401k Plan data: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN plan

NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 401k Plan overview

Plan Name	NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN
Plan identification number	001

NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN Benefits

401k Plan Type

Defined 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.
Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
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.
Life insurance

401k Sponsoring company profile

NORTH COAST MERCANTILE COMPANY, INC. has sponsored the creation of one or more 401k plans.

Company Name: NORTH COAST MERCANTILE COMPANY, INC.

Employer identification number (EIN): 941484261

NAIC Classification: 424800

Form 5500 Filing Information

Submission information for form 5500 for 401k plan NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
001 2023-01-01
001 2022-01-01
001 2021-01-01
001 2020-01-01
001 2019-01-01
001 2018-01-01
001 2017-01-01
001 2016-01-01
001 2015-01-01
001 2014-01-01
001 2013-01-01
001 2012-01-01 ROBERT HANSEN 2013-09-30 ROBERT HANSEN 2013-09-30
001 2011-01-01 ROBERT HANSEN 2012-10-08 ROBERT HANSEN 2012-10-08
001 2010-01-01 ROBERT HANSEN 2011-10-02 ROBERT HANSEN 2011-10-02

Plan Statistics for NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN

401k plan membership statisitcs for NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN

Measure Date Value
2023: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year 2023-01-01 53
Total number of active participants reported on line 7a of the Form 5500 2023-01-01 33
Number of retired or separated participants receiving benefits 2023-01-01 0
Number of other retired or separated participants entitled to future benefits 2023-01-01 15
Total of all active and inactive participants 2023-01-01 48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2023-01-01 0
Total participants 2023-01-01 48
Number of participants with account balances 2023-01-01 48
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2023-01-01 3
2022: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year 2022-01-01 50
Total number of active participants reported on line 7a of the Form 5500 2022-01-01 36
Number of retired or separated participants receiving benefits 2022-01-01 0
Number of other retired or separated participants entitled to future benefits 2022-01-01 17
Total of all active and inactive participants 2022-01-01 53
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2022-01-01 0
Total participants 2022-01-01 53
Number of participants with account balances 2022-01-01 52
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2022-01-01 1
2021: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year 2021-01-01 46
Total number of active participants reported on line 7a of the Form 5500 2021-01-01 34
Number of retired or separated participants receiving benefits 2021-01-01 0
Number of other retired or separated participants entitled to future benefits 2021-01-01 16
Total of all active and inactive participants 2021-01-01 50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2021-01-01 0
Total participants 2021-01-01 50
Number of participants with account balances 2021-01-01 50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2021-01-01 2
2020: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year 2020-01-01 58
Total number of active participants reported on line 7a of the Form 5500 2020-01-01 33
Number of retired or separated participants receiving benefits 2020-01-01 0
Number of other retired or separated participants entitled to future benefits 2020-01-01 13
Total of all active and inactive participants 2020-01-01 46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2020-01-01 0
Total participants 2020-01-01 46
Number of participants with account balances 2020-01-01 46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2020-01-01 3
2019: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year 2019-01-01 49
Total number of active participants reported on line 7a of the Form 5500 2019-01-01 36
Number of retired or separated participants receiving benefits 2019-01-01 0
Number of other retired or separated participants entitled to future benefits 2019-01-01 22
Total of all active and inactive participants 2019-01-01 58
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-01-01 0
Total participants 2019-01-01 58
Number of participants with account balances 2019-01-01 57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-01-01 3

