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SEDGWICK BUSINESS INTERIORS 401(K) PLAN 401k Plan overview

Plan NameSEDGWICK BUSINESS INTERIORS 401(K) PLAN
Plan identification number 001

SEDGWICK BUSINESS INTERIORS 401(K) 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.
  • 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

SEDGWICK BUSINESS INTERIORS has sponsored the creation of one or more 401k plans.

Company Name:SEDGWICK BUSINESS INTERIORS
Employer identification number (EIN):161530910
NAIC Classification:453990

Form 5500 Filing Information

Submission information for form 5500 for 401k plan SEDGWICK BUSINESS INTERIORS 401(K) PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012023-01-01
0012022-01-01
0012021-01-01
0012020-01-01
0012019-01-01
0012018-01-01
0012017-01-01
0012016-01-01
0012015-01-01
0012014-01-01
0012013-01-01CFOSHAY
0012012-01-01CFOSHAY
0012011-01-01CAROL FOSHAY
0012010-01-01CFOSHAY
0012009-01-01CAROL FOSHAY

Plan Statistics for SEDGWICK BUSINESS INTERIORS 401(K) PLAN

401k plan membership statisitcs for SEDGWICK BUSINESS INTERIORS 401(K) PLAN

Measure Date Value
2014: SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-0153
Total number of active participants reported on line 7a of the Form 55002014-01-0151
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-018
Total of all active and inactive participants2014-01-0159
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-010
Total participants2014-01-0159
Number of participants with account balances2014-01-0137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-010
2013: SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-0126
Total number of active participants reported on line 7a of the Form 55002013-01-0125
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0112
Total of all active and inactive participants2013-01-0137
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-0137
Number of participants with account balances2013-01-0125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-010
2012: SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-0130
Total number of active participants reported on line 7a of the Form 55002012-01-0125
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-011
Total of all active and inactive participants2012-01-0126
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-0126
Number of participants with account balances2012-01-0125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-010
2011: SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-0144
Total number of active participants reported on line 7a of the Form 55002011-01-0133
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-016
Total of all active and inactive participants2011-01-0139
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-0139
Number of participants with account balances2011-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-010
2010: SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2010 401k membership
Total participants, beginning-of-year2010-01-0145
Total number of active participants reported on line 7a of the Form 55002010-01-0138
Number of retired or separated participants receiving benefits2010-01-010
Number of other retired or separated participants entitled to future benefits2010-01-017
Total of all active and inactive participants2010-01-0145
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2010-01-010
Total participants2010-01-0145
Number of participants with account balances2010-01-0134
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2010-01-010
2009: SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-0133
Total number of active participants reported on line 7a of the Form 55002009-01-0132
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-011
Total of all active and inactive participants2009-01-0133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-0133
Number of participants with account balances2009-01-0133
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on SEDGWICK BUSINESS INTERIORS 401(K) PLAN

