Civic Intelligence
Filing

Herker Industries Inc Medical and Prescription Drug Plan

MULTI-FAB PRODUCTS - NOVA TECHNOLOGY, INC. • EIN 39-0837496 • Plan year 2000

Company ProfileSource Archive
Filing Insights

Participants

Down

163 → 124

-39 • -23.93%

Assets

Flat

$0 → $0

$0

Investment Management Fee

$0

Admin expenses $0 • Total expenses $0

Filing Details

Context
Net investment result
$0

Status Flags

Fidelity bond in place

Yes

Limited-scope audit performed

Not reported

Contributions transmitted on time

No

Participant loans in default

No

Leases in default

No

Reportable party-in-interest issues

No

Loss discovered during year

No

Assets with undetermined value

No

Non-cash contributions

No

Assets held for investment

No

5% transactions reported

No

All plan assets distributed

No

Benefits paid when due

Not reported

Plan blackout period

Not reported

Plan termination resolution adopted

No

Counterparties

Company Timeline

This filing is highlighted inside the broader sponsor history.

Year / FilingFilingsParticipantsAssetsContributionsContrib./Participant
20241197$22,546,498$1,463,259$7,428iApproximate average salary by contribution assumption: employee only about $185,693 at 4% or $123,795 at 6%; with 50% employer match about $123,795 at 4% or $82,530 at 6%; with 100% employer match about $92,846 at 4% or $61,898 at 6%.
Herker Industries Inc Dental Plan-197$22,546,498$1,463,259$7,428iApproximate average salary by contribution assumption: employee only about $185,693 at 4% or $123,795 at 6%; with 50% employer match about $123,795 at 4% or $82,530 at 6%; with 100% employer match about $92,846 at 4% or $61,898 at 6%.
20234204$22,114,755$1,995,015$9,779iApproximate average salary by contribution assumption: employee only about $244,487 at 4% or $162,991 at 6%; with 50% employer match about $162,991 at 4% or $108,661 at 6%; with 100% employer match about $122,244 at 4% or $81,496 at 6%.
Herker Industries Inc Dental Plan-202$22,114,755$1,995,015$9,876iApproximate average salary by contribution assumption: employee only about $246,908 at 4% or $164,605 at 6%; with 50% employer match about $164,605 at 4% or $109,737 at 6%; with 100% employer match about $123,454 at 4% or $82,303 at 6%.
Herker Industries Inc. Health Plan-162---
Herker Industries Inc. Dental Plan-151---
Herker Industries Inc Medical and Prescription Drug Plan-204---
20224189$18,808,036$1,780,886$9,423iApproximate average salary by contribution assumption: employee only about $235,567 at 4% or $157,045 at 6%; with 50% employer match about $157,045 at 4% or $104,696 at 6%; with 100% employer match about $117,783 at 4% or $78,522 at 6%.
Herker Industries Inc Dental Plan-185$18,808,036$1,780,886$9,626iApproximate average salary by contribution assumption: employee only about $240,660 at 4% or $160,440 at 6%; with 50% employer match about $160,440 at 4% or $106,960 at 6%; with 100% employer match about $120,330 at 4% or $80,220 at 6%.
Herker Industries Inc. Health Plan-169---
Herker Industries Inc Medical and Prescription Drug Plan-189---
Herker Industries Inc. Dental Plan-152---
20214192$21,897,669$1,530,221$7,970iApproximate average salary by contribution assumption: employee only about $199,248 at 4% or $132,832 at 6%; with 50% employer match about $132,832 at 4% or $88,554 at 6%; with 100% employer match about $99,624 at 4% or $66,416 at 6%.
Herker Industries Inc Dental Plan-179$21,897,669$1,530,221$8,549iApproximate average salary by contribution assumption: employee only about $213,718 at 4% or $142,479 at 6%; with 50% employer match about $142,479 at 4% or $94,986 at 6%; with 100% employer match about $106,859 at 4% or $71,239 at 6%.
Herker Industries Inc. Health Plan-83---
Herker Industries Inc Medical and Prescription Drug Plan-192---
Herker Industries Inc. Dental Plan-155---
