CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS (LOCAL 164B) W has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN
401k plan membership statisitcs for CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN
| Measure | Date | Value |
|---|
| 2022 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2022 401k financial data |
|---|
| Total unrealized appreciation/depreciation of assets | 2022-09-30 | $0 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-09-30 | $206,936 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2022-09-30 | $52,830 |
| Total income from all sources (including contributions) | 2022-09-30 | $3,890,745 |
| Total loss/gain on sale of assets | 2022-09-30 | $0 |
| Total of all expenses incurred | 2022-09-30 | $4,167,315 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2022-09-30 | $3,963,970 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2022-09-30 | $3,857,860 |
| Value of total assets at end of year | 2022-09-30 | $7,090,190 |
| Value of total assets at beginning of year | 2022-09-30 | $7,212,654 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2022-09-30 | $203,345 |
| Total interest from all sources | 2022-09-30 | $32,885 |
| Total dividends received (eg from common stock, registered investment company shares) | 2022-09-30 | $0 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2022-09-30 | No |
| Administrative expenses professional fees incurred | 2022-09-30 | $72,432 |
| Was this plan covered by a fidelity bond | 2022-09-30 | Yes |
| Value of fidelity bond cover | 2022-09-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2022-09-30 | No |
| Contributions received from participants | 2022-09-30 | $260,539 |
| Participant contributions at end of year | 2022-09-30 | $17,580 |
| Participant contributions at beginning of year | 2022-09-30 | $15,480 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2022-09-30 | $9,156 |
| Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year | 2022-09-30 | $155,434 |
| Administrative expenses (other) incurred | 2022-09-30 | $4,068 |
| Liabilities. Value of operating payables at end of year | 2022-09-30 | $14,011 |
| Liabilities. Value of operating payables at beginning of year | 2022-09-30 | $22,474 |
| Total non interest bearing cash at end of year | 2022-09-30 | $24,853 |
| Total non interest bearing cash at beginning of year | 2022-09-30 | $11,290 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2022-09-30 | No |
| Value of net income/loss | 2022-09-30 | $-276,570 |
| Value of net assets at end of year (total assets less liabilities) | 2022-09-30 | $6,883,254 |
| Value of net assets at beginning of year (total assets less liabilities) | 2022-09-30 | $7,159,824 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2022-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2022-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2022-09-30 | No |
| Investment advisory and management fees | 2022-09-30 | $12,727 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2022-09-30 | $426,721 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2022-09-30 | $326,251 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2022-09-30 | $6,333,579 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2022-09-30 | $6,561,359 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2022-09-30 | $6,561,359 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2022-09-30 | $32,885 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2022-09-30 | $3,959,943 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2022-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2022-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2022-09-30 | No |
| Contributions received in cash from employer | 2022-09-30 | $3,597,321 |
| Employer contributions (assets) at end of year | 2022-09-30 | $287,457 |
| Employer contributions (assets) at beginning of year | 2022-09-30 | $289,118 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2022-09-30 | $4,027 |
| Contract administrator fees | 2022-09-30 | $114,118 |
| Liabilities. Value of benefit claims payable at end of year | 2022-09-30 | $37,491 |
| Liabilities. Value of benefit claims payable at beginning of year | 2022-09-30 | $30,356 |
| Did the plan have assets held for investment | 2022-09-30 | 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 | 2022-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2022-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2022-09-30 | Unqualified |
| Accountancy firm name | 2022-09-30 | WITHUMSMITH+BROWN, PC |
| Accountancy firm EIN | 2022-09-30 | 222027092 |
| 2021 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2021 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-09-30 | $52,830 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2021-09-30 | $35,128 |
| Total income from all sources (including contributions) | 2021-09-30 | $3,847,363 |
| Total of all expenses incurred | 2021-09-30 | $3,886,986 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2021-09-30 | $3,680,902 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2021-09-30 | $3,784,628 |
| Value of total assets at end of year | 2021-09-30 | $7,212,654 |
| Value of total assets at beginning of year | 2021-09-30 | $7,234,575 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2021-09-30 | $206,084 |
| Total interest from all sources | 2021-09-30 | $44,423 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2021-09-30 | No |
| Administrative expenses professional fees incurred | 2021-09-30 | $74,265 |
| Was this plan covered by a fidelity bond | 2021-09-30 | Yes |
| Value of fidelity bond cover | 2021-09-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2021-09-30 | No |
| Contributions received from participants | 2021-09-30 | $201,792 |
| Participant contributions at end of year | 2021-09-30 | $15,480 |
| Participant contributions at beginning of year | 2021-09-30 | $15,220 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2021-09-30 | $9,156 |
| Other income not declared elsewhere | 2021-09-30 | $18,312 |
| Administrative expenses (other) incurred | 2021-09-30 | $4,217 |
| Liabilities. Value of operating payables at end of year | 2021-09-30 | $22,474 |
| Liabilities. Value of operating payables at beginning of year | 2021-09-30 | $14,671 |
| Total non interest bearing cash at end of year | 2021-09-30 | $11,290 |
| Total non interest bearing cash at beginning of year | 2021-09-30 | $22,574 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2021-09-30 | No |
| Value of net income/loss | 2021-09-30 | $-39,623 |
| Value of net assets at end of year (total assets less liabilities) | 2021-09-30 | $7,159,824 |
| Value of net assets at beginning of year (total assets less liabilities) | 2021-09-30 | $7,199,447 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2021-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2021-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2021-09-30 | No |
| Investment advisory and management fees | 2021-09-30 | $13,010 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2021-09-30 | $326,251 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2021-09-30 | $188,145 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2021-09-30 | $6,561,359 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2021-09-30 | $6,721,308 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2021-09-30 | $6,721,308 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2021-09-30 | $44,423 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2021-09-30 | $3,675,021 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2021-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2021-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2021-09-30 | No |
