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OBI RETIREE BENEFIT PLAN 401k Plan overview

Plan NameOBI RETIREE BENEFIT PLAN
Plan identification number 501

OBI RETIREE BENEFIT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Health (other than dental or vision)
  • Dental

401k Sponsoring company profile

OBI RETIREE VOLUNTARY EMPLOYEE BENEFITS ASSOCIATION has sponsored the creation of one or more 401k plans.

Company Name:OBI RETIREE VOLUNTARY EMPLOYEE BENEFITS ASSOCIATION
Employer identification number (EIN):203970900
NAIC Classification:525100
NAIC Description: Insurance and Employee Benefit Funds

Form 5500 Filing Information

Submission information for form 5500 for 401k plan OBI RETIREE BENEFIT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5012022-01-01
5012021-01-01
5012020-01-01
5012019-01-01
5012018-01-01
5012017-01-01THOMAS G. FORD2018-07-23 THOMAS G. FORD2018-07-23
5012016-01-01THOMAS G. FORD2017-07-13 THOMAS G. FORD2017-07-13
5012015-01-01THOMAS G. FORD2016-07-29 THOMAS G. FORD2016-07-29
5012014-01-01THOMAS G. FORD2015-07-15 THOMAS G. FORD2015-07-15
5012013-01-01THOMAS G. FORD2014-07-15 THOMAS G. FORD2014-07-15
5012012-01-01THOMAS G. FORD2013-07-15 THOMAS G. FORD2013-07-15
5012011-01-01THOMAS G. FORD2012-07-18 THOMAS G. FORD2012-07-15
5012009-01-01THOMAS G. FORD2010-10-06 THOMAS G. FORD2010-10-06

Plan Statistics for OBI RETIREE BENEFIT PLAN

401k plan membership statisitcs for OBI RETIREE BENEFIT PLAN

Measure Date Value
2022: OBI RETIREE BENEFIT PLAN 2022 401k membership
Total participants, beginning-of-year2022-01-01521
Total number of active participants reported on line 7a of the Form 55002022-01-010
Number of retired or separated participants receiving benefits2022-01-01331
Number of other retired or separated participants entitled to future benefits2022-01-010
Total of all active and inactive participants2022-01-01331
2021: OBI RETIREE BENEFIT PLAN 2021 401k membership
Total participants, beginning-of-year2021-01-01537
Number of retired or separated participants receiving benefits2021-01-01521
Number of other retired or separated participants entitled to future benefits2021-01-010
Total of all active and inactive participants2021-01-01521
2020: OBI RETIREE BENEFIT PLAN 2020 401k membership
Total participants, beginning-of-year2020-01-01601
Number of retired or separated participants receiving benefits2020-01-01537
Number of other retired or separated participants entitled to future benefits2020-01-010
Total of all active and inactive participants2020-01-01537
2019: OBI RETIREE BENEFIT PLAN 2019 401k membership
Total participants, beginning-of-year2019-01-01730
Number of retired or separated participants receiving benefits2019-01-01601
Number of other retired or separated participants entitled to future benefits2019-01-010
Total of all active and inactive participants2019-01-01601
Total participants2019-01-01601
2018: OBI RETIREE BENEFIT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01805
Number of retired or separated participants receiving benefits2018-01-01730
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-01730
Total participants2018-01-01730
2017: OBI RETIREE BENEFIT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01876
Number of retired or separated participants receiving benefits2017-01-01805
Number of other retired or separated participants entitled to future benefits2017-01-010
Total of all active and inactive participants2017-01-01805
2016: OBI RETIREE BENEFIT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01971
Number of retired or separated participants receiving benefits2016-01-01876
Number of other retired or separated participants entitled to future benefits2016-01-010
Total of all active and inactive participants2016-01-01876
2015: OBI RETIREE BENEFIT PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-011,047
Number of retired or separated participants receiving benefits2015-01-01971
Number of other retired or separated participants entitled to future benefits2015-01-010
Total of all active and inactive participants2015-01-01971
2014: OBI RETIREE BENEFIT PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-011,170
Number of retired or separated participants receiving benefits2014-01-011,047
Number of other retired or separated participants entitled to future benefits2014-01-010
Total of all active and inactive participants2014-01-011,047
2013: OBI RETIREE BENEFIT PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-011,081
Number of retired or separated participants receiving benefits2013-01-011,170
Number of other retired or separated participants entitled to future benefits2013-01-010
Total of all active and inactive participants2013-01-011,170
2012: OBI RETIREE BENEFIT PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-011,162
Number of retired or separated participants receiving benefits2012-01-011,081
Number of other retired or separated participants entitled to future benefits2012-01-010
Total of all active and inactive participants2012-01-011,081
2011: OBI RETIREE BENEFIT PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-011,343
Number of retired or separated participants receiving benefits2011-01-011,162
Number of other retired or separated participants entitled to future benefits2011-01-010
Total of all active and inactive participants2011-01-011,162
2009: OBI RETIREE BENEFIT PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-011,410
Total number of active participants reported on line 7a of the Form 55002009-01-010
Number of retired or separated participants receiving benefits2009-01-01830
Number of other retired or separated participants entitled to future benefits2009-01-010
Total of all active and inactive participants2009-01-01830