20204198$20,678,635$1,126,674$5,690iApproximate average salary by contribution assumption: employee only about $142,257 at 4% or $94,838 at 6%; with 50% employer match about $94,838 at 4% or $63,225 at 6%; with 100% employer match about $71,128 at 4% or $47,419 at 6%.
Herker Industries Inc Dental Plan-195$20,678,635$1,126,674$5,778iApproximate average salary by contribution assumption: employee only about $144,445 at 4% or $96,297 at 6%; with 50% employer match about $96,297 at 4% or $64,198 at 6%; with 100% employer match about $72,223 at 4% or $48,148 at 6%.
Herker Industries Inc. Health Plan-177---
Herker Industries Inc Medical and Prescription Drug Plan-198---
Herker Industries Inc. Dental Plan-169---
20194219$20,823,673$1,898,182$8,667iApproximate average salary by contribution assumption: employee only about $216,687 at 4% or $144,458 at 6%; with 50% employer match about $144,458 at 4% or $96,306 at 6%; with 100% employer match about $108,344 at 4% or $72,229 at 6%.
Herker Industries Inc Dental Plan-210$20,823,673$1,898,182$9,039iApproximate average salary by contribution assumption: employee only about $225,974 at 4% or $150,649 at 6%; with 50% employer match about $150,649 at 4% or $100,433 at 6%; with 100% employer match about $112,987 at 4% or $75,325 at 6%.
Herker Industries Inc. Health Plan-190---
Herker Industries Inc Medical and Prescription Drug Plan-219---
Herker Industries Inc. Dental Plan-182---
20184209$16,314,875$931,394$4,456iApproximate average salary by contribution assumption: employee only about $111,411 at 4% or $74,274 at 6%; with 50% employer match about $74,274 at 4% or $49,516 at 6%; with 100% employer match about $55,705 at 4% or $37,137 at 6%.
Herker Industries Inc Dental Plan-175$16,314,875$931,394$5,322iApproximate average salary by contribution assumption: employee only about $133,056 at 4% or $88,704 at 6%; with 50% employer match about $88,704 at 4% or $59,136 at 6%; with 100% employer match about $66,528 at 4% or $44,352 at 6%.
Herker Industries Inc. Health Plan-188---
Herker Industries Inc Medical and Prescription Drug Plan-209---
Herker Industries Inc. Dental Plan-168---
20174204$17,155,599$886,925$4,348iApproximate average salary by contribution assumption: employee only about $108,692 at 4% or $72,461 at 6%; with 50% employer match about $72,461 at 4% or $48,307 at 6%; with 100% employer match about $54,346 at 4% or $36,231 at 6%.
Herker Industries Inc Dental Plan-161$17,155,599$886,925$5,509iApproximate average salary by contribution assumption: employee only about $137,721 at 4% or $91,814 at 6%; with 50% employer match about $91,814 at 4% or $61,209 at 6%; with 100% employer match about $68,861 at 4% or $45,907 at 6%.
Herker Industries Inc. Health Plan-182---
Herker Industries Inc Medical and Prescription Drug Plan-204---
Herker Industries Inc. Dental Plan-166---
20164183$14,244,088$893,178$4,881iApproximate average salary by contribution assumption: employee only about $122,019 at 4% or $81,346 at 6%; with 50% employer match about $81,346 at 4% or $54,231 at 6%; with 100% employer match about $61,009 at 4% or $40,673 at 6%.
Herker Industries Inc Dental Plan-158$14,244,088$893,178$5,653iApproximate average salary by contribution assumption: employee only about $141,326 at 4% or $94,217 at 6%; with 50% employer match about $94,217 at 4% or $62,811 at 6%; with 100% employer match about $70,663 at 4% or $47,109 at 6%.
Herker Industries Inc. Health Plan-152---
Herker Industries Inc Medical and Prescription Drug Plan-183---
Herker Industries Inc. Dental Plan-143---
20154184$13,248,453$660,209$3,588iApproximate average salary by contribution assumption: employee only about $89,702 at 4% or $59,802 at 6%; with 50% employer match about $59,802 at 4% or $39,868 at 6%; with 100% employer match about $44,851 at 4% or $29,901 at 6%.