| Contributions received in cash from employer | 2021-09-30 | $3,582,836 |
| Employer contributions (assets) at end of year | 2021-09-30 | $289,118 |
| Employer contributions (assets) at beginning of year | 2021-09-30 | $287,328 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2021-09-30 | $5,881 |
| Contract administrator fees | 2021-09-30 | $114,592 |
| Liabilities. Value of benefit claims payable at end of year | 2021-09-30 | $30,356 |
| Liabilities. Value of benefit claims payable at beginning of year | 2021-09-30 | $20,457 |
| Did the plan have assets held for investment | 2021-09-30 | 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 | 2021-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2021-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2021-09-30 | Unqualified |
| Accountancy firm name | 2021-09-30 | WITHUMSMITH+BROWN, PC |
| Accountancy firm EIN | 2021-09-30 | 222027092 |
| 2020 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2020 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-09-30 | $35,128 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2020-09-30 | $50,997 |
| Total income from all sources (including contributions) | 2020-09-30 | $3,826,432 |
| Total of all expenses incurred | 2020-09-30 | $3,636,844 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2020-09-30 | $3,417,704 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2020-09-30 | $3,692,300 |
| Value of total assets at end of year | 2020-09-30 | $7,234,575 |
| Value of total assets at beginning of year | 2020-09-30 | $7,060,856 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2020-09-30 | $219,140 |
| Total interest from all sources | 2020-09-30 | $134,132 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2020-09-30 | No |
| Administrative expenses professional fees incurred | 2020-09-30 | $89,976 |
| Was this plan covered by a fidelity bond | 2020-09-30 | Yes |
| Value of fidelity bond cover | 2020-09-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2020-09-30 | No |
| Contributions received from participants | 2020-09-30 | $198,923 |
| Participant contributions at end of year | 2020-09-30 | $15,220 |
| Participant contributions at beginning of year | 2020-09-30 | $10,671 |
| Administrative expenses (other) incurred | 2020-09-30 | $3,998 |
| Liabilities. Value of operating payables at end of year | 2020-09-30 | $14,671 |
| Liabilities. Value of operating payables at beginning of year | 2020-09-30 | $21,593 |
| Total non interest bearing cash at end of year | 2020-09-30 | $22,574 |
| Total non interest bearing cash at beginning of year | 2020-09-30 | $25,333 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2020-09-30 | No |
| Value of net income/loss | 2020-09-30 | $189,588 |
| Value of net assets at end of year (total assets less liabilities) | 2020-09-30 | $7,199,447 |
| Value of net assets at beginning of year (total assets less liabilities) | 2020-09-30 | $7,009,859 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2020-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2020-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2020-09-30 | No |
| Investment advisory and management fees | 2020-09-30 | $12,401 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2020-09-30 | $188,145 |
| Value of interest in registered invesment companies (eg mutual funds) at beginning of year | 2020-09-30 | $266,643 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2020-09-30 | $6,721,308 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2020-09-30 | $6,459,765 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2020-09-30 | $6,459,765 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2020-09-30 | $134,132 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2020-09-30 | $3,411,765 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2020-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2020-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2020-09-30 | No |
| Contributions received in cash from employer | 2020-09-30 | $3,493,377 |
| Employer contributions (assets) at end of year | 2020-09-30 | $287,328 |
| Employer contributions (assets) at beginning of year | 2020-09-30 | $298,444 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2020-09-30 | $5,939 |
| Contract administrator fees | 2020-09-30 | $112,765 |
| Liabilities. Value of benefit claims payable at end of year | 2020-09-30 | $20,457 |
| Liabilities. Value of benefit claims payable at beginning of year | 2020-09-30 | $29,404 |
| Did the plan have assets held for investment | 2020-09-30 | 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 | 2020-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2020-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2020-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2020-09-30 | Unqualified |
| Accountancy firm name | 2020-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2020-09-30 | 522385296 |
| 2019 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2019 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-09-30 | $50,997 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2019-09-30 | $35,356 |
| Total income from all sources (including contributions) | 2019-09-30 | $4,248,176 |
| Total of all expenses incurred | 2019-09-30 | $3,914,523 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2019-09-30 | $3,685,986 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2019-09-30 | $4,103,956 |
| Value of total assets at end of year | 2019-09-30 | $7,060,856 |
| Value of total assets at beginning of year | 2019-09-30 | $6,711,562 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2019-09-30 | $228,537 |
| Total interest from all sources | 2019-09-30 | $144,220 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2019-09-30 | No |
| Administrative expenses professional fees incurred | 2019-09-30 | $93,774 |
| Was this plan covered by a fidelity bond | 2019-09-30 | Yes |
| Value of fidelity bond cover | 2019-09-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2019-09-30 | No |
| Contributions received from participants | 2019-09-30 | $281,034 |
| Participant contributions at end of year | 2019-09-30 | $10,671 |
| Participant contributions at beginning of year | 2019-09-30 | $31,757 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2019-09-30 | $33,996 |
| Administrative expenses (other) incurred | 2019-09-30 | $7,622 |
| Liabilities. Value of operating payables at end of year | 2019-09-30 | $21,593 |
| Liabilities. Value of operating payables at beginning of year | 2019-09-30 | $22,865 |
| Total non interest bearing cash at end of year | 2019-09-30 | $25,333 |
| Total non interest bearing cash at beginning of year | 2019-09-30 | $29,297 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2019-09-30 | No |
| Value of net income/loss | 2019-09-30 | $333,653 |
| Value of net assets at end of year (total assets less liabilities) | 2019-09-30 | $7,009,859 |
| Value of net assets at beginning of year (total assets less liabilities) | 2019-09-30 | $6,676,206 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2019-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2019-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2019-09-30 | No |
| Investment advisory and management fees | 2019-09-30 | $11,533 |