Financial Data on OBI RETIREE BENEFIT PLAN

Measure Date Value
2022 : OBI RETIREE BENEFIT PLAN 2022 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2022-12-31$-9,384
Total unrealized appreciation/depreciation of assets2022-12-31$-9,384
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2022-12-31$0
Total income from all sources (including contributions)2022-12-31$139,020
Total loss/gain on sale of assets2022-12-31$-431
Total of all expenses incurred2022-12-31$223,707
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2022-12-31$111,022
Total contributions o plan (from employers,participants, others, non cash contrinutions)2022-12-31$0
Value of total assets at end of year2022-12-31$2,816,417
Value of total assets at beginning of year2022-12-31$2,901,104
Total of administrative expenses incurred including professional, contract, advisory and management fees2022-12-31$112,685
Total interest from all sources2022-12-31$18,670
Total dividends received (eg from common stock, registered investment company shares)2022-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2022-12-31No
Administrative expenses professional fees incurred2022-12-31$0
Was this plan covered by a fidelity bond2022-12-31Yes
Value of fidelity bond cover2022-12-31$500,000
If this is an individual account plan, was there a blackout period2022-12-31No
Were there any nonexempt tranactions with any party-in-interest2022-12-31No
Assets. Other investments not covered elsewhere at end of year2022-12-31$51,230
Assets. Other investments not covered elsewhere at beginning of year2022-12-31$51,279
Other income not declared elsewhere2022-12-31$130,165
Administrative expenses (other) incurred2022-12-31$94,000
Total non interest bearing cash at end of year2022-12-31$1,772
Total non interest bearing cash at beginning of year2022-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Value of net income/loss2022-12-31$-84,687
Value of net assets at end of year (total assets less liabilities)2022-12-31$2,816,417
Value of net assets at beginning of year (total assets less liabilities)2022-12-31$2,901,104
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2022-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2022-12-31No
Were any leases to which the plan was party in default or uncollectible2022-12-31No
Investment advisory and management fees2022-12-31$8,655
Income. Interest from US Government securities2022-12-31$8,363
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2022-12-31$1,979,840
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2022-12-31$1,850,525
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2022-12-31$1,850,525
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2022-12-31$10,307
Expenses. Payments to insurance carriers foe the provision of benefits2022-12-31$43,782
Asset value of US Government securities at end of year2022-12-31$783,575
Asset value of US Government securities at beginning of year2022-12-31$999,300
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2022-12-31Yes
Was there a failure to transmit to the plan any participant contributions2022-12-31No
Has the plan failed to provide any benefit when due under the plan2022-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2022-12-31$67,240
Contract administrator fees2022-12-31$10,030
Did the plan have assets held for investment2022-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2022-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2022-12-31No
Aggregate proceeds on sale of assets2022-12-31$-431
Opinion of an independent qualified public accountant for this plan2022-12-31Unqualified
Accountancy firm name2022-12-31CLIFTONLARSONALLEN LLP
Accountancy firm EIN2022-12-31410746749
2021 : OBI RETIREE BENEFIT PLAN 2021 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2021-12-31$1,722
Total unrealized appreciation/depreciation of assets2021-12-31$1,722
Total income from all sources (including contributions)2021-12-31$165,540
Total loss/gain on sale of assets2021-12-31$-8,713
Total of all expenses incurred2021-12-31$275,315
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2021-12-31$137,446
Value of total assets at end of year2021-12-31$2,901,104
Value of total assets at beginning of year2021-12-31$3,010,879
Total of administrative expenses incurred including professional, contract, advisory and management fees2021-12-31$137,869
Total interest from all sources2021-12-31$11,777
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2021-12-31No
Administrative expenses professional fees incurred2021-12-31$23,000
Was this plan covered by a fidelity bond2021-12-31Yes
Value of fidelity bond cover2021-12-31$500,000
If this is an individual account plan, was there a blackout period2021-12-31No
Were there any nonexempt tranactions with any party-in-interest2021-12-31No
Assets. Other investments not covered elsewhere at end of year2021-12-31$51,279
Assets. Other investments not covered elsewhere at beginning of year2021-12-31$51,279
Other income not declared elsewhere2021-12-31$160,754
Administrative expenses (other) incurred2021-12-31$94,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Value of net income/loss2021-12-31$-109,775
Value of net assets at end of year (total assets less liabilities)2021-12-31$2,901,104
Value of net assets at beginning of year (total assets less liabilities)2021-12-31$3,010,879
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2021-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2021-12-31No
Were any leases to which the plan was party in default or uncollectible2021-12-31No
Investment advisory and management fees2021-12-31$10,066
Income. Interest from US Government securities2021-12-31$11,237
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2021-12-31$1,850,525
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2021-12-31$1,953,740
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2021-12-31$1,953,740
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2021-12-31$540
Expenses. Payments to insurance carriers foe the provision of benefits2021-12-31$65,945
Asset value of US Government securities at end of year2021-12-31$999,300
Asset value of US Government securities at beginning of year2021-12-31$1,005,860
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2021-12-31Yes
Was there a failure to transmit to the plan any participant contributions2021-12-31No
Has the plan failed to provide any benefit when due under the plan2021-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2021-12-31$71,501
Contract administrator fees2021-12-31$10,803
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32021-12-31No
Did the plan have assets held for investment2021-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2021-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2021-12-31No
Aggregate proceeds on sale of assets2021-12-31$-8,713
Opinion of an independent qualified public accountant for this plan2021-12-31Unqualified
Accountancy firm name2021-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2021-12-31043236498
2020 : OBI RETIREE BENEFIT PLAN 2020 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2020-12-31$-2,853
Total unrealized appreciation/depreciation of assets2020-12-31$-2,853
Total income from all sources (including contributions)2020-12-31$211,594
Total loss/gain on sale of assets2020-12-31$-5,772
Total of all expenses incurred2020-12-31$322,654
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2020-12-31$163,458
Value of total assets at end of year2020-12-31$3,010,879
Value of total assets at beginning of year2020-12-31$3,121,939
Total of administrative expenses incurred including professional, contract, advisory and management fees2020-12-31$159,196
Total interest from all sources2020-12-31$43,475
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2020-12-31No
Administrative expenses professional fees incurred2020-12-31$33,000
Was this plan covered by a fidelity bond2020-12-31Yes
Value of fidelity bond cover2020-12-31$500,000
If this is an individual account plan, was there a blackout period2020-12-31No
Were there any nonexempt tranactions with any party-in-interest2020-12-31No
Assets. Other investments not covered elsewhere at end of year2020-12-31$51,279
Assets. Other investments not covered elsewhere at beginning of year2020-12-31$56,297
Other income not declared elsewhere2020-12-31$176,744
Administrative expenses (other) incurred2020-12-31$104,647
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Value of net income/loss2020-12-31$-111,060
Value of net assets at end of year (total assets less liabilities)2020-12-31$3,010,879
Value of net assets at beginning of year (total assets less liabilities)2020-12-31$3,121,939
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2020-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2020-12-31No
Were any leases to which the plan was party in default or uncollectible2020-12-31No
