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-12-31 | $3,718,019 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-12-31 | No |
| Investment advisory and management fees | 2020-12-31 | $20,789 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-12-31 | $657,333 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-12-31 | $313,130 |
| Value of interest in pooled separate accounts at end of year | 2020-12-31 | $0 |
| Income. Interest from US Government securities | 2020-12-31 | $33,641 |
| Income. Interest from corporate debt instruments | 2020-12-31 | $47,417 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-12-31 | $245,889 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-12-31 | $223,846 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-12-31 | $223,846 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-12-31 | $695 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-12-31 | $2,654,899 |
| Asset value of US Government securities at end of year | 2020-12-31 | $1,788,715 |
| Asset value of US Government securities at beginning of year | 2020-12-31 | $1,808,727 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2020-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-12-31 | No |
| Contributions received in cash from employer | 2020-12-31 | $7,924,017 |
| Employer contributions (assets) at end of year | 2020-12-31 | $682,427 |
| Employer contributions (assets) at beginning of year | 2020-12-31 | $621,284 |
| Income. Dividends from common stock | 2020-12-31 | $28,254 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-12-31 | $5,050,457 |
| Asset. Corporate debt instrument debt (other) at end of year | 2020-12-31 | $1,643,170 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2020-12-31 | $1,485,676 |
| Contract administrator fees | 2020-12-31 | $274,800 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2020-12-31 | No |
| Assets. Corporate common stocks other than exployer securities at end of year | 2020-12-31 | $1,882,277 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2020-12-31 | $1,628,415 |
| Liabilities. Value of benefit claims payable at end of year | 2020-12-31 | $513,433 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-12-31 | $519,506 |
| Did the plan have assets held for investment | 2020-12-31 | 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 | 2020-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-12-31 | No |
| Aggregate proceeds on sale of assets | 2020-12-31 | $3,159,422 |
| Aggregate carrying amount (costs) on sale of assets | 2020-12-31 | $3,155,476 |
| Opinion of an independent qualified public accountant for this plan | 2020-12-31 | Unqualified |
| Accountancy firm name | 2020-12-31 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2020-12-31 | 930809066 |
| 2019 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2019 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2019-12-31 | $359,390 |
| Total unrealized appreciation/depreciation of assets | 2019-12-31 | $359,390 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $3,404,768 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-12-31 | $3,479,164 |
| Total income from all sources (including contributions) | 2019-12-31 | $8,902,385 |
| Total loss/gain on sale of assets | 2019-12-31 | $180,528 |
| Total of all expenses incurred | 2019-12-31 | $7,977,881 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-12-31 | $7,538,137 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-12-31 | $8,248,875 |
| Value of total assets at end of year | 2019-12-31 | $7,122,787 |
| Value of total assets at beginning of year | 2019-12-31 | $6,272,679 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-12-31 | $439,744 |
| Total interest from all sources | 2019-12-31 | $86,408 |
| Total dividends received (eg from common stock, registered investment company shares) | 2019-12-31 | $27,184 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-12-31 | No |
| Administrative expenses professional fees incurred | 2019-12-31 | $111,357 |
| Was this plan covered by a fidelity bond | 2019-12-31 | Yes |
| Value of fidelity bond cover | 2019-12-31 | $3,000,000 |
| If this is an individual account plan, was there a blackout period | 2019-12-31 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2019-12-31 | No |
| Contributions received from participants | 2019-12-31 | $401,534 |
| Participant contributions at end of year | 2019-12-31 | $29,989 |
| Participant contributions at beginning of year | 2019-12-31 | $34,803 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2019-12-31 | $78,486 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-12-31 | $80,669 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2019-12-31 | $2,775,853 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2019-12-31 | $2,802,978 |
| Administrative expenses (other) incurred | 2019-12-31 | $37,721 |
| Liabilities. Value of operating payables at end of year | 2019-12-31 | $109,409 |
| Liabilities. Value of operating payables at beginning of year | 2019-12-31 | $100,497 |
| Total non interest bearing cash at end of year | 2019-12-31 | $933,234 |
| Total non interest bearing cash at beginning of year | 2019-12-31 | $994,165 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-12-31 | No |
| Value of net income/loss | 2019-12-31 | $924,504 |
| Value of net assets at end of year (total assets less liabilities) | 2019-12-31 | $3,718,019 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-12-31 | $2,793,515 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-12-31 | No |
| Investment advisory and management fees | 2019-12-31 | $15,866 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-12-31 | $313,130 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2019-12-31 | $298,666 |
| Value of interest in pooled separate accounts at end of year | 2019-12-31 | $0 |
| Income. Interest from US Government securities | 2019-12-31 | $33,382 |
| Income. Interest from corporate debt instruments | 2019-12-31 | $47,403 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-12-31 | $223,846 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-12-31 | $269,919 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-12-31 | $269,919 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-12-31 | $5,623 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-12-31 | $2,482,975 |
| Asset value of US Government securities at end of year | 2019-12-31 | $1,808,727 |
| Asset value of US Government securities at beginning of year | 2019-12-31 | $1,506,685 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-12-31 | No |
| Contributions received in cash from employer | 2019-12-31 | $7,847,341 |
| Employer contributions (assets) at end of year | 2019-12-31 | $621,284 |
| Employer contributions (assets) at beginning of year | 2019-12-31 | $651,086 |
| Income. Dividends from common stock | 2019-12-31 | $27,184 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-12-31 | $5,055,162 |
| Asset. Corporate debt instrument debt (other) at end of year | 2019-12-31 | $1,485,676 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2019-12-31 | $1,190,402 |
| Contract administrator fees | 2019-12-31 | $274,800 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2019-12-31 | No |
| Assets. Corporate common stocks other than exployer securities at end of year | 2019-12-31 | $1,628,415 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2019-12-31 | $1,246,284 |
| Liabilities. Value of benefit claims payable at end of year | 2019-12-31 | $519,506 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-12-31 | $575,689 |
| Did the plan have assets held for investment | 2019-12-31 | 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 | 2019-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-12-31 | No |
| Aggregate proceeds on sale of assets | 2019-12-31 | $2,676,207 |
| Aggregate carrying amount (costs) on sale of assets | 2019-12-31 | $2,495,679 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-12-31 | Unqualified |
| Accountancy firm name | 2019-12-31 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2019-12-31 | 930809066 |
| 2018 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2018 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2018-12-31 | $-70,374 |
| Total unrealized appreciation/depreciation of assets | 2018-12-31 | $-70,374 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $3,479,164 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-12-31 | $2,999,270 |
| Total income from all sources (including contributions) | 2018-12-31 | $7,957,335 |
| Total loss/gain on sale of assets | 2018-12-31 | $48,805 |
| Total of all expenses incurred | 2018-12-31 | $7,786,486 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-12-31 | $7,361,036 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-12-31 | $7,865,717 |
| Value of total assets at end of year | 2018-12-31 | $6,272,679 |
| Value of total assets at beginning of year | 2018-12-31 | $5,621,936 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-12-31 | $425,450 |
| Total interest from all sources | 2018-12-31 | $75,423 |
| Total dividends received (eg from common stock, registered investment company shares) | 2018-12-31 | $21,455 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-12-31 | No |
| Administrative expenses professional fees incurred | 2018-12-31 | $108,140 |
| Was this plan covered by a fidelity bond | 2018-12-31 | Yes |
| Value of fidelity bond cover | 2018-12-31 | $3,000,000 |
| 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 |
| Contributions received from participants | 2018-12-31 | $469,814 |
| Participant contributions at end of year | 2018-12-31 | $34,803 |
| Participant contributions at beginning of year | 2018-12-31 | $39,243 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-12-31 | $80,669 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2018-12-31 | $34,684 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2018-12-31 | $2,802,978 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2018-12-31 | $2,803,468 |
| Other income not declared elsewhere | 2018-12-31 | $16,309 |
| Administrative expenses (other) incurred | 2018-12-31 | $28,800 |
| Liabilities. Value of operating payables at end of year | 2018-12-31 | $100,497 |
| Liabilities. Value of operating payables at beginning of year | 2018-12-31 | $86,901 |
| Total non interest bearing cash at end of year | 2018-12-31 | $994,165 |
| Total non interest bearing cash at beginning of year | 2018-12-31 | $500,558 |
| 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 | $170,849 |
| Value of net assets at end of year (total assets less liabilities) | 2018-12-31 | $2,793,515 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-12-31 | $2,622,666 |