| Value of interest in registered invesment companies (eg mutual funds) at end of year | 2019-09-30 | $266,643 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2019-09-30 | $6,459,765 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2019-09-30 | $6,141,775 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2019-09-30 | $6,141,775 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2019-09-30 | $144,220 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2019-09-30 | $3,677,480 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2019-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2019-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2019-09-30 | No |
| Contributions received in cash from employer | 2019-09-30 | $3,822,922 |
| Employer contributions (assets) at end of year | 2019-09-30 | $298,444 |
| Employer contributions (assets) at beginning of year | 2019-09-30 | $474,737 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2019-09-30 | $8,506 |
| Contract administrator fees | 2019-09-30 | $115,608 |
| Liabilities. Value of benefit claims payable at end of year | 2019-09-30 | $29,404 |
| Liabilities. Value of benefit claims payable at beginning of year | 2019-09-30 | $12,491 |
| Did the plan have assets held for investment | 2019-09-30 | 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 | 2019-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2019-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2019-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2019-09-30 | Unqualified |
| Accountancy firm name | 2019-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2019-09-30 | 522385296 |
| 2018 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2018 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-09-30 | $35,356 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2018-09-30 | $81,281 |
| Total income from all sources (including contributions) | 2018-09-30 | $5,488,920 |
| Total of all expenses incurred | 2018-09-30 | $4,956,786 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2018-09-30 | $4,684,395 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2018-09-30 | $5,397,486 |
| Value of total assets at end of year | 2018-09-30 | $6,711,562 |
| Value of total assets at beginning of year | 2018-09-30 | $6,225,353 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2018-09-30 | $272,391 |
| Total interest from all sources | 2018-09-30 | $91,434 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2018-09-30 | No |
| Administrative expenses professional fees incurred | 2018-09-30 | $144,617 |
| Was this plan covered by a fidelity bond | 2018-09-30 | Yes |
| Value of fidelity bond cover | 2018-09-30 | $500,000 |
| Were there any nonexempt tranactions with any party-in-interest | 2018-09-30 | No |
| Contributions received from participants | 2018-09-30 | $416,893 |
| Participant contributions at end of year | 2018-09-30 | $31,757 |
| Participant contributions at beginning of year | 2018-09-30 | $31,757 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2018-09-30 | $33,996 |
| Administrative expenses (other) incurred | 2018-09-30 | $1,466 |
| Liabilities. Value of operating payables at end of year | 2018-09-30 | $22,865 |
| Liabilities. Value of operating payables at beginning of year | 2018-09-30 | $40,558 |
| Total non interest bearing cash at end of year | 2018-09-30 | $29,297 |
| Total non interest bearing cash at beginning of year | 2018-09-30 | $26,301 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2018-09-30 | No |
| Value of net income/loss | 2018-09-30 | $532,134 |
| Value of net assets at end of year (total assets less liabilities) | 2018-09-30 | $6,676,206 |
| Value of net assets at beginning of year (total assets less liabilities) | 2018-09-30 | $6,144,072 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2018-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2018-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2018-09-30 | No |
| Investment advisory and management fees | 2018-09-30 | $10,335 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2018-09-30 | $6,141,775 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2018-09-30 | $5,755,462 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2018-09-30 | $5,755,462 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2018-09-30 | $91,434 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2018-09-30 | $4,673,100 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2018-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2018-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2018-09-30 | No |
| Contributions received in cash from employer | 2018-09-30 | $4,980,593 |
| Employer contributions (assets) at end of year | 2018-09-30 | $474,737 |
| Employer contributions (assets) at beginning of year | 2018-09-30 | $411,833 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2018-09-30 | $11,295 |
| Contract administrator fees | 2018-09-30 | $115,973 |
| Liabilities. Value of benefit claims payable at end of year | 2018-09-30 | $12,491 |
| Liabilities. Value of benefit claims payable at beginning of year | 2018-09-30 | $40,723 |
| Did the plan have assets held for investment | 2018-09-30 | 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 | 2018-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2018-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2018-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2018-09-30 | Unqualified |
| Accountancy firm name | 2018-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2018-09-30 | 522385296 |
| 2017 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2017 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-09-30 | $81,281 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2017-09-30 | $48,752 |
| Total income from all sources (including contributions) | 2017-09-30 | $4,639,356 |
| Total of all expenses incurred | 2017-09-30 | $4,704,875 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2017-09-30 | $4,458,642 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2017-09-30 | $4,570,091 |
| Value of total assets at end of year | 2017-09-30 | $6,225,353 |
| Value of total assets at beginning of year | 2017-09-30 | $6,258,343 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2017-09-30 | $246,233 |
| Total interest from all sources | 2017-09-30 | $69,265 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2017-09-30 | No |
| Administrative expenses professional fees incurred | 2017-09-30 | $114,882 |
| Was this plan covered by a fidelity bond | 2017-09-30 | Yes |
| Value of fidelity bond cover | 2017-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2017-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2017-09-30 | No |
| Contributions received from participants | 2017-09-30 | $424,357 |
| Participant contributions at end of year | 2017-09-30 | $31,757 |
| Participant contributions at beginning of year | 2017-09-30 | $10,326 |
| Administrative expenses (other) incurred | 2017-09-30 | $1,977 |
| Liabilities. Value of operating payables at end of year | 2017-09-30 | $40,558 |
| Liabilities. Value of operating payables at beginning of year | 2017-09-30 | $15,570 |
| Total non interest bearing cash at end of year | 2017-09-30 | $26,301 |
| Total non interest bearing cash at beginning of year | 2017-09-30 | $14,070 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2017-09-30 | No |
| Value of net income/loss | 2017-09-30 | $-65,519 |
| Value of net assets at end of year (total assets less liabilities) | 2017-09-30 | $6,144,072 |
