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CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 401k Plan overview

Plan NameCAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN
Plan identification number 001

CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Participant-directed brokerage accounts provided as an investment option under the plan.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.

401k Sponsoring company profile

CAPITAL CITY SHEET METAL, INC. has sponsored the creation of one or more 401k plans.

Company Name:CAPITAL CITY SHEET METAL, INC.
Employer identification number (EIN):391612854
NAIC Classification:238900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012022-01-01KEITH BECKER2022-10-18
0012021-01-01KEITH BECKER2022-05-31
0012020-01-01KEITH BECKER2021-08-24
0012019-01-01KEITH BECKER2020-04-08
0012018-01-01KEITH BECKER
0012017-01-01KEITH BECKER
0012016-01-01KEITH BECKER
0012015-01-01KEITH BECKER
0012014-01-01KEITH BECKER
0012013-01-01KEITH BECKER
0012012-01-01KEITH BECKER
0012011-01-01KEITH BECKER
0012009-01-01KEITH BECKER KEITH BECKER2010-04-19

Plan Statistics for CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN

401k plan membership statisitcs for CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN

Measure Date Value
2018: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-0112
Total number of active participants reported on line 7a of the Form 55002018-01-019
Number of retired or separated participants receiving benefits2018-01-011
Number of other retired or separated participants entitled to future benefits2018-01-013
Total of all active and inactive participants2018-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-0113
Number of participants with account balances2018-01-0112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-0114
Total number of active participants reported on line 7a of the Form 55002017-01-018
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-013
Total of all active and inactive participants2017-01-0111
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-0111
Number of participants with account balances2017-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-011
2016: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-0112
Total number of active participants reported on line 7a of the Form 55002016-01-0110
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-014
Total of all active and inactive participants2016-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-0114
Number of participants with account balances2016-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-0113
Total number of active participants reported on line 7a of the Form 55002015-01-0110
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-014
Total of all active and inactive participants2015-01-0114
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-0114
Number of participants with account balances2015-01-0114
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-010
2014: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0113
Total number of active participants reported on line 7a of the Form 55002014-01-019
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-014
Total of all active and inactive participants2014-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0113
Number of participants with account balances2014-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0113
Total number of active participants reported on line 7a of the Form 55002013-01-017
Number of retired or separated participants receiving benefits2013-01-016
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0113
Number of participants with account balances2013-01-0113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-013
2012: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0110
Total number of active participants reported on line 7a of the Form 55002012-01-0110
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-013
Total of all active and inactive participants2012-01-0113
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0113
Number of participants with account balances2012-01-0111
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0114
Total number of active participants reported on line 7a of the Form 55002011-01-017
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-013
Total of all active and inactive participants2011-01-0110
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0110
Number of participants with account balances2011-01-019
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-012
2009: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0116
Total number of active participants reported on line 7a of the Form 55002009-01-0110
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-016
Total of all active and inactive participants2009-01-0116
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0116
Number of participants with account balances2009-01-0116
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-015