Investment advisory and management fees2020-12-31$10,773
Income. Interest from US Government securities2020-12-31$38,086
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2020-12-31$1,953,740
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2020-12-31$959,870
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2020-12-31$959,870
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2020-12-31$5,389
Expenses. Payments to insurance carriers foe the provision of benefits2020-12-31$99,963
Asset value of US Government securities at end of year2020-12-31$1,005,860
Asset value of US Government securities at beginning of year2020-12-31$2,105,772
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2020-12-31Yes
Was there a failure to transmit to the plan any participant contributions2020-12-31No
Has the plan failed to provide any benefit when due under the plan2020-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2020-12-31$63,495
Contract administrator fees2020-12-31$10,776
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32020-12-31No
Did the plan have assets held for investment2020-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2020-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2020-12-31No
Aggregate proceeds on sale of assets2020-12-31$-5,772
Opinion of an independent qualified public accountant for this plan2020-12-31Disclaimer
Accountancy firm name2020-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2020-12-31043236498
2019 : OBI RETIREE BENEFIT PLAN 2019 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$18,382
Unrealized appreciation/depreciation of other (non real estate) assets2019-12-31$18,382
Total unrealized appreciation/depreciation of assets2019-12-31$18,382
Total unrealized appreciation/depreciation of assets2019-12-31$18,382
Total income from all sources (including contributions)2019-12-31$302,010
Total income from all sources (including contributions)2019-12-31$302,010
Total loss/gain on sale of assets2019-12-31$964
Total loss/gain on sale of assets2019-12-31$964
Total of all expenses incurred2019-12-31$323,964
Total of all expenses incurred2019-12-31$323,964
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2019-12-31$167,342
Value of total assets at end of year2019-12-31$3,121,939
Value of total assets at end of year2019-12-31$3,121,939
Value of total assets at beginning of year2019-12-31$3,143,893
Value of total assets at beginning of year2019-12-31$3,143,893
Total of administrative expenses incurred including professional, contract, advisory and management fees2019-12-31$156,622
Total interest from all sources2019-12-31$66,218
Total interest from all sources2019-12-31$66,218
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2019-12-31No
Administrative expenses professional fees incurred2019-12-31$22,000
Administrative expenses professional fees incurred2019-12-31$22,000
Was this plan covered by a fidelity bond2019-12-31Yes
Was this plan covered by a fidelity bond2019-12-31Yes
Value of fidelity bond cover2019-12-31$500,000
If this is an individual account plan, was there a blackout period2019-12-31No
If this is an individual account plan, was there a blackout period2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Were there any nonexempt tranactions with any party-in-interest2019-12-31No
Assets. Other investments not covered elsewhere at end of year2019-12-31$56,297
Assets. Other investments not covered elsewhere at end of year2019-12-31$56,297
Assets. Other investments not covered elsewhere at beginning of year2019-12-31$60,765
Other income not declared elsewhere2019-12-31$216,446
Other income not declared elsewhere2019-12-31$216,446
Administrative expenses (other) incurred2019-12-31$107,794
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Value of net income/loss2019-12-31$-21,954
Value of net assets at end of year (total assets less liabilities)2019-12-31$3,121,939
Value of net assets at end of year (total assets less liabilities)2019-12-31$3,121,939
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$3,143,893
Value of net assets at beginning of year (total assets less liabilities)2019-12-31$3,143,893
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Were any leases to which the plan was party in default or uncollectible2019-12-31No
Investment advisory and management fees2019-12-31$11,783
Investment advisory and management fees2019-12-31$11,783
Income. Interest from US Government securities2019-12-31$46,093
Income. Interest from US Government securities2019-12-31$46,093
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$959,870
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2019-12-31$959,870
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$995,909
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$995,909
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2019-12-31$995,909
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2019-12-31$995,909
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2019-12-31$20,125
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$99,245
Expenses. Payments to insurance carriers foe the provision of benefits2019-12-31$99,245
Asset value of US Government securities at end of year2019-12-31$2,105,772
Asset value of US Government securities at end of year2019-12-31$2,105,772
Asset value of US Government securities at beginning of year2019-12-31$2,087,219
Asset value of US Government securities at beginning of year2019-12-31$2,087,219
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2019-12-31Yes
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Was there a failure to transmit to the plan any participant contributions2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Has the plan failed to provide any benefit when due under the plan2019-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$68,097
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2019-12-31$68,097
Contract administrator fees2019-12-31$15,045
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32019-12-31No
Did the plan have assets held for investment2019-12-31Yes
Did the plan have assets held for investment2019-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2019-12-31No
Aggregate proceeds on sale of assets2019-12-31$964
Aggregate proceeds on sale of assets2019-12-31$964
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2019-12-31Yes
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Opinion of an independent qualified public accountant for this plan2019-12-31Disclaimer
Accountancy firm name2019-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm name2019-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2019-12-31043236498
Accountancy firm EIN2019-12-31043236498
2018 : OBI RETIREE BENEFIT PLAN 2018 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2018-12-31$10,425
Total unrealized appreciation/depreciation of assets2018-12-31$10,425
Total income from all sources (including contributions)2018-12-31$327,255
Total loss/gain on sale of assets2018-12-31$1,935
Total of all expenses incurred2018-12-31$374,800
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-12-31$216,311
Value of total assets at end of year2018-12-31$3,143,893
Value of total assets at beginning of year2018-12-31$3,191,438
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-12-31$158,489
Total interest from all sources2018-12-31$34,688
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-12-31No
Administrative expenses professional fees incurred2018-12-31$22,000
Was this plan covered by a fidelity bond2018-12-31Yes
Value of fidelity bond cover2018-12-31$500,000
If this is an individual account plan, was there a blackout period2018-12-31No
Were there any nonexempt tranactions with any party-in-interest2018-12-31No
Assets. Other investments not covered elsewhere at end of year2018-12-31$60,765
Assets. Other investments not covered elsewhere at beginning of year2018-12-31$66,630
Other income not declared elsewhere2018-12-31$280,207
Administrative expenses (other) incurred2018-12-31$107,831
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Value of net income/loss2018-12-31$-47,545
Value of net assets at end of year (total assets less liabilities)2018-12-31$3,143,893
Value of net assets at beginning of year (total assets less liabilities)2018-12-31$3,191,438
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-12-31No
Were any leases to which the plan was party in default or uncollectible2018-12-31No
Investment advisory and management fees2018-12-31$12,623
Income. Interest from US Government securities2018-12-31$17,526
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2018-12-31$995,909
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2018-12-31$957,871
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2018-12-31$957,871
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2018-12-31$17,162