| Value of net assets at beginning of year (total assets less liabilities) | 2017-09-30 | $6,209,591 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2017-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2017-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2017-09-30 | No |
| Investment advisory and management fees | 2017-09-30 | $10,576 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2017-09-30 | $5,755,462 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2017-09-30 | $5,838,253 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2017-09-30 | $5,838,253 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2017-09-30 | $69,265 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2017-09-30 | $4,448,867 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2017-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2017-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2017-09-30 | No |
| Contributions received in cash from employer | 2017-09-30 | $4,145,734 |
| Employer contributions (assets) at end of year | 2017-09-30 | $411,833 |
| Employer contributions (assets) at beginning of year | 2017-09-30 | $395,694 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2017-09-30 | $9,775 |
| Contract administrator fees | 2017-09-30 | $118,798 |
| 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 | 2017-09-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2017-09-30 | $40,723 |
| Liabilities. Value of benefit claims payable at beginning of year | 2017-09-30 | $33,182 |
| Did the plan have assets held for investment | 2017-09-30 | 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 | 2017-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2017-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2017-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2017-09-30 | Unqualified |
| Accountancy firm name | 2017-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2017-09-30 | 522385296 |
| 2016 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2016 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-09-30 | $48,752 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2016-09-30 | $53,976 |
| Total income from all sources (including contributions) | 2016-09-30 | $4,423,045 |
| Total of all expenses incurred | 2016-09-30 | $5,297,691 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2016-09-30 | $5,060,204 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2016-09-30 | $4,361,181 |
| Value of total assets at end of year | 2016-09-30 | $6,258,343 |
| Value of total assets at beginning of year | 2016-09-30 | $7,138,213 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2016-09-30 | $237,487 |
| Total interest from all sources | 2016-09-30 | $61,220 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2016-09-30 | No |
| Administrative expenses professional fees incurred | 2016-09-30 | $98,872 |
| Was this plan covered by a fidelity bond | 2016-09-30 | Yes |
| Value of fidelity bond cover | 2016-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2016-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2016-09-30 | No |
| Contributions received from participants | 2016-09-30 | $322,762 |
| Participant contributions at end of year | 2016-09-30 | $10,326 |
| Participant contributions at beginning of year | 2016-09-30 | $38,466 |
| Other income not declared elsewhere | 2016-09-30 | $644 |
| Administrative expenses (other) incurred | 2016-09-30 | $11,873 |
| Liabilities. Value of operating payables at end of year | 2016-09-30 | $15,570 |
| Liabilities. Value of operating payables at beginning of year | 2016-09-30 | $24,360 |
| Total non interest bearing cash at end of year | 2016-09-30 | $14,070 |
| Total non interest bearing cash at beginning of year | 2016-09-30 | $13,542 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2016-09-30 | No |
| Value of net income/loss | 2016-09-30 | $-874,646 |
| Value of net assets at end of year (total assets less liabilities) | 2016-09-30 | $6,209,591 |
| Value of net assets at beginning of year (total assets less liabilities) | 2016-09-30 | $7,084,237 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2016-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2016-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2016-09-30 | No |
| Investment advisory and management fees | 2016-09-30 | $10,593 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2016-09-30 | $5,838,253 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2016-09-30 | $6,548,452 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2016-09-30 | $6,548,452 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2016-09-30 | $61,220 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2016-09-30 | $5,049,146 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2016-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2016-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2016-09-30 | No |
| Contributions received in cash from employer | 2016-09-30 | $4,038,419 |
| Employer contributions (assets) at end of year | 2016-09-30 | $395,694 |
| Employer contributions (assets) at beginning of year | 2016-09-30 | $537,753 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2016-09-30 | $11,058 |
| Contract administrator fees | 2016-09-30 | $116,149 |
| 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 | 2016-09-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2016-09-30 | $33,182 |
| Liabilities. Value of benefit claims payable at beginning of year | 2016-09-30 | $29,616 |
| Did the plan have assets held for investment | 2016-09-30 | 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 | 2016-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2016-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2016-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2016-09-30 | Unqualified |
| Accountancy firm name | 2016-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2016-09-30 | 522385296 |
| 2015 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2015 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-09-30 | $53,976 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2015-09-30 | $77,224 |
| Total income from all sources (including contributions) | 2015-09-30 | $8,894,214 |
| Total of all expenses incurred | 2015-09-30 | $7,571,082 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2015-09-30 | $7,346,421 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2015-09-30 | $8,764,422 |
| Value of total assets at end of year | 2015-09-30 | $7,138,213 |
| Value of total assets at beginning of year | 2015-09-30 | $5,838,329 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2015-09-30 | $224,661 |
| Total interest from all sources | 2015-09-30 | $35,330 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2015-09-30 | No |
| Administrative expenses professional fees incurred | 2015-09-30 | $87,493 |
| Was this plan covered by a fidelity bond | 2015-09-30 | Yes |
| Value of fidelity bond cover | 2015-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2015-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2015-09-30 | No |
| Contributions received from participants | 2015-09-30 | $588,180 |
| Participant contributions at end of year | 2015-09-30 | $38,466 |
| Participant contributions at beginning of year | 2015-09-30 | $51,805 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2015-09-30 | $95,811 |
| Other income not declared elsewhere | 2015-09-30 | $94,462 |
| Administrative expenses (other) incurred | 2015-09-30 | $5,150 |
| Liabilities. Value of operating payables at end of year | 2015-09-30 | $24,360 |
| Liabilities. Value of operating payables at beginning of year | 2015-09-30 | $17,529 |