Financial Data on CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN

Measure Date Value
2018 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2018 401k financial data
Total income from all sources2018-12-31$36,545
Expenses. Total of all expenses incurred2018-12-31$16,361
Benefits paid (including direct rollovers)2018-12-31$8,425
Total plan assets at end of year2018-12-31$1,411,166
Total plan assets at beginning of year2018-12-31$1,390,982
Value of fidelity bond covering the plan2018-12-31$1,400,000
Total contributions received or receivable from participants2018-12-31$64,945
Expenses. Other expenses not covered elsewhere2018-12-31$0
Contributions received from other sources (not participants or employers)2018-12-31$0
Other income received2018-12-31$-75,345
Noncash contributions received2018-12-31$0
Net income (gross income less expenses)2018-12-31$20,184
Net plan assets at end of year (total assets less liabilities)2018-12-31$1,411,166
Net plan assets at beginning of year (total assets less liabilities)2018-12-31$1,390,982
Total contributions received or receivable from employer(s)2018-12-31$46,945
Value of certain deemed distributions of participant loans2018-12-31$0
Value of corrective distributions2018-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2018-12-31$7,936
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2018-12-31$0
2017 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2017 401k financial data
Total income from all sources2017-12-31$287,166
Expenses. Total of all expenses incurred2017-12-31$54,961
Benefits paid (including direct rollovers)2017-12-31$48,428
Total plan assets at end of year2017-12-31$1,390,982
Total plan assets at beginning of year2017-12-31$1,158,777
Value of fidelity bond covering the plan2017-12-31$1,400,000
Total contributions received or receivable from participants2017-12-31$55,610
Other income received2017-12-31$176,682
Net income (gross income less expenses)2017-12-31$232,205
Net plan assets at end of year (total assets less liabilities)2017-12-31$1,390,982
Net plan assets at beginning of year (total assets less liabilities)2017-12-31$1,158,777
Total contributions received or receivable from employer(s)2017-12-31$54,874
Expenses. Administrative service providers (salaries,fees and commissions)2017-12-31$6,533
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
2016 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2016 401k financial data
Total income from all sources2016-12-31$256,211
Expenses. Total of all expenses incurred2016-12-31$1,278,139
Benefits paid (including direct rollovers)2016-12-31$1,265,634
Total plan assets at end of year2016-12-31$1,158,777
Total plan assets at beginning of year2016-12-31$2,180,705
Value of fidelity bond covering the plan2016-12-31$1,300,000
Total contributions received or receivable from participants2016-12-31$45,152
Other income received2016-12-31$155,032
Net income (gross income less expenses)2016-12-31$-1,021,928
Net plan assets at end of year (total assets less liabilities)2016-12-31$1,158,777
Net plan assets at beginning of year (total assets less liabilities)2016-12-31$2,180,705
Total contributions received or receivable from employer(s)2016-12-31$56,027
Expenses. Administrative service providers (salaries,fees and commissions)2016-12-31$12,505
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
2015 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2015 401k financial data
Total income from all sources2015-12-31$49,348
Expenses. Total of all expenses incurred2015-12-31$12,489
Total plan assets at end of year2015-12-31$2,180,705
Total plan assets at beginning of year2015-12-31$2,143,846
Value of fidelity bond covering the plan2015-12-31$1,300,000
Total contributions received or receivable from participants2015-12-31$44,103
Other income received2015-12-31$-49,587
Net income (gross income less expenses)2015-12-31$36,859
Net plan assets at end of year (total assets less liabilities)2015-12-31$2,180,705
Net plan assets at beginning of year (total assets less liabilities)2015-12-31$2,143,846
Total contributions received or receivable from employer(s)2015-12-31$54,832
Expenses. Administrative service providers (salaries,fees and commissions)2015-12-31$12,489
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
2014 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2014 401k financial data
Total income from all sources2014-12-31$215,024
Expenses. Total of all expenses incurred2014-12-31$20,405
Benefits paid (including direct rollovers)2014-12-31$8,818
Total plan assets at end of year2014-12-31$2,143,846
Total plan assets at beginning of year2014-12-31$1,949,227
Value of fidelity bond covering the plan2014-12-31$1,300,000
Total contributions received or receivable from participants2014-12-31$33,040
Other income received2014-12-31$139,687
Net income (gross income less expenses)2014-12-31$194,619
Net plan assets at end of year (total assets less liabilities)2014-12-31$2,143,846
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,949,227
Total contributions received or receivable from employer(s)2014-12-31$42,297
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$11,587
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2013 401k financial data
Total income from all sources2013-12-31$210,186
Expenses. Total of all expenses incurred2013-12-31$9,664
Total plan assets at end of year2013-12-31$1,949,227
Total plan assets at beginning of year2013-12-31$1,748,705
Value of fidelity bond covering the plan2013-12-31$1,300,000
Total contributions received or receivable from participants2013-12-31$32,961
Other income received2013-12-31$136,482
Net income (gross income less expenses)2013-12-31$200,522
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,949,227
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,748,705
Total contributions received or receivable from employer(s)2013-12-31$40,743
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$9,664
2012 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2012 401k financial data
Total income from all sources2012-12-31$258,796
Expenses. Total of all expenses incurred2012-12-31$10,085
Total plan assets at end of year2012-12-31$1,748,705
Total plan assets at beginning of year2012-12-31$1,499,994
Value of fidelity bond covering the plan2012-12-31$1,300,000
Total contributions received or receivable from participants2012-12-31$31,924
Other income received2012-12-31$185,977
Net income (gross income less expenses)2012-12-31$248,711
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,748,705
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,499,994
Total contributions received or receivable from employer(s)2012-12-31$40,895
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$10,085
2011 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2011 401k financial data
Total income from all sources2011-12-31$-12,022
Expenses. Total of all expenses incurred2011-12-31$79,433
Benefits paid (including direct rollovers)2011-12-31$69,066
Total plan assets at end of year2011-12-31$1,499,994
Total plan assets at beginning of year2011-12-31$1,591,449
Value of fidelity bond covering the plan2011-12-31$1,300,000
Total contributions received or receivable from participants2011-12-31$24,489
Other income received2011-12-31$-48,756
Net income (gross income less expenses)2011-12-31$-91,455
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,499,994
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,591,449
Total contributions received or receivable from employer(s)2011-12-31$12,245
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$10,367
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2010 401k financial data
Total income from all sources2010-12-31$245,108
Expenses. Total of all expenses incurred2010-12-31$29,955
Benefits paid (including direct rollovers)2010-12-31$20,338
Total plan assets at end of year2010-12-31$1,591,449
Total plan assets at beginning of year2010-12-31$1,376,296
Value of fidelity bond covering the plan2010-12-31$1,300,000
Total contributions received or receivable from participants2010-12-31$33,081
Other income received2010-12-31$169,032
Net income (gross income less expenses)2010-12-31$215,153
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,591,449
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,376,296
Total contributions received or receivable from employer(s)2010-12-31$42,995
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$9,617
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN

2018: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingNo
2018-01-01This return/report is a short plan year return/report (less than 12 months)No
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2018-01-01Plan benefit arrangement - TrustYes
2017: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2017-01-01Plan benefit arrangement - TrustYes
2016: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Submission has been amendedNo
2015-01-01This submission is the final filingNo
2015-01-01This return/report is a short plan year return/report (less than 12 months)No
2015-01-01Plan is a collectively bargained planNo
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement - TrustYes
2014: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Submission has been amendedNo
2014-01-01This submission is the final filingNo
2014-01-01This return/report is a short plan year return/report (less than 12 months)No
2014-01-01Plan is a collectively bargained planNo
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement - TrustYes
2013: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Submission has been amendedNo
2013-01-01This submission is the final filingNo
2013-01-01This return/report is a short plan year return/report (less than 12 months)No
2013-01-01Plan is a collectively bargained planNo
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement - TrustYes
2012: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Submission has been amendedNo
2012-01-01This submission is the final filingNo
2012-01-01This return/report is a short plan year return/report (less than 12 months)No
2012-01-01Plan is a collectively bargained planNo
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement - TrustYes
2011: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedNo
2011-01-01This submission is the final filingNo
2011-01-01This return/report is a short plan year return/report (less than 12 months)No
2011-01-01Plan is a collectively bargained planNo
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement - TrustYes
2009: CAPITAL CITY SHEET METAL, INC. PROFIT SHARING PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01Submission has been amendedNo
2009-01-01This submission is the final filingNo
2009-01-01This return/report is a short plan year return/report (less than 12 months)No
2009-01-01Plan is a collectively bargained planNo
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract numberGP 31129
Policy instance 1
Insurance contract or identification numberGP 31129
Number of Individuals Covered12
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $704
Total amount of fees paid to insurance companyUSD $623
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees623
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATOR
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $704
THE LINCOLN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65675 )
Policy contract numberGP 31129
Policy instance 1
Insurance contract or identification numberGP 31129
Number of Individuals Covered11
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $609
Total amount of fees paid to insurance companyUSD $805
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 planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Amount paid for insurance broker fees805
Additional information about fees paid to insurance brokerTHIRD PARTY ADMINISTRATOR
Insurance broker organization code?5
Commission paid to Insurance BrokerUSD $609
Insurance broker nameUBS FINANCIAL SERVICES INC.

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