| 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 |
| Investment advisory and management fees | 2018-12-31 | $13,710 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2018-12-31 | $298,666 |
| Value of interest in pooled separate accounts at end of year | 2018-12-31 | $0 |
| Income. Interest from US Government securities | 2018-12-31 | $29,907 |
| Income. Interest from corporate debt instruments | 2018-12-31 | $40,738 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-12-31 | $269,919 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-12-31 | $319,208 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-12-31 | $319,208 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-12-31 | $4,778 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-12-31 | $2,784,606 |
| Asset value of US Government securities at end of year | 2018-12-31 | $1,506,685 |
| Asset value of US Government securities at beginning of year | 2018-12-31 | $1,664,503 |
| 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 |
| Contributions received in cash from employer | 2018-12-31 | $7,395,903 |
| Employer contributions (assets) at end of year | 2018-12-31 | $651,086 |
| Employer contributions (assets) at beginning of year | 2018-12-31 | $614,134 |
| Income. Dividends from common stock | 2018-12-31 | $21,455 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-12-31 | $4,576,430 |
| Asset. Corporate debt instrument debt (other) at end of year | 2018-12-31 | $1,190,402 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2018-12-31 | $1,113,492 |
| Contract administrator fees | 2018-12-31 | $274,800 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2018-12-31 | No |
| Assets. Corporate common stocks other than exployer securities at end of year | 2018-12-31 | $1,246,284 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2018-12-31 | $1,336,114 |
| Liabilities. Value of benefit claims payable at end of year | 2018-12-31 | $575,689 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-12-31 | $108,901 |
| Did the plan have assets held for investment | 2018-12-31 | 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 | 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 |
| Aggregate proceeds on sale of assets | 2018-12-31 | $1,580,878 |
| Aggregate carrying amount (costs) on sale of assets | 2018-12-31 | $1,532,073 |
| 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 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2018-12-31 | 930809066 |
| 2017 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2017 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2017-12-31 | $168,433 |
| Total unrealized appreciation/depreciation of assets | 2017-12-31 | $168,433 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $2,999,270 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-12-31 | $2,726,491 |
| Total income from all sources (including contributions) | 2017-12-31 | $7,943,719 |
| Total loss/gain on sale of assets | 2017-12-31 | $121,210 |
| Total of all expenses incurred | 2017-12-31 | $8,296,348 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-12-31 | $7,974,502 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-12-31 | $7,556,747 |
| Value of total assets at end of year | 2017-12-31 | $5,621,936 |
| Value of total assets at beginning of year | 2017-12-31 | $5,701,786 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-12-31 | $321,846 |
| Total interest from all sources | 2017-12-31 | $76,789 |
| Total dividends received (eg from common stock, registered investment company shares) | 2017-12-31 | $20,540 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-12-31 | No |
| Administrative expenses professional fees incurred | 2017-12-31 | $129,036 |
| Was this plan covered by a fidelity bond | 2017-12-31 | Yes |
| Value of fidelity bond cover | 2017-12-31 | $3,000,000 |
| 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 |
| Contributions received from participants | 2017-12-31 | $486,782 |
| Participant contributions at end of year | 2017-12-31 | $39,243 |
| Participant contributions at beginning of year | 2017-12-31 | $39,965 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2017-12-31 | $34,684 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2017-12-31 | $35,089 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2017-12-31 | $2,803,468 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2017-12-31 | $2,561,480 |
| Administrative expenses (other) incurred | 2017-12-31 | $30,810 |
| Liabilities. Value of operating payables at end of year | 2017-12-31 | $86,901 |
| Liabilities. Value of operating payables at beginning of year | 2017-12-31 | $64,365 |
| Total non interest bearing cash at end of year | 2017-12-31 | $500,558 |
| Total non interest bearing cash at beginning of year | 2017-12-31 | $388,755 |
| 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 | $-352,629 |
| Value of net assets at end of year (total assets less liabilities) | 2017-12-31 | $2,622,666 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-12-31 | $2,975,295 |
| 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 |
| Income. Interest from US Government securities | 2017-12-31 | $27,701 |
| Income. Interest from corporate debt instruments | 2017-12-31 | $47,644 |
| Value of interest in common/collective trusts at end of year | 2017-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-12-31 | $319,208 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-12-31 | $250,041 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-12-31 | $250,041 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-12-31 | $1,444 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-12-31 | $6,220,358 |
| Asset value of US Government securities at end of year | 2017-12-31 | $1,664,503 |
| Asset value of US Government securities at beginning of year | 2017-12-31 | $1,427,171 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-12-31 | Yes |
| 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 |
| Contributions received in cash from employer | 2017-12-31 | $7,069,965 |
| Employer contributions (assets) at end of year | 2017-12-31 | $614,134 |
| Employer contributions (assets) at beginning of year | 2017-12-31 | $589,533 |
| Income. Dividends from common stock | 2017-12-31 | $20,540 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-12-31 | $1,754,144 |
| Asset. Corporate debt instrument debt (other) at end of year | 2017-12-31 | $1,113,492 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2017-12-31 | $1,614,739 |
| Contract administrator fees | 2017-12-31 | $162,000 |
| Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3 | 2017-12-31 | No |
| Assets. Corporate common stocks other than exployer securities at end of year | 2017-12-31 | $1,336,114 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2017-12-31 | $1,356,493 |
| Liabilities. Value of benefit claims payable at end of year | 2017-12-31 | $108,901 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-12-31 | $100,646 |
| 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 |
| Aggregate proceeds on sale of assets | 2017-12-31 | $2,705,368 |
| Aggregate carrying amount (costs) on sale of assets | 2017-12-31 | $2,584,158 |
| 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 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2017-12-31 | 930809066 |
| 2016 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2016 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2016-12-31 | $68,499 |
| Total unrealized appreciation/depreciation of assets | 2016-12-31 | $68,499 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $2,726,491 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-12-31 | $2,541,261 |
| Total income from all sources (including contributions) | 2016-12-31 | $6,975,257 |
| Total loss/gain on sale of assets | 2016-12-31 | $-21,323 |
| Total of all expenses incurred | 2016-12-31 | $7,639,152 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-12-31 | $7,278,046 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-12-31 | $6,818,205 |
| Value of total assets at end of year | 2016-12-31 | $5,701,786 |
| Value of total assets at beginning of year | 2016-12-31 | $6,180,451 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-12-31 | $361,106 |
| Total interest from all sources | 2016-12-31 | $86,401 |
| Total dividends received (eg from common stock, registered investment company shares) | 2016-12-31 | $23,342 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-12-31 | No |
| Administrative expenses professional fees incurred | 2016-12-31 | $170,099 |
| Was this plan covered by a fidelity bond | 2016-12-31 | Yes |
| Value of fidelity bond cover | 2016-12-31 | $3,000,000 |
| 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 | $535,951 |
| Participant contributions at end of year | 2016-12-31 | $39,965 |
| Participant contributions at beginning of year | 2016-12-31 | $44,307 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2016-12-31 | $35,089 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2016-12-31 | $25,831 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2016-12-31 | $2,561,480 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2016-12-31 | $2,409,131 |
| Other income not declared elsewhere | 2016-12-31 | $133 |
| Administrative expenses (other) incurred | 2016-12-31 | $31,107 |
| Liabilities. Value of operating payables at end of year | 2016-12-31 | $64,365 |
| Liabilities. Value of operating payables at beginning of year | 2016-12-31 | $57,623 |
| Total non interest bearing cash at end of year | 2016-12-31 | $388,755 |
| Total non interest bearing cash at beginning of year | 2016-12-31 | $438,650 |
| 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 | $-663,895 |
| Value of net assets at end of year (total assets less liabilities) | 2016-12-31 | $2,975,295 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-12-31 | $3,639,190 |
| 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 |
| Income. Interest from US Government securities | 2016-12-31 | $21,702 |
| Income. Interest from corporate debt instruments | 2016-12-31 | $64,699 |
| Value of interest in common/collective trusts at end of year | 2016-12-31 | $0 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-12-31 | $250,041 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-12-31 | $265,780 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-12-31 | $265,780 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-12-31 | $5,650,487 |
| Asset value of US Government securities at end of year | 2016-12-31 | $1,427,171 |
| Asset value of US Government securities at beginning of year | 2016-12-31 | $1,739,076 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-12-31 | Yes |