Expenses. Payments to insurance carriers foe the provision of benefits2018-12-31$133,961
Asset value of US Government securities at end of year2018-12-31$2,087,219
Asset value of US Government securities at beginning of year2018-12-31$2,166,937
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-12-31Yes
Was there a failure to transmit to the plan any participant contributions2018-12-31No
Has the plan failed to provide any benefit when due under the plan2018-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-12-31$82,350
Contract administrator fees2018-12-31$16,035
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32018-12-31No
Did the plan have assets held for investment2018-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-12-31No
Aggregate proceeds on sale of assets2018-12-31$1,935
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-12-31Yes
Opinion of an independent qualified public accountant for this plan2018-12-31Disclaimer
Accountancy firm name2018-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2018-12-31043236498
2017 : OBI RETIREE BENEFIT PLAN 2017 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2017-12-31$-1,660
Total unrealized appreciation/depreciation of assets2017-12-31$-1,660
Total income from all sources (including contributions)2017-12-31$263,508
Total loss/gain on sale of assets2017-12-31$-564
Total of all expenses incurred2017-12-31$423,218
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$263,426
Value of total assets at end of year2017-12-31$3,191,438
Value of total assets at beginning of year2017-12-31$3,351,148
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$159,792
Total interest from all sources2017-12-31$25,068
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31No
Administrative expenses professional fees incurred2017-12-31$22,000
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$500,000
If this is an individual account plan, was there a blackout period2017-12-31No
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Assets. Other investments not covered elsewhere at end of year2017-12-31$66,630
Assets. Other investments not covered elsewhere at beginning of year2017-12-31$73,822
Other income not declared elsewhere2017-12-31$240,664
Administrative expenses (other) incurred2017-12-31$107,852
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-159,710
Value of net assets at end of year (total assets less liabilities)2017-12-31$3,191,438
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$3,351,148
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2017-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2017-12-31No
Were any leases to which the plan was party in default or uncollectible2017-12-31No
Investment advisory and management fees2017-12-31$12,910
Income. Interest from US Government securities2017-12-31$17,871
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2017-12-31$957,871
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2017-12-31$1,105,354
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2017-12-31$1,105,354
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2017-12-31$7,197
Expenses. Payments to insurance carriers foe the provision of benefits2017-12-31$142,373
Asset value of US Government securities at end of year2017-12-31$2,166,937
Asset value of US Government securities at beginning of year2017-12-31$2,171,972
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31Yes
Was there a failure to transmit to the plan any participant contributions2017-12-31No
Has the plan failed to provide any benefit when due under the plan2017-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$121,053
Contract administrator fees2017-12-31$17,030
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31No
Did the plan have assets held for investment2017-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2017-12-31No
Aggregate proceeds on sale of assets2017-12-31$-564
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2017-12-31Yes
Opinion of an independent qualified public accountant for this plan2017-12-31Disclaimer
Accountancy firm name2017-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2017-12-31043236498
2016 : OBI RETIREE BENEFIT PLAN 2016 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2016-12-31$-3,500
Total unrealized appreciation/depreciation of assets2016-12-31$-3,500
Total income from all sources (including contributions)2016-12-31$384,488
Total loss/gain on sale of assets2016-12-31$2,721
Total of all expenses incurred2016-12-31$473,199
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$303,591
Value of total assets at end of year2016-12-31$3,351,148
Value of total assets at beginning of year2016-12-31$3,439,859
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$169,608
Total interest from all sources2016-12-31$23,896
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Administrative expenses professional fees incurred2016-12-31$28,500
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$500,000
If this is an individual account plan, was there a blackout period2016-12-31No
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Assets. Other investments not covered elsewhere at end of year2016-12-31$73,822
Assets. Other investments not covered elsewhere at beginning of year2016-12-31$81,046
Other income not declared elsewhere2016-12-31$361,371
Administrative expenses (other) incurred2016-12-31$109,370
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Value of net income/loss2016-12-31$-88,711
Value of net assets at end of year (total assets less liabilities)2016-12-31$3,351,148
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$3,439,859
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2016-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2016-12-31No
Were any leases to which the plan was party in default or uncollectible2016-12-31No
Investment advisory and management fees2016-12-31$12,738
Income. Interest from US Government securities2016-12-31$21,113
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2016-12-31$1,105,354
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2016-12-31$1,286,536
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2016-12-31$1,286,536
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2016-12-31$2,783
Expenses. Payments to insurance carriers foe the provision of benefits2016-12-31$160,667
Asset value of US Government securities at end of year2016-12-31$2,171,972
Asset value of US Government securities at beginning of year2016-12-31$2,072,277
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31Yes
Was there a failure to transmit to the plan any participant contributions2016-12-31No
Has the plan failed to provide any benefit when due under the plan2016-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$142,924
Contract administrator fees2016-12-31$19,000
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32016-12-31No
Did the plan have assets held for investment2016-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2016-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2016-12-31No
Aggregate proceeds on sale of assets2016-12-31$2,721
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2016-12-31Yes
Opinion of an independent qualified public accountant for this plan2016-12-31Disclaimer
Accountancy firm name2016-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2016-12-31043236498
2015 : OBI RETIREE BENEFIT PLAN 2015 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2015-12-31$11,944
Total unrealized appreciation/depreciation of assets2015-12-31$11,944
Total income from all sources (including contributions)2015-12-31$428,785
Total loss/gain on sale of assets2015-12-31$2,516
Total of all expenses incurred2015-12-31$565,764
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$378,684
Value of total assets at end of year2015-12-31$3,439,859
Value of total assets at beginning of year2015-12-31$3,576,838
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$187,080
Total interest from all sources2015-12-31$23,918
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Administrative expenses professional fees incurred2015-12-31$29,500
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$500,000
If this is an individual account plan, was there a blackout period2015-12-31No
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Assets. Other investments not covered elsewhere at end of year2015-12-31$81,046
Assets. Other investments not covered elsewhere at beginning of year2015-12-31$90,169
Other income not declared elsewhere2015-12-31$390,407
Administrative expenses (other) incurred2015-12-31$122,889
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$-136,979
Value of net assets at end of year (total assets less liabilities)2015-12-31$3,439,859
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$3,576,838