Herker Industries Inc Dental Plan-171$13,248,453$660,209$3,861iApproximate average salary by contribution assumption: employee only about $96,522 at 4% or $64,348 at 6%; with 50% employer match about $64,348 at 4% or $42,899 at 6%; with 100% employer match about $48,261 at 4% or $32,174 at 6%.
Herker Industries Inc Medical and Prescription Drug Plan-184---
Herker Industries Inc. Health Plan-151---
Herker Industries Inc. Dental Plan-147---
20144193$13,297,177$584,103$3,026iApproximate average salary by contribution assumption: employee only about $75,661 at 4% or $50,441 at 6%; with 50% employer match about $50,441 at 4% or $33,627 at 6%; with 100% employer match about $37,831 at 4% or $25,220 at 6%.
Herker Industries Inc Dental Plan-161$13,297,177$584,103$3,628iApproximate average salary by contribution assumption: employee only about $90,699 at 4% or $60,466 at 6%; with 50% employer match about $60,466 at 4% or $40,311 at 6%; with 100% employer match about $45,350 at 4% or $30,233 at 6%.
Herker Industries Inc. Dental Plan-156---
Herker Industries Inc Medical and Prescription Drug Plan-193---
Herker Industries Inc. Health Plan-162---
20134183$12,908,403$651,448$3,560iApproximate average salary by contribution assumption: employee only about $88,996 at 4% or $59,330 at 6%; with 50% employer match about $59,330 at 4% or $39,554 at 6%; with 100% employer match about $44,498 at 4% or $29,665 at 6%.
Herker Industries Inc Dental Plan-171$12,908,403$651,448$3,810iApproximate average salary by contribution assumption: employee only about $95,241 at 4% or $63,494 at 6%; with 50% employer match about $63,494 at 4% or $42,329 at 6%; with 100% employer match about $47,620 at 4% or $31,747 at 6%.
Herker Industries Inc. Health Plan-152---
Herker Industries Inc. Dental Plan-147---
Herker Industries Inc Medical and Prescription Drug Plan-183---
20124214$10,614,469$692,061$3,234iApproximate average salary by contribution assumption: employee only about $80,848 at 4% or $53,899 at 6%; with 50% employer match about $53,899 at 4% or $35,933 at 6%; with 100% employer match about $40,424 at 4% or $26,949 at 6%.
Herker Industries Inc Dental Plan-183$10,614,469$692,061$3,782iApproximate average salary by contribution assumption: employee only about $94,544 at 4% or $63,029 at 6%; with 50% employer match about $63,029 at 4% or $42,019 at 6%; with 100% employer match about $47,272 at 4% or $31,515 at 6%.
Herker Industries Inc. Health Plan-180---
Herker Industries Inc Medical and Prescription Drug Plan-214---
Herker Industries Inc. Dental Plan-174---
20114202$9,323,251$642,451$3,180iApproximate average salary by contribution assumption: employee only about $79,511 at 4% or $53,008 at 6%; with 50% employer match about $53,008 at 4% or $35,338 at 6%; with 100% employer match about $39,756 at 4% or $26,504 at 6%.
Herker Industries Inc Dental Plan-145$9,323,251$642,451$4,431iApproximate average salary by contribution assumption: employee only about $110,767 at 4% or $73,845 at 6%; with 50% employer match about $73,845 at 4% or $49,230 at 6%; with 100% employer match about $55,384 at 4% or $36,922 at 6%.
Herker Industries Inc. Health Plan-170---
Herker Industries Inc Medical and Prescription Drug Plan-202---
Herker Industries Inc. Dental Plan-159---
20104164$10,771,139$488,416$2,978iApproximate average salary by contribution assumption: employee only about $74,454 at 4% or $49,636 at 6%; with 50% employer match about $49,636 at 4% or $33,091 at 6%; with 100% employer match about $37,227 at 4% or $24,818 at 6%.
Herker Industries Inc Dental Plan-142$10,771,139$488,416$3,440iApproximate average salary by contribution assumption: employee only about $85,989 at 4% or $57,326 at 6%; with 50% employer match about $57,326 at 4% or $38,217 at 6%; with 100% employer match about $42,994 at 4% or $28,663 at 6%.
Herker Industries Inc. Health Plan-135---