| 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 |
| Contributions received in cash from employer | 2016-12-31 | $6,282,254 |
| Employer contributions (assets) at end of year | 2016-12-31 | $589,533 |
| Employer contributions (assets) at beginning of year | 2016-12-31 | $450,593 |
| Income. Dividends from common stock | 2016-12-31 | $23,342 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-12-31 | $1,627,559 |
| Asset. Corporate debt instrument debt (other) at end of year | 2016-12-31 | $1,614,739 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2016-12-31 | $1,775,487 |
| Contract administrator fees | 2016-12-31 | $159,900 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2016-12-31 | $1,356,493 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2016-12-31 | $1,440,727 |
| Liabilities. Value of benefit claims payable at end of year | 2016-12-31 | $100,646 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-12-31 | $74,507 |
| 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 |
| Aggregate proceeds on sale of assets | 2016-12-31 | $2,525,586 |
| Aggregate carrying amount (costs) on sale of assets | 2016-12-31 | $2,546,909 |
| 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 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2016-12-31 | 930809066 |
| 2015 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2015 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2015-12-31 | $7,704 |
| Total unrealized appreciation/depreciation of assets | 2015-12-31 | $7,704 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $2,541,261 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-12-31 | $2,289,682 |
| Total income from all sources (including contributions) | 2015-12-31 | $6,056,331 |
| Total loss/gain on sale of assets | 2015-12-31 | $52,227 |
| Total of all expenses incurred | 2015-12-31 | $7,099,500 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-12-31 | $6,733,889 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-12-31 | $5,870,224 |
| Value of total assets at end of year | 2015-12-31 | $6,180,451 |
| Value of total assets at beginning of year | 2015-12-31 | $6,972,041 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-12-31 | $365,611 |
| Total interest from all sources | 2015-12-31 | $97,983 |
| Total dividends received (eg from common stock, registered investment company shares) | 2015-12-31 | $22,190 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-12-31 | No |
| Administrative expenses professional fees incurred | 2015-12-31 | $182,309 |
| Was this plan covered by a fidelity bond | 2015-12-31 | Yes |
| Value of fidelity bond cover | 2015-12-31 | $3,000,000 |
| 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 | $555,979 |
| Participant contributions at end of year | 2015-12-31 | $44,307 |
| Participant contributions at beginning of year | 2015-12-31 | $44,923 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2015-12-31 | $25,831 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-12-31 | $37,060 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2015-12-31 | $2,409,131 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2015-12-31 | $2,165,144 |
| Other income not declared elsewhere | 2015-12-31 | $6,003 |
| Administrative expenses (other) incurred | 2015-12-31 | $29,702 |
| Liabilities. Value of operating payables at end of year | 2015-12-31 | $57,623 |
| Liabilities. Value of operating payables at beginning of year | 2015-12-31 | $57,684 |
| Total non interest bearing cash at end of year | 2015-12-31 | $438,650 |
| Total non interest bearing cash at beginning of year | 2015-12-31 | $312,092 |
| 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 | $-1,043,169 |
| Value of net assets at end of year (total assets less liabilities) | 2015-12-31 | $3,639,190 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-12-31 | $4,682,359 |
| 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 |
| Income. Interest from US Government securities | 2015-12-31 | $23,157 |
| Income. Interest from corporate debt instruments | 2015-12-31 | $74,820 |
| Value of interest in common/collective trusts at end 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 | $265,780 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-12-31 | $117,039 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-12-31 | $117,039 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-12-31 | $6 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-12-31 | $5,279,457 |
| Asset value of US Government securities at end of year | 2015-12-31 | $1,739,076 |
| Asset value of US Government securities at beginning of year | 2015-12-31 | $2,000,726 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-12-31 | Yes |
| 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 | $5,314,245 |
| Employer contributions (assets) at end of year | 2015-12-31 | $450,593 |
| Employer contributions (assets) at beginning of year | 2015-12-31 | $369,466 |
| Income. Dividends from common stock | 2015-12-31 | $22,190 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-12-31 | $1,454,432 |
| Asset. Corporate debt instrument debt (other) at end of year | 2015-12-31 | $1,775,487 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2015-12-31 | $2,234,333 |
| Contract administrator fees | 2015-12-31 | $153,600 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2015-12-31 | $1,440,727 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2015-12-31 | $1,856,402 |
| Liabilities. Value of benefit claims payable at end of year | 2015-12-31 | $74,507 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-12-31 | $66,854 |
| 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 |
| Aggregate proceeds on sale of assets | 2015-12-31 | $3,317,379 |
| Aggregate carrying amount (costs) on sale of assets | 2015-12-31 | $3,265,152 |
| 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 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2015-12-31 | 930809066 |
| 2014 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2014 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2014-12-31 | $400,577 |
| Total unrealized appreciation/depreciation of assets | 2014-12-31 | $400,577 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $2,289,682 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-12-31 | $2,332,924 |
| Total income from all sources (including contributions) | 2014-12-31 | $6,894,033 |
| Total loss/gain on sale of assets | 2014-12-31 | $-193,508 |
| Total of all expenses incurred | 2014-12-31 | $7,630,479 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-12-31 | $7,293,928 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-12-31 | $6,530,100 |
| Value of total assets at end of year | 2014-12-31 | $6,972,041 |
| Value of total assets at beginning of year | 2014-12-31 | $7,751,729 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-12-31 | $336,551 |
| Total interest from all sources | 2014-12-31 | $132,674 |
| Total dividends received (eg from common stock, registered investment company shares) | 2014-12-31 | $24,190 |
| 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 | $152,684 |
| Was this plan covered by a fidelity bond | 2014-12-31 | No |
| 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 | $586,134 |
| Participant contributions at end of year | 2014-12-31 | $44,923 |
| Participant contributions at beginning of year | 2014-12-31 | $50,879 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-12-31 | $37,060 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-12-31 | $43,858 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2014-12-31 | $2,165,144 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2014-12-31 | $2,165,306 |
| Administrative expenses (other) incurred | 2014-12-31 | $30,267 |
| Liabilities. Value of operating payables at end of year | 2014-12-31 | $57,684 |
| Liabilities. Value of operating payables at beginning of year | 2014-12-31 | $83,825 |
| Total non interest bearing cash at end of year | 2014-12-31 | $312,092 |
| Total non interest bearing cash at beginning of year | 2014-12-31 | $424,828 |
| 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 | $-736,446 |
| Value of net assets at end of year (total assets less liabilities) | 2014-12-31 | $4,682,359 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-12-31 | $5,418,805 |
| 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 |
| Income. Interest from US Government securities | 2014-12-31 | $15,844 |
| Income. Interest from corporate debt instruments | 2014-12-31 | $116,786 |
| Value of interest in common/collective trusts at end 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 | $117,039 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-12-31 | $383,393 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-12-31 | $383,393 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-12-31 | $44 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-12-31 | $5,746,924 |
| Asset value of US Government securities at end of year | 2014-12-31 | $2,000,726 |
| Asset value of US Government securities at beginning of year | 2014-12-31 | $1,387,523 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-12-31 | Yes |
| 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 | $5,943,966 |
| Employer contributions (assets) at end of year | 2014-12-31 | $369,466 |
| Employer contributions (assets) at beginning of year | 2014-12-31 | $545,603 |
| Income. Dividends from common stock | 2014-12-31 | $24,190 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-12-31 | $1,547,004 |
| Asset. Corporate debt instrument debt (other) at end of year | 2014-12-31 | $2,234,333 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2014-12-31 | $2,932,098 |
| Contract administrator fees | 2014-12-31 | $153,600 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2014-12-31 | $1,856,402 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2014-12-31 | $1,983,547 |
| Liabilities. Value of benefit claims payable at end of year | 2014-12-31 | $66,854 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-12-31 | $83,793 |
| Did the plan have assets held for investment | 2014-12-31 | 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 | 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 |
| Aggregate proceeds on sale of assets | 2014-12-31 | $3,401,017 |
| Aggregate carrying amount (costs) on sale of assets | 2014-12-31 | $3,594,525 |
| 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 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2014-12-31 | 930809066 |
| 2013 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2013 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2013-12-31 | $217,646 |