Measure Date Value
2014 : SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2014 401k financial data
Transfers to/from the plan2014-12-31$0
Total plan liabilities at end of year2014-12-31$0
Total plan liabilities at beginning of year2014-12-31$0
Total income from all sources2014-12-31$217,963
Expenses. Total of all expenses incurred2014-12-31$60,060
Benefits paid (including direct rollovers)2014-12-31$53,304
Total plan assets at end of year2014-12-31$1,649,308
Total plan assets at beginning of year2014-12-31$1,491,405
Value of fidelity bond covering the plan2014-12-31$150,000
Assets. Value of tangible personal property2014-12-31$0
Total contributions received or receivable from participants2014-12-31$127,663
Assets. Value of loans (other than to participants)2014-12-31$0
Expenses. Other expenses not covered elsewhere2014-12-31$0
Contributions received from other sources (not participants or employers)2014-12-31$0
Other income received2014-12-31$72,410
Noncash contributions received2014-12-31$0
Net income (gross income less expenses)2014-12-31$157,903
Net plan assets at end of year (total assets less liabilities)2014-12-31$1,649,308
Net plan assets at beginning of year (total assets less liabilities)2014-12-31$1,491,405
Assets. Value of participant loans2014-12-31$6,628
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2014-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2014-12-31$0
Assets. Value of assets in partnership/joint-venture interests2014-12-31$0
Assets. Value of real-estate (other than employer real property)2014-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022014-12-31$0
Assets. Value of employer securities2014-12-31$0
Assets. Value of employer real property2014-12-31$0
Total contributions received or receivable from employer(s)2014-12-31$17,890
Value of certain deemed distributions of participant loans2014-12-31$6,534
Value of corrective distributions2014-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2014-12-31$222
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2014-12-31$0
2013 : SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2013 401k financial data
Transfers to/from the plan2013-12-31$0
Total plan liabilities at end of year2013-12-31$0
Total plan liabilities at beginning of year2013-12-31$0
Total income from all sources2013-12-31$368,801
Expenses. Total of all expenses incurred2013-12-31$8,556
Benefits paid (including direct rollovers)2013-12-31$0
Total plan assets at end of year2013-12-31$1,491,405
Total plan assets at beginning of year2013-12-31$1,131,160
Value of fidelity bond covering the plan2013-12-31$150,000
Assets. Value of tangible personal property2013-12-31$0
Total contributions received or receivable from participants2013-12-31$81,413
Assets. Value of loans (other than to participants)2013-12-31$0
Expenses. Other expenses not covered elsewhere2013-12-31$0
Contributions received from other sources (not participants or employers)2013-12-31$0
Other income received2013-12-31$287,388
Noncash contributions received2013-12-31$0
Net income (gross income less expenses)2013-12-31$360,245
Net plan assets at end of year (total assets less liabilities)2013-12-31$1,491,405
Net plan assets at beginning of year (total assets less liabilities)2013-12-31$1,131,160
Assets. Value of participant loans2013-12-31$16,473
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2013-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2013-12-31$0
Assets. Value of assets in partnership/joint-venture interests2013-12-31$0
Assets. Value of real-estate (other than employer real property)2013-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022013-12-31$0
Assets. Value of employer securities2013-12-31$0
Assets. Value of employer real property2013-12-31$0
Total contributions received or receivable from employer(s)2013-12-31$0
Value of certain deemed distributions of participant loans2013-12-31$0
Value of corrective distributions2013-12-31$8,488
Expenses. Administrative service providers (salaries,fees and commissions)2013-12-31$68
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2013-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2013-12-31$0
2012 : SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2012 401k financial data
Transfers to/from the plan2012-12-31$0
Total plan liabilities at end of year2012-12-31$0
Total plan liabilities at beginning of year2012-12-31$0
Total income from all sources2012-12-31$236,909
Expenses. Total of all expenses incurred2012-12-31$203,055
Benefits paid (including direct rollovers)2012-12-31$203,055
Total plan assets at end of year2012-12-31$1,131,160
Total plan assets at beginning of year2012-12-31$1,097,306
Value of fidelity bond covering the plan2012-12-31$150,000
Assets. Value of tangible personal property2012-12-31$0
Total contributions received or receivable from participants2012-12-31$72,897
Assets. Value of loans (other than to participants)2012-12-31$0
Expenses. Other expenses not covered elsewhere2012-12-31$0
Contributions received from other sources (not participants or employers)2012-12-31$0
Other income received2012-12-31$164,012
Noncash contributions received2012-12-31$0
Net income (gross income less expenses)2012-12-31$33,854
Net plan assets at end of year (total assets less liabilities)2012-12-31$1,131,160
Net plan assets at beginning of year (total assets less liabilities)2012-12-31$1,097,306
Assets. Value of participant loans2012-12-31$8,773
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2012-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2012-12-31$0
Assets. Value of assets in partnership/joint-venture interests2012-12-31$0
Assets. Value of real-estate (other than employer real property)2012-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022012-12-31$0
Assets. Value of employer securities2012-12-31$0
Assets. Value of employer real property2012-12-31$0
Total contributions received or receivable from employer(s)2012-12-31$0
Value of certain deemed distributions of participant loans2012-12-31$0
Value of corrective distributions2012-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2012-12-31$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2012-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2012-12-31$0
2011 : SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2011 401k financial data
Transfers to/from the plan2011-12-31$0
Total plan liabilities at end of year2011-12-31$0
Total plan liabilities at beginning of year2011-12-31$0
Total income from all sources2011-12-31$19,355
Expenses. Total of all expenses incurred2011-12-31$156,952
Benefits paid (including direct rollovers)2011-12-31$156,952
Total plan assets at end of year2011-12-31$1,097,306
Total plan assets at beginning of year2011-12-31$1,234,903
Value of fidelity bond covering the plan2011-12-31$150,000
Assets. Value of tangible personal property2011-12-31$0
Total contributions received or receivable from participants2011-12-31$92,654
Assets. Value of loans (other than to participants)2011-12-31$0
Expenses. Other expenses not covered elsewhere2011-12-31$0
Contributions received from other sources (not participants or employers)2011-12-31$0
Other income received2011-12-31$-73,299
Noncash contributions received2011-12-31$0
Net income (gross income less expenses)2011-12-31$-137,597
Net plan assets at end of year (total assets less liabilities)2011-12-31$1,097,306
Net plan assets at beginning of year (total assets less liabilities)2011-12-31$1,234,903
Assets. Value of participant loans2011-12-31$39,681
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2011-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2011-12-31$0
Assets. Value of assets in partnership/joint-venture interests2011-12-31$0
Assets. Value of real-estate (other than employer real property)2011-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022011-12-31$0
Assets. Value of employer securities2011-12-31$0
Assets. Value of employer real property2011-12-31$0
Total contributions received or receivable from employer(s)2011-12-31$0
Value of certain deemed distributions of participant loans2011-12-31$0
Value of corrective distributions2011-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2011-12-31$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2011-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2011-12-31$0
2010 : SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2010 401k financial data
Transfers to/from the plan2010-12-31$0
Total plan liabilities at end of year2010-12-31$0
Total plan liabilities at beginning of year2010-12-31$0
Total income from all sources2010-12-31$216,311
Expenses. Total of all expenses incurred2010-12-31$43,778
Benefits paid (including direct rollovers)2010-12-31$43,778
Total plan assets at end of year2010-12-31$1,234,903
Total plan assets at beginning of year2010-12-31$1,062,370
Value of fidelity bond covering the plan2010-12-31$150,000
Assets. Value of tangible personal property2010-12-31$0
Total contributions received or receivable from participants2010-12-31$69,442
Assets. Value of loans (other than to participants)2010-12-31$0
Expenses. Other expenses not covered elsewhere2010-12-31$0
Contributions received from other sources (not participants or employers)2010-12-31$0
Other income received2010-12-31$146,869
Noncash contributions received2010-12-31$0
Net income (gross income less expenses)2010-12-31$172,533
Net plan assets at end of year (total assets less liabilities)2010-12-31$1,234,903
Net plan assets at beginning of year (total assets less liabilities)2010-12-31$1,062,370
Assets. Value of participant loans2010-12-31$46,312
Value of loans by the plan or fixed income obligations due to the plan which were in default or classified as uncollectible at the close of the plan year2010-12-31$0
Value of leases to which the plan was a party in default or classified as uncollectible during the plan year2010-12-31$0
Assets. Value of assets in partnership/joint-venture interests2010-12-31$0
Assets. Value of real-estate (other than employer real property)2010-12-31$0
Value of participant contributions where there was a failure to transmit these to the plan within the time period described in 29 CFR 2510.3-1022010-12-31$0
Assets. Value of employer securities2010-12-31$0
Assets. Value of employer real property2010-12-31$0
Total contributions received or receivable from employer(s)2010-12-31$0
Value of certain deemed distributions of participant loans2010-12-31$0
Value of corrective distributions2010-12-31$0
Expenses. Administrative service providers (salaries,fees and commissions)2010-12-31$0
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2010-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
2009 : SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2009 401k financial data
Aggregate amount of withdrawal liability assessed or estimated to be assessed against such withdrawn employers2009-12-310
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0
Funding deficiency by the employer to the plan for this plan year2009-12-31$0
Minimum employer required contribution for this plan year2009-12-31$0
Amount contributed by the employer to the plan for this plan year2009-12-31$0