Herker Industries Inc Medical and Prescription Drug Plan-164---
Herker Industries Inc. Dental Plan-134---
20094135$10,130,045$286,219$2,120iApproximate average salary by contribution assumption: employee only about $53,004 at 4% or $35,336 at 6%; with 50% employer match about $35,336 at 4% or $23,557 at 6%; with 100% employer match about $26,502 at 4% or $17,668 at 6%.
Herker Industries Inc Dental Plan-130$10,130,045$286,219$2,202iApproximate average salary by contribution assumption: employee only about $55,042 at 4% or $36,695 at 6%; with 50% employer match about $36,695 at 4% or $24,463 at 6%; with 100% employer match about $27,521 at 4% or $18,347 at 6%.
Herker Industries Inc. Health Plan-113---
Herker Industries Inc Medical and Prescription Drug Plan-135---
Herker Industries Inc. Dental Plan-111---
20084157$8,241,560$560,577$3,571iApproximate average salary by contribution assumption: employee only about $89,264 at 4% or $59,509 at 6%; with 50% employer match about $59,509 at 4% or $39,673 at 6%; with 100% employer match about $44,632 at 4% or $29,755 at 6%.
Herker Industries Inc Dental Plan-153$8,241,560$560,577$3,664iApproximate average salary by contribution assumption: employee only about $91,598 at 4% or $61,065 at 6%; with 50% employer match about $61,065 at 4% or $40,710 at 6%; with 100% employer match about $45,799 at 4% or $30,533 at 6%.
Herker Industries Inc. Dental Plan-114---
Herker Industries Inc. Health Plan-131---
Herker Industries Inc Medical and Prescription Drug Plan-157---
20074195$10,961,007$583,408$2,992iApproximate average salary by contribution assumption: employee only about $74,796 at 4% or $49,864 at 6%; with 50% employer match about $49,864 at 4% or $33,243 at 6%; with 100% employer match about $37,398 at 4% or $24,932 at 6%.
Herker Industries Inc Dental Plan-167$10,961,007$583,408$3,493iApproximate average salary by contribution assumption: employee only about $87,337 at 4% or $58,224 at 6%; with 50% employer match about $58,224 at 4% or $38,816 at 6%; with 100% employer match about $43,668 at 4% or $29,112 at 6%.
Herker Industries Inc. Dental Plan-163---
Herker Industries Inc. Health Plan-165---
Herker Industries Inc Medical and Prescription Drug Plan-195---
20064194$10,105,112$602,425$3,105iApproximate average salary by contribution assumption: employee only about $77,632 at 4% or $51,755 at 6%; with 50% employer match about $51,755 at 4% or $34,503 at 6%; with 100% employer match about $38,816 at 4% or $25,877 at 6%.
Herker Industries Inc Dental Plan-178$10,105,112$602,425$3,384iApproximate average salary by contribution assumption: employee only about $84,610 at 4% or $56,407 at 6%; with 50% employer match about $56,407 at 4% or $37,605 at 6%; with 100% employer match about $42,305 at 4% or $28,203 at 6%.
Herker Industries Inc Medical and Prescription Drug Plan-194---
Herker Industries Inc. Health Plan-156---
Herker Industries Inc. Dental Plan-160---
20054191$9,093,093$483,251$2,530iApproximate average salary by contribution assumption: employee only about $63,253 at 4% or $42,168 at 6%; with 50% employer match about $42,168 at 4% or $28,112 at 6%; with 100% employer match about $31,626 at 4% or $21,084 at 6%.
Herker Industries Inc Dental Plan-176$9,093,093$483,251$2,746iApproximate average salary by contribution assumption: employee only about $68,644 at 4% or $45,762 at 6%; with 50% employer match about $45,762 at 4% or $30,508 at 6%; with 100% employer match about $34,322 at 4% or $22,881 at 6%.
Herker Industries Inc. Dental Plan-152---
Herker Industries Inc Medical and Prescription Drug Plan-191---
Herker Industries Inc. Health Plan-155---
20044173$8,429,879$410,444$2,373iApproximate average salary by contribution assumption: employee only about $59,313 at 4% or $39,542 at 6%; with 50% employer match about $39,542 at 4% or $26,361 at 6%; with 100% employer match about $29,656 at 4% or $19,771 at 6%.