| Total unrealized appreciation/depreciation of assets | 2013-12-31 | $217,646 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $2,332,924 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-12-31 | $1,758,172 |
| Total income from all sources (including contributions) | 2013-12-31 | $5,988,826 |
| Total loss/gain on sale of assets | 2013-12-31 | $111,328 |
| Total of all expenses incurred | 2013-12-31 | $6,346,325 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-12-31 | $6,003,444 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-12-31 | $5,472,132 |
| Value of total assets at end of year | 2013-12-31 | $7,751,729 |
| Value of total assets at beginning of year | 2013-12-31 | $7,534,476 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-12-31 | $342,881 |
| Total interest from all sources | 2013-12-31 | $158,821 |
| Total dividends received (eg from common stock, registered investment company shares) | 2013-12-31 | $28,435 |
| 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 | $167,091 |
| Was this plan covered by a fidelity bond | 2013-12-31 | Yes |
| Value of fidelity bond cover | 2013-12-31 | $3,000,000 |
| 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 | $650,741 |
| Participant contributions at end of year | 2013-12-31 | $50,879 |
| Participant contributions at beginning of year | 2013-12-31 | $55,055 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-12-31 | $43,858 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-12-31 | $45,498 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2013-12-31 | $2,165,306 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2013-12-31 | $1,634,713 |
| Other income not declared elsewhere | 2013-12-31 | $464 |
| Administrative expenses (other) incurred | 2013-12-31 | $22,190 |
| Liabilities. Value of operating payables at end of year | 2013-12-31 | $83,825 |
| Liabilities. Value of operating payables at beginning of year | 2013-12-31 | $54,457 |
| Total non interest bearing cash at end of year | 2013-12-31 | $424,828 |
| Total non interest bearing cash at beginning of year | 2013-12-31 | $330,990 |
| 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 | $-357,499 |
| Value of net assets at end of year (total assets less liabilities) | 2013-12-31 | $5,418,805 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-12-31 | $5,776,304 |
| 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 |
| Income. Interest from US Government securities | 2013-12-31 | $20,063 |
| Income. Interest from corporate debt instruments | 2013-12-31 | $138,711 |
| 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 | $383,393 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-12-31 | $304,044 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-12-31 | $304,044 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-12-31 | $47 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-12-31 | $4,575,586 |
| Asset value of US Government securities at end of year | 2013-12-31 | $1,387,523 |
| Asset value of US Government securities at beginning of year | 2013-12-31 | $1,842,693 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-12-31 | No |
| 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 | $4,821,391 |
| Employer contributions (assets) at end of year | 2013-12-31 | $545,603 |
| Employer contributions (assets) at beginning of year | 2013-12-31 | $432,845 |
| Income. Dividends from common stock | 2013-12-31 | $28,435 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-12-31 | $1,427,858 |
| Asset. Corporate debt instrument debt (other) at end of year | 2013-12-31 | $2,932,098 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2013-12-31 | $2,654,584 |
| Contract administrator fees | 2013-12-31 | $153,600 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2013-12-31 | $1,983,547 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2013-12-31 | $1,868,767 |
| Liabilities. Value of benefit claims payable at end of year | 2013-12-31 | $83,793 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-12-31 | $69,002 |
| 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 |
| Aggregate proceeds on sale of assets | 2013-12-31 | $3,535,793 |
| Aggregate carrying amount (costs) on sale of assets | 2013-12-31 | $3,424,465 |
| 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 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2013-12-31 | 930809066 |
| 2012 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2012 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2012-12-31 | $184,741 |
| Total unrealized appreciation/depreciation of assets | 2012-12-31 | $184,741 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $1,758,172 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-12-31 | $2,304,242 |
| Total income from all sources (including contributions) | 2012-12-31 | $5,334,386 |
| Total loss/gain on sale of assets | 2012-12-31 | $17,838 |
| Total of all expenses incurred | 2012-12-31 | $5,356,202 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-12-31 | $5,040,757 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-12-31 | $4,916,437 |
| Value of total assets at end of year | 2012-12-31 | $7,534,476 |
| Value of total assets at beginning of year | 2012-12-31 | $8,102,362 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-12-31 | $315,445 |
| Total interest from all sources | 2012-12-31 | $176,261 |
| Total dividends received (eg from common stock, registered investment company shares) | 2012-12-31 | $38,740 |
| 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 | $146,315 |
| Was this plan covered by a fidelity bond | 2012-12-31 | Yes |
| Value of fidelity bond cover | 2012-12-31 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2012-12-31 | No |
| Contributions received from participants | 2012-12-31 | $936,220 |
| Participant contributions at end of year | 2012-12-31 | $55,055 |
| Participant contributions at beginning of year | 2012-12-31 | $60,564 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-12-31 | $45,498 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-12-31 | $51,258 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2012-12-31 | $1,634,713 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2012-12-31 | $2,176,119 |
| Other income not declared elsewhere | 2012-12-31 | $369 |
| Administrative expenses (other) incurred | 2012-12-31 | $18,930 |
| Liabilities. Value of operating payables at end of year | 2012-12-31 | $54,457 |
| Liabilities. Value of operating payables at beginning of year | 2012-12-31 | $51,181 |
| Total non interest bearing cash at end of year | 2012-12-31 | $330,990 |
| Total non interest bearing cash at beginning of year | 2012-12-31 | $607,848 |
| 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 | $-21,816 |
| Value of net assets at end of year (total assets less liabilities) | 2012-12-31 | $5,776,304 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-12-31 | $5,798,120 |
| 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 registered invesment companies (eg mutual funds) at beginning of year | 2012-12-31 | $90,277 |
| Income. Interest from US Government securities | 2012-12-31 | $45,688 |
| Income. Interest from corporate debt instruments | 2012-12-31 | $130,503 |
| 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 | $304,044 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-12-31 | $275,950 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-12-31 | $275,950 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-12-31 | $70 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-12-31 | $3,762,197 |
| Asset value of US Government securities at end of year | 2012-12-31 | $1,842,693 |
| Asset value of US Government securities at beginning of year | 2012-12-31 | $2,667,571 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-12-31 | Yes |
| 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 | $3,980,217 |
| Employer contributions (assets) at end of year | 2012-12-31 | $432,845 |
| Employer contributions (assets) at beginning of year | 2012-12-31 | $394,094 |
| Income. Dividends from common stock | 2012-12-31 | $38,740 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-12-31 | $1,278,560 |
| Asset. Corporate debt instrument debt (other) at end of year | 2012-12-31 | $2,654,584 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2012-12-31 | $1,930,276 |
| Contract administrator fees | 2012-12-31 | $150,200 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2012-12-31 | $1,868,767 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2012-12-31 | $2,024,524 |
| Liabilities. Value of benefit claims payable at end of year | 2012-12-31 | $69,002 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-12-31 | $76,942 |
| 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 |
| Aggregate proceeds on sale of assets | 2012-12-31 | $4,706,184 |
| Aggregate carrying amount (costs) on sale of assets | 2012-12-31 | $4,688,346 |
| 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 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2012-12-31 | 930809066 |
| 2011 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2011 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2011-12-31 | $154,367 |
| Total unrealized appreciation/depreciation of assets | 2011-12-31 | $154,367 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $2,304,242 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-12-31 | $1,633,325 |
| Total income from all sources (including contributions) | 2011-12-31 | $6,073,662 |
| Total loss/gain on sale of assets | 2011-12-31 | $-160,744 |
| Total of all expenses incurred | 2011-12-31 | $5,937,732 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-12-31 | $5,672,058 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-12-31 | $5,793,618 |
| Value of total assets at end of year | 2011-12-31 | $8,102,362 |
| Value of total assets at beginning of year | 2011-12-31 | $7,295,515 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-12-31 | $265,674 |
| Total interest from all sources | 2011-12-31 | $157,620 |
| Total dividends received (eg from common stock, registered investment company shares) | 2011-12-31 | $31,622 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-12-31 | No |
| Administrative expenses professional fees incurred | 2011-12-31 | $108,425 |
| Was this plan covered by a fidelity bond | 2011-12-31 | Yes |
| Value of fidelity bond cover | 2011-12-31 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2011-12-31 | No |
| Contributions received from participants | 2011-12-31 | $653,791 |
| Participant contributions at end of year | 2011-12-31 | $60,564 |