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2015-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2015-12-31No
Were any leases to which the plan was party in default or uncollectible2015-12-31No
Investment advisory and management fees2015-12-31$12,735
Income. Interest from US Government securities2015-12-31$22,746
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2015-12-31$1,286,536
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2015-12-31$656,084
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2015-12-31$656,084
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2015-12-31$1,172
Expenses. Payments to insurance carriers foe the provision of benefits2015-12-31$207,513
Asset value of US Government securities at end of year2015-12-31$2,072,277
Asset value of US Government securities at beginning of year2015-12-31$2,830,585
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31Yes
Was there a failure to transmit to the plan any participant contributions2015-12-31No
Has the plan failed to provide any benefit when due under the plan2015-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$171,171
Contract administrator fees2015-12-31$21,956
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32015-12-31No
Did the plan have assets held for investment2015-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2015-12-31No
Aggregate proceeds on sale of assets2015-12-31$2,516
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2015-12-31Yes
Opinion of an independent qualified public accountant for this plan2015-12-31Disclaimer
Accountancy firm name2015-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2015-12-31043236498
2014 : OBI RETIREE BENEFIT PLAN 2014 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2014-12-31$21,886
Total unrealized appreciation/depreciation of assets2014-12-31$21,886
Total income from all sources (including contributions)2014-12-31$491,155
Total of all expenses incurred2014-12-31$636,544
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$435,516
Value of total assets at end of year2014-12-31$3,576,838
Value of total assets at beginning of year2014-12-31$3,722,227
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$201,028
Total interest from all sources2014-12-31$30,416
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Administrative expenses professional fees incurred2014-12-31$27,500
Was this plan covered by a fidelity bond2014-12-31Yes
Value of fidelity bond cover2014-12-31$500,000
If this is an individual account plan, was there a blackout period2014-12-31No
Were there any nonexempt tranactions with any party-in-interest2014-12-31No
Assets. Other investments not covered elsewhere at end of year2014-12-31$90,169
Assets. Other investments not covered elsewhere at beginning of year2014-12-31$98,043
Other income not declared elsewhere2014-12-31$438,853
Administrative expenses (other) incurred2014-12-31$138,920
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-145,389
Value of net assets at end of year (total assets less liabilities)2014-12-31$3,576,838
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$3,722,227
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2014-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2014-12-31No
Were any leases to which the plan was party in default or uncollectible2014-12-31No
Investment advisory and management fees2014-12-31$12,663
Income. Interest from US Government securities2014-12-31$30,052
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2014-12-31$656,084
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2014-12-31$565,503
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2014-12-31$565,503
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2014-12-31$364
Expenses. Payments to insurance carriers foe the provision of benefits2014-12-31$235,845
Asset value of US Government securities at end of year2014-12-31$2,830,585
Asset value of US Government securities at beginning of year2014-12-31$3,058,681
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31Yes
Was there a failure to transmit to the plan any participant contributions2014-12-31No
Has the plan failed to provide any benefit when due under the plan2014-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$199,671
Contract administrator fees2014-12-31$21,945
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32014-12-31No
Did the plan have assets held for investment2014-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2014-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2014-12-31Yes
Opinion of an independent qualified public accountant for this plan2014-12-31Disclaimer
Accountancy firm name2014-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2014-12-31043236498
2013 : OBI RETIREE BENEFIT PLAN 2013 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2013-12-31$-59,295
Total unrealized appreciation/depreciation of assets2013-12-31$-59,295
Total income from all sources (including contributions)2013-12-31$437,225
Total of all expenses incurred2013-12-31$698,184
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$495,429
Value of total assets at end of year2013-12-31$3,722,227
Value of total assets at beginning of year2013-12-31$3,983,186
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$202,755
Total interest from all sources2013-12-31$35,414
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Administrative expenses professional fees incurred2013-12-31$27,500
Was this plan covered by a fidelity bond2013-12-31Yes
Value of fidelity bond cover2013-12-31$500,000
If this is an individual account plan, was there a blackout period2013-12-31No
Were there any nonexempt tranactions with any party-in-interest2013-12-31No
Assets. Other investments not covered elsewhere at end of year2013-12-31$98,043
Assets. Other investments not covered elsewhere at beginning of year2013-12-31$128,898
Other income not declared elsewhere2013-12-31$461,106
Administrative expenses (other) incurred2013-12-31$138,777
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Value of net income/loss2013-12-31$-260,959
Value of net assets at end of year (total assets less liabilities)2013-12-31$3,722,227
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$3,983,186
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2013-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2013-12-31No
Were any leases to which the plan was party in default or uncollectible2013-12-31No
Investment advisory and management fees2013-12-31$12,856
Income. Interest from US Government securities2013-12-31$34,520
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2013-12-31$565,503
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2013-12-31$736,312
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2013-12-31$736,312
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2013-12-31$894
Expenses. Payments to insurance carriers foe the provision of benefits2013-12-31$278,506
Asset value of US Government securities at end of year2013-12-31$3,058,681
Asset value of US Government securities at beginning of year2013-12-31$3,117,976
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2013-12-31No
Was there a failure to transmit to the plan any participant contributions2013-12-31No
Has the plan failed to provide any benefit when due under the plan2013-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$216,923
Contract administrator fees2013-12-31$23,622
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32013-12-31No
Did the plan have assets held for investment2013-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2013-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2013-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2013-12-31Yes
Opinion of an independent qualified public accountant for this plan2013-12-31Disclaimer
Accountancy firm name2013-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2013-12-31043236498
2012 : OBI RETIREE BENEFIT PLAN 2012 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2012-12-31$1,363
Total unrealized appreciation/depreciation of assets2012-12-31$1,363
Total income from all sources (including contributions)2012-12-31$521,114
Total loss/gain on sale of assets2012-12-31$-1,840
Total of all expenses incurred2012-12-31$812,546
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$611,844
Value of total assets at end of year2012-12-31$3,983,186
Value of total assets at beginning of year2012-12-31$4,274,618
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$200,702
Total interest from all sources2012-12-31$33,660
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$2
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2012-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2012-12-31$2
Administrative expenses professional fees incurred2012-12-31$26,500
Was this plan covered by a fidelity bond2012-12-31Yes