| Total non interest bearing cash at end of year | 2015-09-30 | $13,542 |
| Total non interest bearing cash at beginning of year | 2015-09-30 | $23,190 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2015-09-30 | No |
| Value of net income/loss | 2015-09-30 | $1,323,132 |
| Value of net assets at end of year (total assets less liabilities) | 2015-09-30 | $7,084,237 |
| Value of net assets at beginning of year (total assets less liabilities) | 2015-09-30 | $5,761,105 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2015-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2015-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2015-09-30 | No |
| Investment advisory and management fees | 2015-09-30 | $6,682 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2015-09-30 | $6,548,452 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2015-09-30 | $4,895,049 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2015-09-30 | $4,895,049 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2015-09-30 | $35,330 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2015-09-30 | $7,336,776 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2015-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2015-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2015-09-30 | No |
| Contributions received in cash from employer | 2015-09-30 | $8,176,242 |
| Employer contributions (assets) at end of year | 2015-09-30 | $537,753 |
| Employer contributions (assets) at beginning of year | 2015-09-30 | $772,474 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2015-09-30 | $9,645 |
| Contract administrator fees | 2015-09-30 | $125,336 |
| 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 | 2015-09-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2015-09-30 | $29,616 |
| Liabilities. Value of benefit claims payable at beginning of year | 2015-09-30 | $59,695 |
| Did the plan have assets held for investment | 2015-09-30 | 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 | 2015-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2015-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2015-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2015-09-30 | Unqualified |
| Accountancy firm name | 2015-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2015-09-30 | 522385296 |
| 2014 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2014 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-09-30 | $77,224 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-09-30 | $71,013 |
| Total income from all sources (including contributions) | 2014-09-30 | $9,502,592 |
| Total of all expenses incurred | 2014-09-30 | $7,931,549 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-09-30 | $7,741,131 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-09-30 | $9,326,520 |
| Value of total assets at end of year | 2014-09-30 | $5,838,329 |
| Value of total assets at beginning of year | 2014-09-30 | $4,261,075 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-09-30 | $190,418 |
| Total interest from all sources | 2014-09-30 | $6,915 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-09-30 | No |
| Administrative expenses professional fees incurred | 2014-09-30 | $61,327 |
| Was this plan covered by a fidelity bond | 2014-09-30 | Yes |
| Value of fidelity bond cover | 2014-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-09-30 | No |
| Contributions received from participants | 2014-09-30 | $623,770 |
| Participant contributions at end of year | 2014-09-30 | $51,805 |
| Participant contributions at beginning of year | 2014-09-30 | $43,790 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2014-09-30 | $95,811 |
| Other income not declared elsewhere | 2014-09-30 | $169,157 |
| Administrative expenses (other) incurred | 2014-09-30 | $6,172 |
| Liabilities. Value of operating payables at end of year | 2014-09-30 | $17,529 |
| Liabilities. Value of operating payables at beginning of year | 2014-09-30 | $17,536 |
| Total non interest bearing cash at end of year | 2014-09-30 | $23,190 |
| Total non interest bearing cash at beginning of year | 2014-09-30 | $18,527 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-09-30 | No |
| Value of net income/loss | 2014-09-30 | $1,571,043 |
| Value of net assets at end of year (total assets less liabilities) | 2014-09-30 | $5,761,105 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-09-30 | $4,190,062 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-09-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-09-30 | $4,895,049 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-09-30 | $3,553,029 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-09-30 | $3,553,029 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-09-30 | $6,915 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-09-30 | $7,731,639 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2014-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-09-30 | No |
| Contributions received in cash from employer | 2014-09-30 | $8,702,750 |
| Employer contributions (assets) at end of year | 2014-09-30 | $772,474 |
| Employer contributions (assets) at beginning of year | 2014-09-30 | $645,729 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-09-30 | $9,492 |
| Contract administrator fees | 2014-09-30 | $122,919 |
| 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 | 2014-09-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2014-09-30 | $59,695 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-09-30 | $53,477 |
| Did the plan have assets held for investment | 2014-09-30 | 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 | 2014-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-09-30 | Unqualified |
| Accountancy firm name | 2014-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2014-09-30 | 522385296 |
| 2013 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-09-30 | $71,013 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-09-30 | $47,811 |
| Total income from all sources (including contributions) | 2013-09-30 | $9,784,809 |
| Total of all expenses incurred | 2013-09-30 | $9,036,690 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-09-30 | $8,840,841 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-09-30 | $9,645,359 |
| Value of total assets at end of year | 2013-09-30 | $4,261,075 |
| Value of total assets at beginning of year | 2013-09-30 | $3,489,754 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-09-30 | $195,849 |
| Total interest from all sources | 2013-09-30 | $5,077 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-09-30 | No |
| Administrative expenses professional fees incurred | 2013-09-30 | $63,619 |
| Was this plan covered by a fidelity bond | 2013-09-30 | Yes |
| Value of fidelity bond cover | 2013-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-09-30 | No |
| Contributions received from participants | 2013-09-30 | $637,451 |
| Participant contributions at end of year | 2013-09-30 | $43,790 |
| Participant contributions at beginning of year | 2013-09-30 | $41,810 |
| Other income not declared elsewhere | 2013-09-30 | $134,373 |
| Administrative expenses (other) incurred | 2013-09-30 | $6,760 |
| Liabilities. Value of operating payables at end of year | 2013-09-30 | $17,536 |
| Liabilities. Value of operating payables at beginning of year | 2013-09-30 | $21,792 |
| Total non interest bearing cash at end of year | 2013-09-30 | $18,527 |
| Total non interest bearing cash at beginning of year | 2013-09-30 | $39,727 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-09-30 | No |