| Participant contributions at beginning of year | 2011-12-31 | $53,026 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-12-31 | $51,258 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-12-31 | $45,007 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2011-12-31 | $2,176,119 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2011-12-31 | $1,560,857 |
| Other income not declared elsewhere | 2011-12-31 | $97,179 |
| Administrative expenses (other) incurred | 2011-12-31 | $24,049 |
| Liabilities. Value of operating payables at end of year | 2011-12-31 | $51,181 |
| Liabilities. Value of operating payables at beginning of year | 2011-12-31 | $30,191 |
| Total non interest bearing cash at end of year | 2011-12-31 | $607,848 |
| Total non interest bearing cash at beginning of year | 2011-12-31 | $378,285 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-12-31 | No |
| Value of net income/loss | 2011-12-31 | $135,930 |
| Value of net assets at end of year (total assets less liabilities) | 2011-12-31 | $5,798,120 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-12-31 | $5,662,190 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-12-31 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-12-31 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-12-31 | No |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2011-12-31 | $90,277 |
| Income. Interest from US Government securities | 2011-12-31 | $84,562 |
| Income. Interest from corporate debt instruments | 2011-12-31 | $72,711 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-12-31 | $275,950 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-12-31 | $186,744 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-12-31 | $186,744 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-12-31 | $347 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-12-31 | $4,518,509 |
| Asset value of US Government securities at end of year | 2011-12-31 | $2,667,571 |
| Asset value of US Government securities at beginning of year | 2011-12-31 | $2,933,685 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-12-31 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-12-31 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-12-31 | No |
| Contributions received in cash from employer | 2011-12-31 | $5,139,827 |
| Employer contributions (assets) at end of year | 2011-12-31 | $394,094 |
| Employer contributions (assets) at beginning of year | 2011-12-31 | $253,970 |
| Income. Dividends from common stock | 2011-12-31 | $31,622 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-12-31 | $1,153,549 |
| Asset. Corporate debt instrument debt (other) at end of year | 2011-12-31 | $1,930,276 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2011-12-31 | $1,345,348 |
| Contract administrator fees | 2011-12-31 | $133,200 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2011-12-31 | $2,024,524 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2011-12-31 | $2,099,450 |
| Liabilities. Value of benefit claims payable at end of year | 2011-12-31 | $76,942 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-12-31 | $42,277 |
| Did the plan have assets held for investment | 2011-12-31 | 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 | 2011-12-31 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-12-31 | No |
| Aggregate proceeds on sale of assets | 2011-12-31 | $2,708,970 |
| Aggregate carrying amount (costs) on sale of assets | 2011-12-31 | $2,869,714 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-12-31 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-12-31 | Unqualified |
| Accountancy firm name | 2011-12-31 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2011-12-31 | 930809066 |
| 2010 : CEMENT MASONS - EMPLOYERS HEALTH, WELFARE AND VACATION PLAN 2010 401k financial data |
|---|
| Unrealized appreciation/depreciation of other (non real estate) assets | 2010-12-31 | $423,015 |
| Total unrealized appreciation/depreciation of assets | 2010-12-31 | $423,015 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $1,633,325 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2010-12-31 | $1,576,515 |
| Total income from all sources (including contributions) | 2010-12-31 | $4,446,559 |
| Total loss/gain on sale of assets | 2010-12-31 | $-24,028 |
| Total of all expenses incurred | 2010-12-31 | $4,518,937 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2010-12-31 | $4,261,432 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2010-12-31 | $3,842,437 |
| Value of total assets at end of year | 2010-12-31 | $7,295,515 |
| Value of total assets at beginning of year | 2010-12-31 | $7,311,083 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2010-12-31 | $257,505 |
| Total interest from all sources | 2010-12-31 | $150,869 |
| Total dividends received (eg from common stock, registered investment company shares) | 2010-12-31 | $28,835 |
| 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 | $102,829 |
| Was this plan covered by a fidelity bond | 2010-12-31 | Yes |
| Value of fidelity bond cover | 2010-12-31 | $2,000,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2010-12-31 | No |
| Contributions received from participants | 2010-12-31 | $520,262 |
| Participant contributions at end of year | 2010-12-31 | $53,026 |
| Participant contributions at beginning of year | 2010-12-31 | $41,597 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2010-12-31 | $45,007 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2010-12-31 | $57,228 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2010-12-31 | $1,560,857 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year | 2010-12-31 | $1,424,656 |
| Other income not declared elsewhere | 2010-12-31 | $25,431 |
| Administrative expenses (other) incurred | 2010-12-31 | $22,076 |
| Liabilities. Value of operating payables at end of year | 2010-12-31 | $30,191 |
| Liabilities. Value of operating payables at beginning of year | 2010-12-31 | $43,125 |
| Total non interest bearing cash at end of year | 2010-12-31 | $378,285 |
| Total non interest bearing cash at beginning of year | 2010-12-31 | $267,438 |
| 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 | $-72,378 |
| Value of net assets at end of year (total assets less liabilities) | 2010-12-31 | $5,662,190 |
| Value of net assets at beginning of year (total assets less liabilities) | 2010-12-31 | $5,734,568 |
| 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 |
| Income. Interest from US Government securities | 2010-12-31 | $58,483 |
| Income. Interest from corporate debt instruments | 2010-12-31 | $91,439 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2010-12-31 | $186,744 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2010-12-31 | $547,048 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2010-12-31 | $547,048 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2010-12-31 | $947 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2010-12-31 | $3,466,312 |
| Asset value of US Government securities at end of year | 2010-12-31 | $2,933,685 |
| Asset value of US Government securities at beginning of year | 2010-12-31 | $2,855,320 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2010-12-31 | Yes |
| 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 | $3,322,175 |
| Employer contributions (assets) at end of year | 2010-12-31 | $253,970 |
| Employer contributions (assets) at beginning of year | 2010-12-31 | $268,541 |
| Income. Dividends from common stock | 2010-12-31 | $28,835 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2010-12-31 | $795,120 |
| Asset. Corporate debt instrument debt (other) at end of year | 2010-12-31 | $1,345,348 |
| Asset. Corporate debt instrument debt (other) at beginning of year | 2010-12-31 | $1,319,973 |
| Contract administrator fees | 2010-12-31 | $132,600 |
| Assets. Corporate common stocks other than exployer securities at end of year | 2010-12-31 | $2,099,450 |
| Assets. Corporate common stocks other than exployer securities at beginning of year | 2010-12-31 | $1,953,938 |
| Liabilities. Value of benefit claims payable at end of year | 2010-12-31 | $42,277 |
| Liabilities. Value of benefit claims payable at beginning of year | 2010-12-31 | $108,734 |
| 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 |
| Aggregate proceeds on sale of assets | 2010-12-31 | $2,478,590 |
| Aggregate carrying amount (costs) on sale of assets | 2010-12-31 | $2,502,618 |
| 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 | MIDDLETON & CO., CPA, PC |
| Accountancy firm EIN | 2010-12-31 | 930809066 |
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820, S5921 |
| Policy instance | 5 |
| Insurance contract or identification number | S5820, S5921 | | Number of Individuals Covered | 11 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $12,405 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 1 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 221 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,117,425 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 2 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,830 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 3 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 517 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $22,151 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 973 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 190202956 |
| Policy instance | 14 |
| Insurance contract or identification number | 190202956 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,176 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 6 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $5,017 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 7 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Other welfare benefits provided | MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $33,928 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-00020605 |
| Policy instance | 8 |
| Insurance contract or identification number | 47-MSL-00020605 | | Number of Individuals Covered | 445 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $23,844 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001724 |
| Policy instance | 9 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1086 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40416 |
| Policy instance | 10 |
| Insurance contract or identification number | HCCLOT40416 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Total amount of commissions paid to insurance broker | USD $8,261 | | Other welfare benefits provided | TRANSPLANT COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $82,610 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | R0279725500 |
| Policy instance | 11 |