Measure	Date	Value
2023: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2023 401k membership
Total participants, beginning-of-year	2023-01-01	53
Total number of active participants reported on line 7a of the Form 5500	2023-01-01	33
Number of retired or separated participants receiving benefits	2023-01-01	0
Number of other retired or separated participants entitled to future benefits	2023-01-01	15
Total of all active and inactive participants	2023-01-01	48
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2023-01-01	0
Total participants	2023-01-01	48
Number of participants with account balances	2023-01-01	48
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2023-01-01	3
2022: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2022 401k membership
Total participants, beginning-of-year	2022-01-01	50
Total number of active participants reported on line 7a of the Form 5500	2022-01-01	36
Number of retired or separated participants receiving benefits	2022-01-01	0
Number of other retired or separated participants entitled to future benefits	2022-01-01	17
Total of all active and inactive participants	2022-01-01	53
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2022-01-01	0
Total participants	2022-01-01	53
Number of participants with account balances	2022-01-01	52
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2022-01-01	1
2021: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2021 401k membership
Total participants, beginning-of-year	2021-01-01	46
Total number of active participants reported on line 7a of the Form 5500	2021-01-01	34
Number of retired or separated participants receiving benefits	2021-01-01	0
Number of other retired or separated participants entitled to future benefits	2021-01-01	16
Total of all active and inactive participants	2021-01-01	50
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2021-01-01	0
Total participants	2021-01-01	50
Number of participants with account balances	2021-01-01	50
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2021-01-01	2
2020: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2020 401k membership
Total participants, beginning-of-year	2020-01-01	58
Total number of active participants reported on line 7a of the Form 5500	2020-01-01	33
Number of retired or separated participants receiving benefits	2020-01-01	0
Number of other retired or separated participants entitled to future benefits	2020-01-01	13
Total of all active and inactive participants	2020-01-01	46
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2020-01-01	0
Total participants	2020-01-01	46
Number of participants with account balances	2020-01-01	46
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2020-01-01	3
2019: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2019 401k membership
Total participants, beginning-of-year	2019-01-01	49
Total number of active participants reported on line 7a of the Form 5500	2019-01-01	36
Number of retired or separated participants receiving benefits	2019-01-01	0
Number of other retired or separated participants entitled to future benefits	2019-01-01	22
Total of all active and inactive participants	2019-01-01	58
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-01-01	0
Total participants	2019-01-01	58
Number of participants with account balances	2019-01-01	57
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-01-01	3