| Value of net income/loss | 2013-09-30 | $748,119 |
| Value of net assets at end of year (total assets less liabilities) | 2013-09-30 | $4,190,062 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-09-30 | $3,441,943 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-09-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-09-30 | $3,553,029 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-09-30 | $2,648,597 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-09-30 | $2,648,597 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-09-30 | $5,077 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-09-30 | $8,819,326 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2013-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-09-30 | No |
| Contributions received in cash from employer | 2013-09-30 | $9,007,908 |
| Employer contributions (assets) at end of year | 2013-09-30 | $645,729 |
| Employer contributions (assets) at beginning of year | 2013-09-30 | $759,620 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-09-30 | $21,515 |
| Contract administrator fees | 2013-09-30 | $125,470 |
| 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 | 2013-09-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2013-09-30 | $53,477 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-09-30 | $26,019 |
| Did the plan have assets held for investment | 2013-09-30 | 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 | 2013-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-09-30 | Unqualified |
| Accountancy firm name | 2013-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2013-09-30 | 522385296 |
| 2012 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-09-30 | $47,811 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-09-30 | $100,805 |
| Total income from all sources (including contributions) | 2012-09-30 | $10,590,604 |
| Total of all expenses incurred | 2012-09-30 | $9,811,866 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-09-30 | $9,586,433 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-09-30 | $10,585,868 |
| Value of total assets at end of year | 2012-09-30 | $3,489,754 |
| Value of total assets at beginning of year | 2012-09-30 | $2,764,010 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-09-30 | $225,433 |
| Total interest from all sources | 2012-09-30 | $4,163 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-09-30 | No |
| Administrative expenses professional fees incurred | 2012-09-30 | $82,079 |
| Was this plan covered by a fidelity bond | 2012-09-30 | Yes |
| Value of fidelity bond cover | 2012-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-09-30 | No |
| Contributions received from participants | 2012-09-30 | $581,607 |
| Participant contributions at end of year | 2012-09-30 | $41,810 |
| Participant contributions at beginning of year | 2012-09-30 | $3,000 |
| Other income not declared elsewhere | 2012-09-30 | $573 |
| Administrative expenses (other) incurred | 2012-09-30 | $24,191 |
| Liabilities. Value of operating payables at end of year | 2012-09-30 | $21,792 |
| Liabilities. Value of operating payables at beginning of year | 2012-09-30 | $15,798 |
| Total non interest bearing cash at end of year | 2012-09-30 | $39,727 |
| Total non interest bearing cash at beginning of year | 2012-09-30 | $29,493 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-09-30 | No |
| Value of net income/loss | 2012-09-30 | $778,738 |
| Value of net assets at end of year (total assets less liabilities) | 2012-09-30 | $3,441,943 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-09-30 | $2,663,205 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-09-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-09-30 | $2,648,597 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-09-30 | $1,870,456 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-09-30 | $1,870,456 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-09-30 | $4,163 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-09-30 | $9,423,779 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2012-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-09-30 | No |
| Contributions received in cash from employer | 2012-09-30 | $10,004,261 |
| Employer contributions (assets) at end of year | 2012-09-30 | $759,620 |
| Employer contributions (assets) at beginning of year | 2012-09-30 | $861,061 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-09-30 | $162,654 |
| Contract administrator fees | 2012-09-30 | $119,163 |
| 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 | 2012-09-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2012-09-30 | $26,019 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-09-30 | $85,007 |
| Did the plan have assets held for investment | 2012-09-30 | 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 | 2012-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-09-30 | Unqualified |
| Accountancy firm name | 2012-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2012-09-30 | 522385296 |
| 2011 : CMTA-GLASS, MOLDERS, POTTERY, PLASTICS & ALLIED WORKERS LOCAL 164B WELFARE PLAN 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-09-30 | $100,805 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-09-30 | $87,599 |
| Total income from all sources (including contributions) | 2011-09-30 | $8,542,793 |
| Total of all expenses incurred | 2011-09-30 | $8,561,135 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-09-30 | $8,377,350 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-09-30 | $8,533,996 |
| Value of total assets at end of year | 2011-09-30 | $2,764,010 |
| Value of total assets at beginning of year | 2011-09-30 | $2,769,146 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-09-30 | $183,785 |
| Total interest from all sources | 2011-09-30 | $3,329 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-09-30 | No |
| Administrative expenses professional fees incurred | 2011-09-30 | $71,001 |
| Was this plan covered by a fidelity bond | 2011-09-30 | Yes |
| Value of fidelity bond cover | 2011-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-09-30 | No |
| Contributions received from participants | 2011-09-30 | $86,266 |
| Participant contributions at end of year | 2011-09-30 | $3,000 |
| Participant contributions at beginning of year | 2011-09-30 | $3,240 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-09-30 | $55,932 |
| Other income not declared elsewhere | 2011-09-30 | $5,468 |
| Administrative expenses (other) incurred | 2011-09-30 | $13,703 |
| Liabilities. Value of operating payables at end of year | 2011-09-30 | $15,798 |
| Liabilities. Value of operating payables at beginning of year | 2011-09-30 | $20,064 |
| Total non interest bearing cash at end of year | 2011-09-30 | $29,493 |
| Total non interest bearing cash at beginning of year | 2011-09-30 | $3,130 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-09-30 | No |
| Value of net income/loss | 2011-09-30 | $-18,342 |
| Value of net assets at end of year (total assets less liabilities) | 2011-09-30 | $2,663,205 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-09-30 | $2,681,547 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-09-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-09-30 | $1,870,456 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-09-30 | $2,164,535 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-09-30 | $2,164,535 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-09-30 | $3,329 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-09-30 | $8,301,855 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-09-30 | No |