| Insurance contract or identification number | R0279725500 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,428 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| STATE FARM (National Association of Insurance Commissioners NAIC id number: 94498 ) |
| Policy contract number | HE354798 3737 |
| Policy instance | 12 |
| Insurance contract or identification number | HE354798 3737 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $4,050 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED HEALTHCARE OF TEXAS INC. (National Association of Insurance Commissioners NAIC id number: 95765 ) |
| Policy contract number | 318441497-1 |
| Policy instance | 13 |
| Insurance contract or identification number | 318441497-1 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2023-01-01 | | Insurance policy end date | 2023-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,889 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 6 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 3 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $5,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 5 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 12 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $42,765 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 983 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 3 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 492 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $21,805 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 2 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 15 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 1 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 204 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,121,578 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 7 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $15,449 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-00020605 |
| Policy instance | 8 |
| Insurance contract or identification number | 47-MSL-00020605 | | Number of Individuals Covered | 426 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $23,149 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $23,149 | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001724 |
| Policy instance | 9 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1084 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | R0279725500 |
| Policy instance | 11 |
| Insurance contract or identification number | R0279725500 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,452 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| STATE FARM (National Association of Insurance Commissioners NAIC id number: 94498 ) |
| Policy contract number | HE354798 3737 |
| Policy instance | 12 |
| Insurance contract or identification number | HE354798 3737 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED HEALTHCARE OF TEXAS INC. (National Association of Insurance Commissioners NAIC id number: 95765 ) |
| Policy contract number | 318441497-1 |
| Policy instance | 13 |
| Insurance contract or identification number | 318441497-1 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $4,148 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 190202956 |
| Policy instance | 14 |
| Insurance contract or identification number | 190202956 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40416 |
| Policy instance | 10 |
| Insurance contract or identification number | HCCLOT40416 | | Number of Individuals Covered | 426 | | Insurance policy start date | 2022-01-01 | | Insurance policy end date | 2022-12-31 | | Total amount of commissions paid to insurance broker | USD $8,049 | | Other welfare benefits provided | TRANSPLANT COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $86,180 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,049 | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001724 |
| Policy instance | 9 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1129 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-00020603 |
| Policy instance | 8 |
| Insurance contract or identification number | 47-MSL-00020603 | | Number of Individuals Covered | 442 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $29,029 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $29,029 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 6 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $5,559 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 5 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $55,131 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1015 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 3 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 520 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $22,770 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40416 |
| Policy instance | 10 |
| Insurance contract or identification number | HCCLOT40416 | | Number of Individuals Covered | 442 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $8,251 | | Other welfare benefits provided | TRANSPLANT COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $86,226 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,251 | | Insurance broker organization code? | 3 |
|
| BANKERS LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61263 ) |
| Policy contract number | 206094238 |
| Policy instance | 11 |
| Insurance contract or identification number | 206094238 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $5,191 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 7 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $18,699 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 2 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,080 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 1 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $1,299,743 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 190202956 |
| Policy instance | 15 |
| Insurance contract or identification number | 190202956 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED HEALTHCARE OF TEXAS INC. (National Association of Insurance Commissioners NAIC id number: 95765 ) |
| Policy contract number | 318441497-1 |
| Policy instance | 14 |
| Insurance contract or identification number | 318441497-1 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,448 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| STATE FARM (National Association of Insurance Commissioners NAIC id number: 94498 ) |
| Policy contract number | HE354798 3737 |
| Policy instance | 13 |
| Insurance contract or identification number | HE354798 3737 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,530 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | R0279725500 |
| Policy instance | 12 |
| Insurance contract or identification number | R0279725500 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,452 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 7 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $16,786 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 6 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $6,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 5 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 18 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $53,609 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1059 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 3 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 546 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $23,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 2 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 16 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $26,503 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 1 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 272 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,395,689 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-00020603 |
| Policy instance | 8 |
| Insurance contract or identification number | 47-MSL-00020603 | | Number of Individuals Covered | 444 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $27,701 | | Welfare Benefit Premiums Paid to Carrier | USD $692,535 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $27,701 | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001724 |
| Policy instance | 9 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1165 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 190202956 |
| Policy instance | 16 |
| Insurance contract or identification number | 190202956 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,150 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED HEALTHCARE OF TEXAS INC. (National Association of Insurance Commissioners NAIC id number: 95765 ) |
| Policy contract number | 318441497-1 |
| Policy instance | 15 |
| Insurance contract or identification number | 318441497-1 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,213 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| STATE FARM (National Association of Insurance Commissioners NAIC id number: 94498 ) |
| Policy contract number | HE354798 3737 |
| Policy instance | 14 |
| Insurance contract or identification number | HE354798 3737 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,179 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | R0279725500 |
| Policy instance | 13 |
| Insurance contract or identification number | R0279725500 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,440 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| BANKERS LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61263 ) |
| Policy contract number | 206094238 |
| Policy instance | 12 |
| Insurance contract or identification number | 206094238 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $4,286 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| ALLCARE HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 12253 ) |
| Policy contract number | 766QPM |
| Policy instance | 11 |
| Insurance contract or identification number | 766QPM | | Number of Individuals Covered | 1 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,251 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40416 |
| Policy instance | 10 |
| Insurance contract or identification number | HCCLOT40416 | | Number of Individuals Covered | 441 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $8,196 | | Other welfare benefits provided | TRANSPLANT COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $81,964 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $8,196 | | Insurance broker organization code? | 3 |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 8 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $16,861 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 7 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $8,303 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 6 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $56,382 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 5 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1049 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 4 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 529 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD&D | | Welfare Benefit Premiums Paid to Carrier | USD $22,457 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-00020602 |