Form 5500 Responses for SEDGWICK BUSINESS INTERIORS 401(K) PLAN

2014: SEDGWICK BUSINESS INTERIORS 401(K) 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: SEDGWICK BUSINESS INTERIORS 401(K) 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: SEDGWICK BUSINESS INTERIORS 401(K) 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: SEDGWICK BUSINESS INTERIORS 401(K) 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 – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2010: SEDGWICK BUSINESS INTERIORS 401(K) PLAN 2010 form 5500 responses
2010-01-01Type of plan entitySingle employer plan
2010-01-01Submission has been amendedNo
2010-01-01This submission is the final filingNo
2010-01-01This return/report is a short plan year return/report (less than 12 months)No
2010-01-01Plan is a collectively bargained planNo
2010-01-01Plan funding arrangement – InsuranceYes
2010-01-01Plan funding arrangement – TrustYes
2010-01-01Plan benefit arrangement – InsuranceYes
2010-01-01Plan benefit arrangement - TrustYes
2009: SEDGWICK BUSINESS INTERIORS 401(K) 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 – InsuranceYes
2009-01-01Plan funding arrangement – TrustYes
2009-01-01Plan benefit arrangement – InsuranceYes
2009-01-01Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )
Policy contract number455874-01
Policy instance 1
Insurance contract or identification number455874-01
Number of Individuals Covered37
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $3,808
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $1,904
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameMARK MODZELESKI
FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )
Policy contract number455874-01
Policy instance 1
Insurance contract or identification number455874-01
Number of Individuals Covered32
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $3,149
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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?Yes
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY
Commission paid to Insurance BrokerUSD $1,574
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameMARK MODZELESKI
FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )
Policy contract number455874-01
Policy instance 1
Insurance contract or identification number455874-01
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $2,630
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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?Yes
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY
Commission paid to Insurance BrokerUSD $0
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameMARK MODZELESKI
FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )
Policy contract number455874-01
Policy instance 1
Insurance contract or identification number455874-01
Number of Individuals Covered33
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $2,858
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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?Yes
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY
FIRST GREAT WEST LIFE INSURANCE & ANNUITY CO (National Association of Insurance Commissioners NAIC id number: 60214 )
Policy contract number455874-01
Policy instance 1
Insurance contract or identification number455874-01
Number of Individuals Covered33
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $5,189
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
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?Yes
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?Yes
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
Welfare Benefit Premiums Paid to CarrierUSD $0
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Other information about contractGROUP ANNUITY
Commission paid to Insurance BrokerUSD $2,595
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameMARK MODZELESKI

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