| Was there a failure to transmit to the plan any participant contributions | 2011-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-09-30 | No |
| Contributions received in cash from employer | 2011-09-30 | $8,447,730 |
| Employer contributions (assets) at end of year | 2011-09-30 | $861,061 |
| Employer contributions (assets) at beginning of year | 2011-09-30 | $542,309 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-09-30 | $75,495 |
| Contract administrator fees | 2011-09-30 | $99,081 |
| 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 | 2011-09-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2011-09-30 | $85,007 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-09-30 | $67,535 |
| Did the plan have assets held for investment | 2011-09-30 | 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 | 2011-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-09-30 | Unqualified |
| Accountancy firm name | 2011-09-30 | LINDQUIST LLP |
| Accountancy firm EIN | 2011-09-30 | 522385296 |
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK969838/FLX968 |
| Policy instance | 4 |
| Insurance contract or identification number | OK969838/FLX968 | | Number of Individuals Covered | 217 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Are there contracts with unallocated funds for contracts of type immediate participation guarantee? | No | | Are there contracts with unallocated funds for contracts of type guaranteed investment? | No | | Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment? | No | | Health Insurance Welfare Benefit | No | | Dental Insurance Welfare Benefit | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | Yes | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Other welfare benefits provided | AD&D | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $6,194 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN INC. (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 8535 |
| Policy instance | 3 |
| Insurance contract or identification number | 8535 | | Number of Individuals Covered | 634 | | Insurance policy start date | 2021-01-01 | | Insurance policy end date | 2021-12-31 | | 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 | No | | Vision Insurance Welfare Benefit | No | | Life Insurance Welfare Benefit | No | | Temporary Disability Insurance Welfare Benefit | No | | Long Term Disability Insurance Welfare Benefit | No | | Unemployment Insurance Welfare Benefit | No | | Were dividends or retroactive rate refunds paid in cash? | No | | Were dividends or retroactive rate refunds paid as a credit? | No | | Welfare Benefit Premiums Paid to Carrier | USD $2,853,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10879 |
| Policy instance | 2 |
| Insurance contract or identification number | 10879 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | | Welfare Benefit Premiums Paid to Carrier | USD $49,827 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 75284 |
| Policy instance | 1 |
| Insurance contract or identification number | 75284 | | Number of Individuals Covered | 463 | | Insurance policy start date | 2021-10-01 | | Insurance policy end date | 2022-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Are there contracts with allocated funds for individual policies? | 0 | | Are there contracts with allocated funds for group deferred annuity? | No | | Are there contracts with allocated funds for types other than group deferred annuity or individual? | No | | Contract purchased, in whole or in part, to distribute benefits from a terminating 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 | | Welfare Benefit Premiums Paid to Carrier | USD $83,044 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK969838/FLX968 |
| Policy instance | 1 |
| Insurance contract or identification number | OK969838/FLX968 | | Number of Individuals Covered | 212 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $4,305 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 636 | | Insurance policy start date | 2020-01-01 | | Insurance policy end date | 2020-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,287,378 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10879 |
| Policy instance | 4 |
| Insurance contract or identification number | 10879 | | Number of Individuals Covered | 69 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $36,573 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 75284 |
| Policy instance | 3 |
| Insurance contract or identification number | 75284 | | Number of Individuals Covered | 519 | | Insurance policy start date | 2020-10-01 | | Insurance policy end date | 2021-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $85,611 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 75284 |
| Policy instance | 3 |
| Insurance contract or identification number | 75284 | | Number of Individuals Covered | 559 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $97,296 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10879 |
| Policy instance | 4 |
| Insurance contract or identification number | 10879 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2019-10-01 | | Insurance policy end date | 2020-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $26,849 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 668 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $3,412,343 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK969838/FLX968 |
| Policy instance | 1 |
| Insurance contract or identification number | OK969838/FLX968 | | Number of Individuals Covered | 226 | | Insurance policy start date | 2019-01-01 | | Insurance policy end date | 2019-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $6,575 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10879 |
| Policy instance | 4 |
| Insurance contract or identification number | 10879 | | Number of Individuals Covered | 48 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $25,128 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 75284 |
| Policy instance | 3 |
| Insurance contract or identification number | 75284 | | Number of Individuals Covered | 594 | | Insurance policy start date | 2018-10-01 | | Insurance policy end date | 2019-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $100,003 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 740 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,394,308 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 ) |
| Policy contract number | OK969838/FLX968 |
| Policy instance | 1 |
| Insurance contract or identification number | OK969838/FLX968 | | Number of Individuals Covered | 253 | | Insurance policy start date | 2018-01-01 | | Insurance policy end date | 2018-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $8,045 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10879 |
| Policy instance | 4 |
| Insurance contract or identification number | 10879 | | Number of Individuals Covered | 62 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $48,363 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 978 | | Insurance policy start date | 2017-01-01 | | Insurance policy end date | 2017-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $4,277,909 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 75284 |
| Policy instance | 3 |
| Insurance contract or identification number | 75284 | | Number of Individuals Covered | 707 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $126,795 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 749159 |