Financial Data on NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN

Measure	Date	Value
2023 : NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2023 401k financial data
Transfers to/from the plan	2023-12-31	$0
Total plan liabilities at end of year	2023-12-31	$0
Total plan liabilities at beginning of year	2023-12-31	$0
Total income from all sources	2023-12-31	$608,018
Expenses. Total of all expenses incurred	2023-12-31	$97,876
Benefits paid (including direct rollovers)	2023-12-31	$94,466
Total plan assets at end of year	2023-12-31	$3,710,288
Total plan assets at beginning of year	2023-12-31	$3,200,146
Value of fidelity bond covering the plan	2023-12-31	$250,000
Total contributions received or receivable from participants	2023-12-31	$146,598
Expenses. Other expenses not covered elsewhere	2023-12-31	$0
Contributions received from other sources (not participants or employers)	2023-12-31	$0
Other income received	2023-12-31	$371,000
Noncash contributions received	2023-12-31	$0
Net income (gross income less expenses)	2023-12-31	$510,142
Net plan assets at end of year (total assets less liabilities)	2023-12-31	$3,710,288
Net plan assets at beginning of year (total assets less liabilities)	2023-12-31	$3,200,146
Total contributions received or receivable from employer(s)	2023-12-31	$90,420
Value of certain deemed distributions of participant loans	2023-12-31	$0
Value of corrective distributions	2023-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2023-12-31	$3,410
2022 : NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2022 401k financial data
Transfers to/from the plan	2022-12-31	$0
Total plan liabilities at end of year	2022-12-31	$0
Total plan liabilities at beginning of year	2022-12-31	$0
Total income from all sources	2022-12-31	$168,253
Expenses. Total of all expenses incurred	2022-12-31	$365,624
Benefits paid (including direct rollovers)	2022-12-31	$362,194
Total plan assets at end of year	2022-12-31	$3,200,146
Total plan assets at beginning of year	2022-12-31	$3,397,517
Value of fidelity bond covering the plan	2022-12-31	$250,000
Total contributions received or receivable from participants	2022-12-31	$141,909
Expenses. Other expenses not covered elsewhere	2022-12-31	$0
Contributions received from other sources (not participants or employers)	2022-12-31	$506,672
Other income received	2022-12-31	$-561,112
Noncash contributions received	2022-12-31	$0
Net income (gross income less expenses)	2022-12-31	$-197,371
Net plan assets at end of year (total assets less liabilities)	2022-12-31	$3,200,146
Net plan assets at beginning of year (total assets less liabilities)	2022-12-31	$3,397,517
Total contributions received or receivable from employer(s)	2022-12-31	$80,784
Value of certain deemed distributions of participant loans	2022-12-31	$0
Value of corrective distributions	2022-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2022-12-31	$3,430
2021 : NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2021 401k financial data
Transfers to/from the plan	2021-12-31	$0
Total plan liabilities at end of year	2021-12-31	$0
Total plan liabilities at beginning of year	2021-12-31	$0
Total income from all sources	2021-12-31	$560,328
Expenses. Total of all expenses incurred	2021-12-31	$338,862
Benefits paid (including direct rollovers)	2021-12-31	$335,937
Total plan assets at end of year	2021-12-31	$3,397,517
Total plan assets at beginning of year	2021-12-31	$3,176,051
Value of fidelity bond covering the plan	2021-12-31	$250,000
Total contributions received or receivable from participants	2021-12-31	$142,154
Expenses. Other expenses not covered elsewhere	2021-12-31	$0
Contributions received from other sources (not participants or employers)	2021-12-31	$0
Other income received	2021-12-31	$384,177
Noncash contributions received	2021-12-31	$0
Net income (gross income less expenses)	2021-12-31	$221,466
Net plan assets at end of year (total assets less liabilities)	2021-12-31	$3,397,517
Net plan assets at beginning of year (total assets less liabilities)	2021-12-31	$3,176,051
Total contributions received or receivable from employer(s)	2021-12-31	$33,997
Value of certain deemed distributions of participant loans	2021-12-31	$0
Value of corrective distributions	2021-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2021-12-31	$2,925
2020 : NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2020 401k financial data
Transfers to/from the plan	2020-12-31	$0
Total plan liabilities at end of year	2020-12-31	$0
Total plan liabilities at beginning of year	2020-12-31	$0
Total income from all sources	2020-12-31	$520,749
Expenses. Total of all expenses incurred	2020-12-31	$95,981
Benefits paid (including direct rollovers)	2020-12-31	$92,641
Total plan assets at end of year	2020-12-31	$3,176,051
Total plan assets at beginning of year	2020-12-31	$2,751,283
Value of fidelity bond covering the plan	2020-12-31	$250,000
Total contributions received or receivable from participants	2020-12-31	$133,889
Expenses. Other expenses not covered elsewhere	2020-12-31	$0
Contributions received from other sources (not participants or employers)	2020-12-31	$0
Other income received	2020-12-31	$299,383
Noncash contributions received	2020-12-31	$0
Net income (gross income less expenses)	2020-12-31	$424,768
Net plan assets at end of year (total assets less liabilities)	2020-12-31	$3,176,051
Net plan assets at beginning of year (total assets less liabilities)	2020-12-31	$2,751,283
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-102	2020-12-31	$0
Total contributions received or receivable from employer(s)	2020-12-31	$87,477
Value of certain deemed distributions of participant loans	2020-12-31	$0
Value of corrective distributions	2020-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2020-12-31	$3,340
2019 : NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2019 401k financial data
Transfers to/from the plan	2019-12-31	$0
Total plan liabilities at end of year	2019-12-31	$0
Total plan liabilities at beginning of year	2019-12-31	$0
Total income from all sources	2019-12-31	$552,706
Expenses. Total of all expenses incurred	2019-12-31	$31,273
Benefits paid (including direct rollovers)	2019-12-31	$28,177
Total plan assets at end of year	2019-12-31	$2,751,283
Total plan assets at beginning of year	2019-12-31	$2,229,850
Value of fidelity bond covering the plan	2019-12-31	$250,000
Total contributions received or receivable from participants	2019-12-31	$111,866
Expenses. Other expenses not covered elsewhere	2019-12-31	$0
Contributions received from other sources (not participants or employers)	2019-12-31	$0
Other income received	2019-12-31	$361,660
Noncash contributions received	2019-12-31	$0
Net income (gross income less expenses)	2019-12-31	$521,433
Net plan assets at end of year (total assets less liabilities)	2019-12-31	$2,751,283
Net plan assets at beginning of year (total assets less liabilities)	2019-12-31	$2,229,850
Total contributions received or receivable from employer(s)	2019-12-31	$79,180
Value of certain deemed distributions of participant loans	2019-12-31	$0
Value of corrective distributions	2019-12-31	$0
Expenses. Administrative service providers (salaries,fees and commissions)	2019-12-31	$3,096