Value of fidelity bond cover2012-12-31$500,000
If this is an individual account plan, was there a blackout period2012-12-31No
Were there any nonexempt tranactions with any party-in-interest2012-12-31No
Assets. Other investments not covered elsewhere at end of year2012-12-31$128,898
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$133,680
Other income not declared elsewhere2012-12-31$487,929
Administrative expenses (other) incurred2012-12-31$137,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Value of net income/loss2012-12-31$-291,432
Value of net assets at end of year (total assets less liabilities)2012-12-31$3,983,186
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$4,274,618
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2012-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2012-12-31No
Were any leases to which the plan was party in default or uncollectible2012-12-31No
Investment advisory and management fees2012-12-31$13,112
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$80,729
Income. Interest from US Government securities2012-12-31$31,924
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2012-12-31$736,312
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2012-12-31$287,877
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2012-12-31$287,877
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2012-12-31$1,736
Expenses. Payments to insurance carriers foe the provision of benefits2012-12-31$277,417
Asset value of US Government securities at end of year2012-12-31$3,117,976
Asset value of US Government securities at beginning of year2012-12-31$3,772,332
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31Yes
Was there a failure to transmit to the plan any participant contributions2012-12-31No
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$334,427
Contract administrator fees2012-12-31$24,090
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32012-12-31No
Did the plan have assets held for investment2012-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2012-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2012-12-31No
Aggregate proceeds on sale of assets2012-12-31$-1,840
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2012-12-31Yes
Opinion of an independent qualified public accountant for this plan2012-12-31Disclaimer
Accountancy firm name2012-12-31WALTER & SHUFFAIN, P.C.
Accountancy firm EIN2012-12-31043236498
2011 : OBI RETIREE BENEFIT PLAN 2011 401k financial data
Unrealized appreciation/depreciation of other (non real estate) assets2011-12-31$11,670
Total unrealized appreciation/depreciation of assets2011-12-31$11,670
Total income from all sources (including contributions)2011-12-31$572,980
Total loss/gain on sale of assets2011-12-31$11,875
Total of all expenses incurred2011-12-31$1,074,967
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$862,372
Value of total assets at end of year2011-12-31$4,274,618
Value of total assets at beginning of year2011-12-31$4,776,605
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$212,595
Total interest from all sources2011-12-31$22,317
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$885
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2011-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2011-12-31$885
Administrative expenses professional fees incurred2011-12-31$26,500
Was this plan covered by a fidelity bond2011-12-31Yes
Value of fidelity bond cover2011-12-31$500,000
If this is an individual account plan, was there a blackout period2011-12-31No
Were there any nonexempt tranactions with any party-in-interest2011-12-31No
Assets. Other investments not covered elsewhere at end of year2011-12-31$133,680
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$155,882
Other income not declared elsewhere2011-12-31$526,233
Administrative expenses (other) incurred2011-12-31$135,000
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-501,987
Value of net assets at end of year (total assets less liabilities)2011-12-31$4,274,618
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$4,776,605
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2011-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2011-12-31No
Were any leases to which the plan was party in default or uncollectible2011-12-31No
Investment advisory and management fees2011-12-31$17,200
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$80,729
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$2,011,481
Income. Interest from US Government securities2011-12-31$19,708
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2011-12-31$287,877
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$2,609,242
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$2,609,242
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2011-12-31$2,609
Expenses. Payments to insurance carriers foe the provision of benefits2011-12-31$372,501
Asset value of US Government securities at end of year2011-12-31$3,772,332
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31Yes
Was there a failure to transmit to the plan any participant contributions2011-12-31No
Has the plan failed to provide any benefit when due under the plan2011-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$489,871
Contract administrator fees2011-12-31$33,895
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32011-12-31No
Did the plan have assets held for investment2011-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2011-12-31No
Aggregate proceeds on sale of assets2011-12-31$11,875
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2011-12-31Yes
Opinion of an independent qualified public accountant for this plan2011-12-31Disclaimer
Accountancy firm name2011-12-31WALTER & SHUFFAIN, PC
Accountancy firm EIN2011-12-31043236498
2010 : OBI RETIREE BENEFIT PLAN 2010 401k financial data
Total income from all sources (including contributions)2010-12-31$550,673
Total of all expenses incurred2010-12-31$1,436,619
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$1,204,647
Value of total assets at end of year2010-12-31$4,776,605
Value of total assets at beginning of year2010-12-31$5,662,551
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$231,972
Total interest from all sources2010-12-31$9,356
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$2,623
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2010-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2010-12-31$2,623
Administrative expenses professional fees incurred2010-12-31$25,800
Was this plan covered by a fidelity bond2010-12-31Yes
Value of fidelity bond cover2010-12-31$500,000
If this is an individual account plan, was there a blackout period2010-12-31No
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Assets. Other investments not covered elsewhere at end of year2010-12-31$155,882
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$208,913
Other income not declared elsewhere2010-12-31$538,694
Administrative expenses (other) incurred2010-12-31$149,767
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Value of net income/loss2010-12-31$-885,946
Value of net assets at end of year (total assets less liabilities)2010-12-31$4,776,605
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$5,662,551
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2010-12-31No
Were any loans by the plan or fixed income obligations due to the plan in default2010-12-31No
Were any leases to which the plan was party in default or uncollectible2010-12-31No
Investment advisory and management fees2010-12-31$19,789
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$2,011,481
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$2,008,858
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$2,609,242
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$3,444,780
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$3,444,780
Interest earned from interest bearing cash (including money market accounts and certificates of deposit)2010-12-31$9,356
Expenses. Payments to insurance carriers foe the provision of benefits2010-12-31$381,789
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31Yes
Was there a failure to transmit to the plan any participant contributions2010-12-31No
Has the plan failed to provide any benefit when due under the plan2010-12-31No
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$822,858
Contract administrator fees2010-12-31$36,616
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32010-12-31No
Did the plan have assets held for investment2010-12-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2010-12-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2010-12-31No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2010-12-31Yes
Opinion of an independent qualified public accountant for this plan2010-12-31Disclaimer
Accountancy firm name2010-12-31WALTER & SHUFFAIN, PC
Accountancy firm EIN2010-12-31043236498