Herker Industries Inc Dental Plan-142$8,429,879$410,444$2,890iApproximate average salary by contribution assumption: employee only about $72,261 at 4% or $48,174 at 6%; with 50% employer match about $48,174 at 4% or $32,116 at 6%; with 100% employer match about $36,131 at 4% or $24,087 at 6%.
Herker Industries Inc. Dental Plan-153---
Herker Industries Inc. Health Plan-166---
Herker Industries Inc Medical and Prescription Drug Plan-173---
20032157$7,661,629$417,959$2,662iApproximate average salary by contribution assumption: employee only about $66,554 at 4% or $44,369 at 6%; with 50% employer match about $44,369 at 4% or $29,580 at 6%; with 100% employer match about $33,277 at 4% or $22,185 at 6%.
Herker Industries Inc Dental Plan-157$7,661,629$417,959$2,662iApproximate average salary by contribution assumption: employee only about $66,554 at 4% or $44,369 at 6%; with 50% employer match about $44,369 at 4% or $29,580 at 6%; with 100% employer match about $33,277 at 4% or $22,185 at 6%.
Herker Industries Inc. Dental Plan-139---
20024171$6,106,943$518,051$3,030iApproximate average salary by contribution assumption: employee only about $75,738 at 4% or $50,492 at 6%; with 50% employer match about $50,492 at 4% or $33,662 at 6%; with 100% employer match about $37,869 at 4% or $25,246 at 6%.
Herker Industries Inc Dental Plan-160$6,106,943$518,051$3,238iApproximate average salary by contribution assumption: employee only about $80,945 at 4% or $53,964 at 6%; with 50% employer match about $53,964 at 4% or $35,976 at 6%; with 100% employer match about $40,473 at 4% or $26,982 at 6%.
Herker Industries Inc Medical and Prescription Drug Plan-163---
Herker Industries Inc. Dental Plan-141---
HERKER INDUSTRIES INC LIFE INSURANCE PLAN-171---
20013428$6,469,563$582,417$1,361iApproximate average salary by contribution assumption: employee only about $34,020 at 4% or $22,680 at 6%; with 50% employer match about $22,680 at 4% or $15,120 at 6%; with 100% employer match about $17,010 at 4% or $11,340 at 6%.
Herker Industries Inc Dental Plan-122$6,469,563$582,417$4,774iApproximate average salary by contribution assumption: employee only about $119,348 at 4% or $79,565 at 6%; with 50% employer match about $79,565 at 4% or $53,043 at 6%; with 100% employer match about $59,674 at 4% or $39,783 at 6%.
Herker Industries Inc Medical and Prescription Drug Plan-428---
Herker Industries Inc. Dental Plan-151---
20003136$6,337,038$453,462$3,334iApproximate average salary by contribution assumption: employee only about $83,357 at 4% or $55,571 at 6%; with 50% employer match about $55,571 at 4% or $37,048 at 6%; with 100% employer match about $41,678 at 4% or $27,786 at 6%.
Herker Industries Inc Dental Plan-116$6,337,038$453,462$3,909iApproximate average salary by contribution assumption: employee only about $97,729 at 4% or $65,153 at 6%; with 50% employer match about $65,153 at 4% or $43,435 at 6%; with 100% employer match about $48,864 at 4% or $32,576 at 6%.
Herker Industries Inc Medical and Prescription Drug PlanCurrent124---
Herker Industries Inc. Dental Plan-136---
19993128$5,920,544$520,264$4,065iApproximate average salary by contribution assumption: employee only about $101,614 at 4% or $67,743 at 6%; with 50% employer match about $67,743 at 4% or $45,162 at 6%; with 100% employer match about $50,807 at 4% or $33,871 at 6%.
Herker Industries Inc Dental Plan-128$5,920,544$520,264$4,065iApproximate average salary by contribution assumption: employee only about $101,614 at 4% or $67,743 at 6%; with 50% employer match about $67,743 at 4% or $45,162 at 6%; with 100% employer match about $50,807 at 4% or $33,871 at 6%.
Herker Industries Inc Medical and Prescription Drug Plan-108---
Herker Industries Inc Dental Plan-112---
Schedule Details