| Policy instance | 9 |
| Insurance contract or identification number | 47-MSL-00020602 | | Number of Individuals Covered | 401 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $24,783 | | Welfare Benefit Premiums Paid to Carrier | USD $619,567 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $24,783 | | Insurance broker organization code? | 3 |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001724 |
| Policy instance | 10 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1188 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HCC LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 92711 ) |
| Policy contract number | HCCLOT40416 |
| Policy instance | 11 |
| Insurance contract or identification number | HCCLOT40416 | | Number of Individuals Covered | 401 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $7,703 | | Other welfare benefits provided | TRANSPLANT COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $77,035 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $7,703 | | Insurance broker organization code? | 3 |
|
| ALLCARE HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 12253 ) |
| Policy contract number | 766QPM |
| Policy instance | 12 |
| Insurance contract or identification number | 766QPM | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $1,668 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| BANKERS LIFE AND CASUALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61263 ) |
| Policy contract number | 206094238 |
| Policy instance | 13 |
| Insurance contract or identification number | 206094238 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $4,097 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| HEALTHNET (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | R0551351400 |
| Policy instance | 14 |
| Insurance contract or identification number | R0551351400 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,173 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| STATE FARM (National Association of Insurance Commissioners NAIC id number: 94498 ) |
| Policy contract number | HE354798 3737 |
| Policy instance | 15 |
| Insurance contract or identification number | HE354798 3737 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $3,122 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| UNITED HEALTHCARE OF TEXAS INC. (National Association of Insurance Commissioners NAIC id number: 95765 ) |
| Policy contract number | 313458067-1 |
| Policy instance | 16 |
| Insurance contract or identification number | 313458067-1 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MEDICARE HEALTH PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $4,438 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 3 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $29,182 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 2 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 297 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,499,969 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 100570 |
| Policy instance | 1 |
| Insurance contract or identification number | 100570 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,785 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 2 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 323 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,612,617 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 3 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $45,075 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 4 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 487 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $20,759 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 5 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1195 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 6 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $53,555 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 8 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $19,925 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| BERKSHIRE HATHAWAY SPECIALTY INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 22276 ) |
| Policy contract number | 47-MSL-00020601 |
| Policy instance | 9 |
| Insurance contract or identification number | 47-MSL-00020601 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $20,630 | | Welfare Benefit Premiums Paid to Carrier | USD $515,750 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $20,630 | | Insurance broker organization code? | 3 |
|
| NATIONAL UNION (National Association of Insurance Commissioners NAIC id number: 19445 ) |
| Policy contract number | 947-6308 |
| Policy instance | 10 |
| Insurance contract or identification number | 947-6308 | | Number of Individuals Covered | 398 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $6,789 | | Other welfare benefits provided | TRANSPLANT COVERAGE | | Welfare Benefit Premiums Paid to Carrier | USD $67,888 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $6,789 | | Insurance broker organization code? | 3 |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 100570 |
| Policy instance | 1 |
| Insurance contract or identification number | 100570 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,918 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 7 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $11,620 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 6 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $50,188 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 8 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 19 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $17,189 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 4 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 449 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,980 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 3 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 22 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $52,550 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 2 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 332 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,613,337 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 100570 |
| Policy instance | 1 |
| Insurance contract or identification number | 100570 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,235 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 5 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 994 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 7 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $11,236 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 2 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 335 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,535,772 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 8 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $13,544 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 100570 |
| Policy instance | 1 |
| Insurance contract or identification number | 100570 | | Number of Individuals Covered | 6 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $24,000 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 4 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 423 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $16,472 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 5 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 1100 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 6 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 21 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $45,903 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 7 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $10,100 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 3 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $54,852 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 105316 |
| Policy instance | 5 |
| Insurance contract or identification number | 105316 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,907 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 4 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 436 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $17,653 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 3 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 32 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $66,205 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 2 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 400 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $1,446,478 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 100570 |
| Policy instance | 1 |
| Insurance contract or identification number | 100570 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,384 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 8 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $10,570 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820/S5921 |
| Policy instance | 9 |
| Insurance contract or identification number | S5820/S5921 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $11,889 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 6 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 321 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 7 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $57,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 10 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $11,219 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 9 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | MED ADVANTAGE PLAN (MEDICARE MEMB.) | | Welfare Benefit Premiums Paid to Carrier | USD $8,406 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1485 |
| Policy instance | 8 |
| Insurance contract or identification number | 1485 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $241,053 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 7 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 36 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $54,396 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MODA HEALTH (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 6 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 328 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 105316 |