Form 5500 Responses for NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN

2023: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2023 form 5500 responses
2023-01-01	Type of plan entity	Single employer plan
2023-01-01	Submission has been amended	No
2023-01-01	This submission is the final filing	No
2023-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2023-01-01	Plan is a collectively bargained plan	No
2023-01-01	Plan funding arrangement – Trust	Yes
2023-01-01	Plan benefit arrangement - Trust	Yes
2022: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2022 form 5500 responses
2022-01-01	Type of plan entity	Single employer plan
2022-01-01	Submission has been amended	No
2022-01-01	This submission is the final filing	No
2022-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2022-01-01	Plan is a collectively bargained plan	No
2022-01-01	Plan funding arrangement – Insurance	Yes
2022-01-01	Plan funding arrangement – Trust	Yes
2022-01-01	Plan benefit arrangement – Insurance	Yes
2022-01-01	Plan benefit arrangement - Trust	Yes
2021: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2021 form 5500 responses
2021-01-01	Type of plan entity	Single employer plan
2021-01-01	This submission is the final filing	No
2021-01-01	Plan is a collectively bargained plan	No
2021-01-01	Plan funding arrangement – Insurance	Yes
2021-01-01	Plan funding arrangement – Trust	Yes
2021-01-01	Plan benefit arrangement – Insurance	Yes
2021-01-01	Plan benefit arrangement - Trust	Yes
2020: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2020 form 5500 responses
2020-01-01	Type of plan entity	Single employer plan
2020-01-01	This submission is the final filing	No
2020-01-01	Plan is a collectively bargained plan	No
2020-01-01	Plan funding arrangement – Insurance	Yes
2020-01-01	Plan funding arrangement – Trust	Yes
2020-01-01	Plan benefit arrangement – Insurance	Yes
2020-01-01	Plan benefit arrangement - Trust	Yes
2019: NORTH COAST MERCANTILE COMPANY, INC. 401K PROFIT SHARING PLAN 2019 form 5500 responses
2019-01-01	Type of plan entity	Single employer plan
2019-01-01	Submission has been amended	No
2019-01-01	This submission is the final filing	No
2019-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2019-01-01	Plan is a collectively bargained plan	No
2019-01-01	Plan funding arrangement – Insurance	Yes
2019-01-01	Plan funding arrangement – Trust	Yes
2019-01-01	Plan benefit arrangement – Insurance	Yes
2019-01-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	0
Insurance policy start date	2022-01-01
Insurance policy end date	2022-12-31
Are there contracts with allocated funds for individual policies?	0
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	0
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 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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	Yes

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	2
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
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
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

AMERICAN GENERAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 60488 )

Policy contract number

VARIOUS

Policy instance

Insurance contract or identification number	VARIOUS
Number of Individuals Covered	16
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
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
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
Commission paid to Insurance Broker	USD $0
Amount paid for insurance broker fees	0

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Company Name:	NORTH COAST MERCANTILE COMPANY, INC.
Employer identification number (EIN):	941484261
NAIC Classification:	424800