Schedule A

Row 1
Filing Id
84037158366282
Form Id
16478457
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372158366030002
Ins Broker 01 Name
MASON BENEFITS GROUP
Ins Broker 01 Street Addr
830 ELM GROVE RD
Ins Broker 01 City
ELM GROVE
Ins Broker 01 State
WI
Ins Broker 01 ZIP Code
53122
Ins Broker Comm Pd 01 Amount
$12,928
Ins Broker Fees Pd 01 Amount
$0
Ins Broker 01 Code
4
Row 2
Filing Id
84037158366282
Form Id
16478458
Page Id
2
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372158366030003
Ins Broker 01 Name
MASON BENEFITS GROUP
Ins Broker 01 Street Addr
830 ELM GROVE RD
Ins Broker 01 City
ELM GROVE
Ins Broker 01 State
WI
Ins Broker 01 ZIP Code
53122
Ins Broker Comm Pd 01 Amount
$2,204
Ins Broker Fees Pd 01 Amount
$0
Row 3
Ins Carrier Name: UNITED HEALTHCARE OF WISCONSIN INC
Filing Id
84037158366282
Form Id
16478457
Schedule A EIN
39-0837496
Schedule A Plan Num
502
Schedule A Plan Year Begin Date
2000-03-01
Schedule A Tax Period
20010228
Ins Carrier Name
UNITED HEALTHCARE OF WISCONSIN INC
Ins Carrier EIN
39-1555888
Ins Carrier Naic Code
124
Ins Contract Num
200888
Ins Prsn Covered End of year Count
344
Ins Policy From Date
2000-03-01
Ins Policy To Date
2001-02-28
Ins Broker Comm Total Amount
$12,928
Ins Broker Fees Total Amount
$24,893
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0
Row 4
Ins Carrier Name: SAFECO LIFE INSURANCE COMPANY
Filing Id
84037158366282
Form Id
16478458
Schedule A EIN
39-0837496
Schedule A Plan Num
502
Schedule A Plan Year Begin Date
2000-03-01
Schedule A Tax Period
20010228
Ins Carrier Name
SAFECO LIFE INSURANCE COMPANY
Ins Carrier EIN
16-0062280
Ins Carrier Naic Code
124
Ins Prsn Covered End of year Count
344
Ins Policy From Date
2000-03-01
Ins Policy To Date
2000-04-30
Ins Broker Comm Total Amount
$2,204
Ins Broker Fees Total Amount
$22,284
Pension End of year Gen Account Amount
$0
Pension End of year Sep Account Amount
$0
Pension Prem Paid Total Amount
$0
Pension Unpaid Premium Amount
$0
Pension Contract Cost Amount
$0
Pension End Prev Bal Amount
$0
Pension Contribution Dep Amount
$0
Pension Divnd Cr Dep Amount
$0
Pension Interest Cr Dur Yr Amount
$0
Pension Transfer From Amount
$0
Pension Other Amount
$0
Pension Total Additions Amount
$0
Pension Total Bal Addn Amount
$0
Pension Bnfts Dsbrsd Amount
$0
Pension Admin Chrg Amount
$0
Pension Transfer To Amount
$0
Pension Oth Ded Amount
$0
Pension Total Ded Amount
$0
Pension End of year Bal Amount
$0
Wlfr Type Bnft Indicator
ADH
Wlfr Premium Rcvd Amount
$0
Wlfr Unpaid Due Amount
$0
Wlfr Reserve Amount
$0
Wlfr Total Earned Prem Amount
$0
Wlfr Claims Paid Amount
$0
Wlfr Incr Reserve Amount
$0
Wlfr Incurred Claim Amount
$0
Wlfr Claims Chrgd Amount
$0
Wlfr Ret Commissions Amount
$0
Wlfr Ret Admin Amount
$0
Wlfr Ret Oth Cost Amount
$0
Wlfr Ret Oth Expense Amount
$0
Wlfr Ret Taxes Amount
$0
Wlfr Ret Charges Amount
$0
Wlfr Ret Oth Chrgs Amount
$0
Wlfr Ret Total Amount
$0
Wlfr Refund Amount
$0
Wlfr Held Bnfts Amount
$0
Wlfr Claims Reserve Amount
$0
Wlfr Oth Reserve Amount
$0
Wlfr Divnds Due Amount
$0
Wlfr Total Charges Paid Amount
$0
Wlfr Acquis Cost Amount
$0