| Policy instance | 5 |
| Insurance contract or identification number | 105316 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,064 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 4 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 412 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,604 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 3 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 37 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $59,970 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 2 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 277 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $829,321 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 100570 |
| Policy instance | 1 |
| Insurance contract or identification number | 100570 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,042 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 1 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $10,902 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 9 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 227 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $757,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 8 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 39 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $56,109 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 7 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 348 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $14,960 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 105316 |
| Policy instance | 6 |
| Insurance contract or identification number | 105316 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,435 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 5 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 293 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 4 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 23 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $52,088 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1485 |
| Policy instance | 3 |
| Insurance contract or identification number | 1485 | | Number of Individuals Covered | 82 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $299,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 2 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Other welfare benefits provided | AARP MEDICARE RX | | Welfare Benefit Premiums Paid to Carrier | USD $8,991 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 100570 |
| Policy instance | 10 |
| Insurance contract or identification number | 100570 | | Number of Individuals Covered | 8 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,690 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 9 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 427 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,146 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 5 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 99 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $285,702 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 6 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 24 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $54,721 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 7 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 275 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001724 |
| Policy instance | 1 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 339 | | Insurance policy start date | 2010-08-01 | | Insurance policy end date | 2011-07-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 100570 |
| Policy instance | 12 |
| Insurance contract or identification number | 100570 | | Number of Individuals Covered | 9 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $29,634 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 6130 |
| Policy instance | 3 |
| Insurance contract or identification number | 6130 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Other welfare benefits provided | AARP MEDICARE RX | | Welfare Benefit Premiums Paid to Carrier | USD $8,442 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | S5820 |
| Policy instance | 2 |
| Insurance contract or identification number | S5820 | | Number of Individuals Covered | 25 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Welfare Benefit Premiums Paid to Carrier | USD $7,753 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 105316 |
| Policy instance | 8 |
| Insurance contract or identification number | 105316 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $6,105 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 40000002 |
| Policy instance | 10 |
| Insurance contract or identification number | 40000002 | | Number of Individuals Covered | 42 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $56,877 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 11 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 265 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $720,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 4 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 184 | | Insurance policy start date | 2011-01-01 | | Insurance policy end date | 2011-12-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $11,185 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 13540 |
| Policy instance | 11 |
| Insurance contract or identification number | 13540 | | Number of Individuals Covered | 20 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $59,695 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR054170 |
| Policy instance | 2 |
| Insurance contract or identification number | OR054170 | | Number of Individuals Covered | 194 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $13,948 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1485 |
| Policy instance | 3 |
| Insurance contract or identification number | 1485 | | Number of Individuals Covered | 95 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $279,946 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF WASHINGTON, INC. (National Association of Insurance Commissioners NAIC id number: 48038 ) |
| Policy contract number | 006130 |
| Policy instance | 12 |
| Insurance contract or identification number | 006130 | | Number of Individuals Covered | 2 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $7,538 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE OF OREGON, INC. (National Association of Insurance Commissioners NAIC id number: 95893 ) |
| Policy contract number | 005825 |
| Policy instance | 13 |
| Insurance contract or identification number | 005825 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $633 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 100570 |
| Policy instance | 14 |
| Insurance contract or identification number | 100570 | | Number of Individuals Covered | 13 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,754 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| REGENCE BLUECROSS BLUESHIELD OF OREGON (National Association of Insurance Commissioners NAIC id number: 54933 ) |
| Policy contract number | 222600 |
| Policy instance | 10 |
| Insurance contract or identification number | 222600 | | Number of Individuals Covered | 40 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Other welfare benefits provided | EMPLOYER SPONSORED MEDICARE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $84,010 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFEMAP ASSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 97985 ) |
| Policy contract number | OR052647 |
| Policy instance | 9 |
| Insurance contract or identification number | OR052647 | | Number of Individuals Covered | 282 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $10,707 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| PROVIDENCE HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 95005 ) |
| Policy contract number | 105316 |
| Policy instance | 8 |
| Insurance contract or identification number | 105316 | | Number of Individuals Covered | 1 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $5,843 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| OREGON DENTAL SERVICE (National Association of Insurance Commissioners NAIC id number: 54941 ) |
| Policy contract number | 10001724 |
| Policy instance | 7 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 300 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Dental Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000787 |
| Policy instance | 6 |
| Insurance contract or identification number | 0000787 | | Number of Individuals Covered | 28 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Health Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AARP MEDICARE SUPPLEMENT | | Welfare Benefit Premiums Paid to Carrier | USD $47,069 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF THE NORTHWEST (National Association of Insurance Commissioners NAIC id number: 95540 ) |
| Policy contract number | 1158 |
| Policy instance | 5 |
| Insurance contract or identification number | 1158 | | Number of Individuals Covered | 208 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Health Insurance Welfare Benefit | Yes | | Dental Insurance Welfare Benefit | Yes | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $621,230 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| ODS HEALTH PLAN (National Association of Insurance Commissioners NAIC id number: 47098 ) |
| Policy contract number | 10001724 |
| Policy instance | 4 |
| Insurance contract or identification number | 10001724 | | Number of Individuals Covered | 243 | | Insurance policy start date | 2009-08-01 | | Insurance policy end date | 2010-07-31 | | Health Insurance Welfare Benefit | Yes | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| UNITEDHEALTHCARE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 79413 ) |
| Policy contract number | 0000165 |
| Policy instance | 1 |
| Insurance contract or identification number | 0000165 | | Number of Individuals Covered | 27 | | Insurance policy start date | 2010-01-01 | | Insurance policy end date | 2010-12-31 | | Other welfare benefits provided | AARP MEDICARE RX | | Welfare Benefit Premiums Paid to Carrier | USD $14,737 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Total amount of commissions paid to insurance broker | USD $15,736 | | Total amount of fees paid to insurance company | USD $1,914 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | Yes | | 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 | | Commission paid to Insurance Broker | USD $15,736 | | Amount paid for insurance broker fees | 1914 | | Additional information about fees paid to insurance broker | BONUS | | Insurance broker organization code? | 3 |
|