| Policy instance | 1 |
| Insurance contract or identification number | 749159 | | Number of Individuals Covered | 334 | | Insurance policy start date | 2017-10-01 | | Insurance policy end date | 2018-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $2,942 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10879 |
| Policy instance | 4 |
| Insurance contract or identification number | 10879 | | Number of Individuals Covered | 74 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $47,720 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 75284 |
| Policy instance | 3 |
| Insurance contract or identification number | 75284 | | Number of Individuals Covered | 890 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $151,862 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 1205 | | Insurance policy start date | 2015-01-01 | | Insurance policy end date | 2015-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Welfare Benefit Premiums Paid to Carrier | USD $6,395,366 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 749159 |
| Policy instance | 1 |
| Insurance contract or identification number | 749159 | | Number of Individuals Covered | 333 | | Insurance policy start date | 2015-10-01 | | Insurance policy end date | 2016-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $10,682 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10879 |
| Policy instance | 4 |
| Insurance contract or identification number | 10879 | | Number of Individuals Covered | 101 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $71,659 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 1785 | | Insurance policy start date | 2014-01-01 | | Insurance policy end date | 2014-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $7,482,137 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 749159 |
| Policy instance | 1 |
| Insurance contract or identification number | 749159 | | Number of Individuals Covered | 447 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $14,901 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 75284 |
| Policy instance | 3 |
| Insurance contract or identification number | 75284 | | Number of Individuals Covered | 1275 | | Insurance policy start date | 2014-10-01 | | Insurance policy end date | 2015-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $235,241 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10879 |
| Policy instance | 4 |
| Insurance contract or identification number | 10879 | | Number of Individuals Covered | 121 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $67,747 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 1716 | | Insurance policy start date | 2013-01-01 | | Insurance policy end date | 2013-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $8,069,198 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 75284 |
| Policy instance | 3 |
| Insurance contract or identification number | 75284 | | Number of Individuals Covered | 1366 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $242,389 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 749159 |
| Policy instance | 1 |
| Insurance contract or identification number | 749159 | | Number of Individuals Covered | 528 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $15,079 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 749159 |
| Policy instance | 1 |
| Insurance contract or identification number | 749159 | | Number of Individuals Covered | 624 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $20,260 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 2012 | | Insurance policy start date | 2012-01-01 | | Insurance policy end date | 2012-12-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $9,006,209 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 10879 |
| Policy instance | 4 |
| Insurance contract or identification number | 10879 | | Number of Individuals Covered | 84 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $58,360 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 75284 |
| Policy instance | 3 |
| Insurance contract or identification number | 75284 | | Number of Individuals Covered | 1461 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $280,713 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 749159 |
| Policy instance | 1 |
| Insurance contract or identification number | 749159 | | Number of Individuals Covered | 576 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $12,321 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 2070 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $9,150,708 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 05284 |
| Policy instance | 4 |
| Insurance contract or identification number | 05284 | | Number of Individuals Covered | 490 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $242,645 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 02479 |
| Policy instance | 5 |
| Insurance contract or identification number | 02479 | | Number of Individuals Covered | 79 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $56,561 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | 63119A |
| Policy instance | 3 |
| Insurance contract or identification number | 63119A | | Number of Individuals Covered | 5 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $9,523 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| CIGNA HEALTH AND LIFE INSURANCE COMPANY AND AFFILIATES (National Association of Insurance Commissioners NAIC id number: 67369 ) |
| Policy contract number | 749159 |
| Policy instance | 1 |
| Insurance contract or identification number | 749159 | | Number of Individuals Covered | 576 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Other welfare benefits provided | AD & D | | Welfare Benefit Premiums Paid to Carrier | USD $10,311 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| KAISER FOUNDATION HEALTH PLAN OF HAWAII (National Association of Insurance Commissioners NAIC id number: 0000 ) |
| Policy contract number | 8535-0000 |
| Policy instance | 2 |
| Insurance contract or identification number | 8535-0000 | | Number of Individuals Covered | 2257 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Other welfare benefits provided | HEALTH CARE SERVICE PLAN | | Welfare Benefit Premiums Paid to Carrier | USD $7,812,106 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 5284-0001 |
| Policy instance | 4 |
| Insurance contract or identification number | 5284-0001 | | Number of Individuals Covered | 618 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $288,043 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DELTA DENTAL OF CALIFORNIA (National Association of Insurance Commissioners NAIC id number: 00000 ) |
| Policy contract number | 2479 |
| Policy instance | 5 |
| Insurance contract or identification number | 2479 | | Number of Individuals Covered | 31 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Dental Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $55,618 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| HEALTH NET (National Association of Insurance Commissioners NAIC id number: 00623 ) |
| Policy contract number | 63119A |
| Policy instance | 3 |
| Insurance contract or identification number | 63119A | | Number of Individuals Covered | 5 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Total amount of commissions paid to insurance broker | USD $0 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Health Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $112,787 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