Schedule C

Schedule C Provider

Provider 1

Provider details

Source fields
Row 1
Filing Id
84037158366282
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372158366030004
Row 2
Filing Id
84037158366282
Page Id
1
Page Seq
0
Page Row Num
1
Row Num
0
Image Form Id
20372158366030004
Provider 01 Name
UNITED HEALTCCARE OF WISCONSIN INC
Provider 01 EIN
39-1555888
Provider 01 Position
CONT. ADMIN.
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$24,893
Provider 01 Srvc Code
12

Schedule C Provider

Provider 2

Provider details

Source fields
Row 3
Filing Id
84037158366282
Page Id
1
Page Seq
0
Page Row Num
2
Row Num
1
Image Form Id
20372158366030004
Provider 01 Name
MASON BENEFITS GROUP INC
Provider 01 EIN
39-1844466
Provider 01 Position
INSURANCE AGENT
Provider 01 Salary Amount
$0
Provider 01 Fees Amount
$12,928
Provider 01 Srvc Code
19

Schedule C Provider

Provider 3

Provider details

Source fields
Row 4
Filing Id
84037158366282
Schedule C EIN
39-0837496
Schedule C Plan number
502
Schedule C Plan Year Begin Date
2000-03-01
Schedule C Tax Period
20010228
Provider Total Comp Paid Amount
$0

Schedule H

Schedule H Financial Statement

Large plan result

Assets, contributions, fees, audit, and compliance fields reported for this large-plan filing.

End-of-year assets$0$0 change

Balance Sheet

Beginning and end of plan year.

Total assets$0$0No change $0
Total liabilities$0$0No change $0
Net assets$0$0No change $0

Contributions

Employer contributions$0
Participant contributions$0
Other contributions$0
Total contributions$0

Income & Investment Result

Total income$0
Interest$0
Dividends$0
Net income$0

Expenses & Fees

Benefits paid$0
Investment management$0
Administrative expenses$0
Total expenses$0

Compliance

Fidelity bondYes
Fidelity bond amount$1,000,000
Participant loans$0
Late contributionsNo
Schedule H source fields
Row 1
Total assets at beginning of year: $0Total assets at end of year: $0Total liabilities at end of year: $0Net income or loss: $0
Filing Id
84037158366282
Schedule H EIN
39-0837496
Schedule H Plan number
502
Schedule H Plan Year Begin Date
2000-03-01
Schedule H Tax Period
20010228
Non Interest Bear Cash Beginning of year Amount
$0
Employer Contribution Beginning of year Amount
$0
Participants Contribution Beginning of year Amount
$0
Other Receivables Beginning of year Amount
$0
Interest Bear Cash Beginning of year Amount
$0
Govt Sec Beginning of year Amount
$0
Corp Debt Preferred Beginning of year Amount
$0
Corp Debt Other Beginning of year Amount
$0
Pref Stock Beginning of year Amount
$0
Common Stock Beginning of year Amount
$0
Joint Venture Beginning of year Amount
$0
Real Estate Beginning of year Amount
$0
Other Loans Beginning of year Amount
$0
Participant loans at beginning of year
$0
Interest Common Tr Beginning of year Amount
$0
Interest Pool Sep Account Beginning of year Amount
$0
Interest Master Tr Beginning of year Amount
$0
Interest 103 12 Investment Beginning of year Amount
$0
Interest in registered investment companies at beginning of year
$0
Ins Co Gen Account Beginning of year Amount
$0
Oth Investment Beginning of year Amount
$0
Employer Sec Beginning of year Amount
$0
Employer Prop Beginning of year Amount
$0
Bldgs Used Beginning of year Amount
$0
Total assets at beginning of year
$0
Bnfts Payable Beginning of year Amount
$0
Oprtng Payable Beginning of year Amount
$0
Acquis Indbt Beginning of year Amount
$0
Other Liability Beginning of year Amount
$0
Total liabilities at beginning of year
$0
Net assets at beginning of year
$0
Non Interest Bear Cash End of year Amount
$0
Employer Contribution End of year Amount
$0
Participants Contribution End of year Amount
$0
Other Receivables End of year Amount
$0
Interest Bear Cash End of year Amount
$0
Govt Sec End of year Amount
$0
Corp Debt Preferred End of year Amount
$0
Corp Debt Other End of year Amount
$0
Pref Stock End of year Amount
$0
Common Stock End of year Amount
$0
Joint Venture End of year Amount
$0
Real Estate End of year Amount
$0
Other Loans End of year Amount
$0
Participant loans at end of year
$0
Interest Common Tr End of year Amount
$0
Interest Pool Sep Account End of year Amount
$0
Interest Master Tr End of year Amount
$0
Interest 103 12 Investment End of year Amount
$0
Interest in registered investment companies at end of year
$0
Ins Co Gen Account End of year Amount
$0
Oth Investment End of year Amount
$0
Employer Sec End of year Amount
$0
Employer Prop End of year Amount
$0
Bldgs Used End of year Amount
$0
Total assets at end of year
$0
Bnfts Payable End of year Amount
$0
Oprtng Payable End of year Amount
$0
Acquis Indbt End of year Amount
$0
Other Liability End of year Amount
$0
Total liabilities at end of year
$0
Net assets at end of year
$0
Employer contributions
$0
Participant contributions
$0
Oth Contribution Rcvd Amount
$0
Non Cash Contribution Bs Amount
$0
Total contributions
$0
Interest Bear Cash Amount
$0
Interest On Govt Sec Amount
$0
Interest On Corp Debt Amount
$0
Interest On Oth Loans Amount
$0
Interest on participant loans
$0
Interest On Oth Investment Amount
$0
Total interest income
$0
Divnd Pref Stock Amount
$0
Divnd Common Stock Amount
$0
Total dividend income
$0
Total Rents Amount
$0
Aggregate Proceeds Amount
$0
Aggregate Costs Amount
$0
Net gain or loss on sale of assets
$0
Unrealized Apprctn Re Amount
$0
Unrealized Apprctn Oth Amount
$0
Net unrealized appreciation or depreciation
$0
Gain Loss Com Trust Amount
$0
Gain Loss Pool Sep Amount
$0
Gain Loss Master Tr Amount
$0
Gain Loss 103 12 Investment Amount
$0
Gain or loss on registered investments
$0
Other Income Amount
$0
Total income
$0
Participant distributions
$0
Ins Carrier Bnfts Amount
$0
Oth Bnft Payment Amount
$0
Total benefit distributions
$0
Total Corrective Distribution Amount
$0
Total Dm Distribution Ptcp Lns A
0
Total Interest Expense Amount
$0
Professional Fees Amount
$0
Contract Admin Fees Amount
$0
Investment management fees
$0
Other Admin Fees Amount
$0
Total administrative expenses
$0
Total expenses
$0
Net income or loss
$0
Total Transfers To Amount
$0
Transfers from other plans
$0
Failed to transmit participant contributions on time
No
Fail Transmit Contribution Amount
$0
Participant loans in default
No
Loans In Default Amount
$0
Leases in default
No
Leases In Default Amount
$0
Nonexempt transactions with parties in interest
No
Party In Interest Not Reported Amount
$0
Fidelity bond in place
Yes
Fidelity bond amount
$1,000,000
Loss discovered during year
No
Loss Discovered Dur Year Amount
$0
Assets with undetermined value
No
Asset Undeterm Valuation Amount
$0
Non-cash contributions reported
No
Non Cash Contribution Amount
$0
Assets held for investment
No
Reportable 5% transactions
No
All plan assets distributed
No
Resolution to terminate plan adopted
No
Res Terminate Plan Adpt Amount
$0