Form 5500 Responses for OBI RETIREE BENEFIT PLAN

2022: OBI RETIREE BENEFIT PLAN 2022 form 5500 responses
2022-01-01Type of plan entitySingle employer plan
2022-01-01Submission has been amendedNo
2022-01-01This submission is the final filingNo
2022-01-01This return/report is a short plan year return/report (less than 12 months)No
2022-01-01Plan is a collectively bargained planNo
2022-01-01Plan funding arrangement – InsuranceYes
2022-01-01Plan funding arrangement – TrustYes
2022-01-01Plan benefit arrangement – InsuranceYes
2022-01-01Plan benefit arrangement - TrustYes
2021: OBI RETIREE BENEFIT PLAN 2021 form 5500 responses
2021-01-01Type of plan entitySingle employer plan
2021-01-01Plan funding arrangement – InsuranceYes
2021-01-01Plan funding arrangement – TrustYes
2021-01-01Plan benefit arrangement – InsuranceYes
2021-01-01Plan benefit arrangement - TrustYes
2020: OBI RETIREE BENEFIT PLAN 2020 form 5500 responses
2020-01-01Type of plan entitySingle employer plan
2020-01-01Plan funding arrangement – InsuranceYes
2020-01-01Plan funding arrangement – TrustYes
2020-01-01Plan benefit arrangement – InsuranceYes
2020-01-01Plan benefit arrangement - TrustYes
2019: OBI RETIREE BENEFIT PLAN 2019 form 5500 responses
2019-01-01Type of plan entitySingle employer plan
2019-01-01Plan funding arrangement – InsuranceYes
2019-01-01Plan funding arrangement – TrustYes
2019-01-01Plan benefit arrangement – InsuranceYes
2019-01-01Plan benefit arrangement - TrustYes
2018: OBI RETIREE BENEFIT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
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: OBI RETIREE BENEFIT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
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: OBI RETIREE BENEFIT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
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: OBI RETIREE BENEFIT PLAN 2015 form 5500 responses
2015-01-01Type of plan entitySingle employer plan
2015-01-01Plan funding arrangement – InsuranceYes
2015-01-01Plan funding arrangement – TrustYes
2015-01-01Plan benefit arrangement – InsuranceYes
2015-01-01Plan benefit arrangement - TrustYes
2014: OBI RETIREE BENEFIT PLAN 2014 form 5500 responses
2014-01-01Type of plan entitySingle employer plan
2014-01-01Plan funding arrangement – InsuranceYes
2014-01-01Plan funding arrangement – TrustYes
2014-01-01Plan benefit arrangement – InsuranceYes
2014-01-01Plan benefit arrangement - TrustYes
2013: OBI RETIREE BENEFIT PLAN 2013 form 5500 responses
2013-01-01Type of plan entitySingle employer plan
2013-01-01Plan funding arrangement – InsuranceYes
2013-01-01Plan funding arrangement – TrustYes
2013-01-01Plan benefit arrangement – InsuranceYes
2013-01-01Plan benefit arrangement - TrustYes
2012: OBI RETIREE BENEFIT PLAN 2012 form 5500 responses
2012-01-01Type of plan entitySingle employer plan
2012-01-01Plan funding arrangement – InsuranceYes
2012-01-01Plan funding arrangement – TrustYes
2012-01-01Plan benefit arrangement – InsuranceYes
2012-01-01Plan benefit arrangement - TrustYes
2011: OBI RETIREE BENEFIT PLAN 2011 form 5500 responses
2011-01-01Type of plan entitySingle employer plan
2011-01-01Submission has been amendedYes
2011-01-01Plan funding arrangement – InsuranceYes
2011-01-01Plan funding arrangement – TrustYes
2011-01-01Plan benefit arrangement – InsuranceYes
2011-01-01Plan benefit arrangement - TrustYes
2009: OBI RETIREE BENEFIT PLAN 2009 form 5500 responses
2009-01-01Type of plan entitySingle employer plan
2009-01-01This submission is the final filingNo
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

MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0000A
Policy instance 3
Insurance contract or identification numberMZ0926153H0000A
Number of Individuals Covered304
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $120,841
Total amount of fees paid to insurance companyUSD $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 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 BenefitYes
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 $649,015
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $55,377
Insurance broker organization code?5
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number4253
Policy instance 2
Insurance contract or identification number4253
Number of Individuals Covered273
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $14,366
Total amount of fees paid to insurance companyUSD $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 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
Welfare Benefit Premiums Paid to CarrierUSD $164,265
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $8,987
Insurance broker organization code?5
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 1
Insurance contract or identification number0135705
Number of Individuals Covered121
Insurance policy start date2022-01-01
Insurance policy end date2022-12-31
Total amount of commissions paid to insurance brokerUSD $3,117
Total amount of fees paid to insurance companyUSD $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 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 BenefitYes
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 $61,734
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,117
Insurance broker organization code?3
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 1
Insurance contract or identification number0135705
Number of Individuals Covered129
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $3,296
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $65,634
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,296
Insurance broker organization code?3
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number4253
Policy instance 2
Insurance contract or identification number4253
Number of Individuals Covered319
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $16,881
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $191,330
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10,561
Insurance broker organization code?5
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0001A
Policy instance 3
Insurance contract or identification numberMZ0926153H0001A
Number of Individuals Covered353
Insurance policy start date2021-01-01
Insurance policy end date2021-12-31
Total amount of commissions paid to insurance brokerUSD $132,677
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $765,926
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $64,500
Insurance broker organization code?5
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 1
Insurance contract or identification number0135705
Number of Individuals Covered142
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $3,648
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $71,716
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,648
Insurance broker organization code?3
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number4252, 4253
Policy instance 2
Insurance contract or identification number4252, 4253
Number of Individuals Covered369
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $25,224
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $285,649
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $15,765
Insurance broker organization code?5
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0001A
Policy instance 3
Insurance contract or identification numberMZ0926153H0001A
Number of Individuals Covered403
Insurance policy start date2020-01-01
Insurance policy end date2020-12-31
Total amount of commissions paid to insurance brokerUSD $158,145
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $849,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $71,738
Insurance broker organization code?5
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number4252, 4253
Policy instance 2
Insurance contract or identification number4252, 4253
Number of Individuals Covered425
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $28,588
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $324,354
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $17,839
Insurance broker organization code?5
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0001A
Policy instance 3
Insurance contract or identification numberMZ0926153H0001A
Number of Individuals Covered459
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $180,480
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $883,464
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $86,459
Insurance broker organization code?5
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 1
Insurance contract or identification number0135705
Number of Individuals Covered157
Insurance policy start date2019-01-01
Insurance policy end date2019-12-31
Total amount of commissions paid to insurance brokerUSD $4,304
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $85,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,304
Insurance broker organization code?3
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number4252, 4253
Policy instance 2
Insurance contract or identification number4252, 4253
Number of Individuals Covered484
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $32,205
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $366,760
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,123
Insurance broker organization code?5
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 1
Insurance contract or identification number0135705
Number of Individuals Covered185
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $4,699
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $92,701
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,699
Insurance broker organization code?3
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0001A
Policy instance 3
Insurance contract or identification numberMZ0926153H0001A
Number of Individuals Covered523
Insurance policy start date2018-01-01
Insurance policy end date2018-12-31
Total amount of commissions paid to insurance brokerUSD $188,054
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $919,791
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $86,384
Insurance broker organization code?5
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0001A
Policy instance 3
Insurance contract or identification numberMZ0926153H0001A
Number of Individuals Covered583
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $205,772
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,004,285
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $94,694
Insurance broker organization code?5
Insurance broker nameWEB TPA
EXPRESS SCRIPTS, INC. (National Association of Insurance Commissioners NAIC id number: 60025 )
Policy contract number4252, 4253
Policy instance 2
Insurance contract or identification number4252, 4253
Number of Individuals Covered548
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $33,375
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $386,062
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $20,874
Insurance broker organization code?5
Insurance broker nameDIETRICH & ASSOCIATES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 1
Insurance contract or identification number0135705
Number of Individuals Covered204
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
Total amount of commissions paid to insurance brokerUSD $4,987
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,772
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,987
Insurance broker organization code?3
Insurance broker nameDIETRICH & ASSOCIATES
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0001A
Policy instance 3
Insurance contract or identification numberMZ0926153H0001A
Number of Individuals Covered699
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $250,690
Total amount of fees paid to insurance companyUSD $0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,142,033
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $120,665
Insurance broker organization code?5
Insurance broker nameWEB TPA
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 1
Insurance contract or identification number0135705
Number of Individuals Covered164
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $4,061
Total amount of fees paid to insurance companyUSD $0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $80,754
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,061
Insurance broker organization code?3
Insurance broker nameDIETRICH & ASSOCIATES
UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 )
Policy contract numberD2734, D2735
Policy instance 2
Insurance contract or identification numberD2734, D2735
Number of Individuals Covered662
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $41,644
Total amount of fees paid to insurance companyUSD $0
Welfare Benefit Premiums Paid to CarrierUSD $374,823
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $31,485
Insurance broker organization code?5
Insurance broker nameDIETRICH & ASSOCIATES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 1
Insurance contract or identification number0135705
Number of Individuals Covered176
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $5,412
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $84,920
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $5,412
Insurance broker organization code?3
Insurance broker nameDIETRICH & ASSOCIATES
STONEBRIDGE LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 65021 )
Policy contract numberS9579007
Policy instance 2
Insurance contract or identification numberS9579007
Number of Individuals Covered728
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $57,344
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $516,127
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $42,860
Insurance broker organization code?5
Insurance broker nameDIETRICH & ASSOCIATES
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0001A
Policy instance 3
Insurance contract or identification numberMZ0926153H0001A
Number of Individuals Covered771
Insurance policy start date2014-01-01
Insurance policy end date2014-12-31
Total amount of commissions paid to insurance brokerUSD $280,471
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,277,702
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $134,998
Insurance broker organization code?5
Insurance broker nameWEB TPA
STONEBRIDGE LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 65021 )
Policy contract numberS9579007
Policy instance 2
Insurance contract or identification numberS9579007
Number of Individuals Covered801
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $59,681
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $537,129
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $44,389
Insurance broker organization code?5
Insurance broker nameDIETRICH & ASSOCIATES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 1
Insurance contract or identification number0135705
Number of Individuals Covered189
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $4,523
Total amount of fees paid to insurance companyUSD $13
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $86,286
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,523
Amount paid for insurance broker fees13
Insurance broker organization code?3
Insurance broker nameDIETRICH & ASSOCIATES
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0001A
Policy instance 3
Insurance contract or identification numberMZ0926153H0001A
Number of Individuals Covered849
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $322,865
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,470,827
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $159,302
Insurance broker organization code?5
Insurance broker nameWEB TPA
STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 )
Policy contract numberS 4802
Policy instance 1
Insurance contract or identification numberS 4802
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $11
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $-216
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $10
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?5
Insurance broker nameDIETRICH & ASSOCIATES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 2
Insurance contract or identification number0135705
Number of Individuals Covered206
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $4,422
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $89,013
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,422
Amount paid for insurance broker fees0
Insurance broker organization code?3
Insurance broker nameDIETRICH & ASSOCIATES
UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 )
Policy contract number2734
Policy instance 3
Insurance contract or identification number2734
Number of Individuals Covered0
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $-477
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $-2,703
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $-159
Insurance broker organization code?3
Additional information about fees paid to insurance brokerN/A
Insurance broker nameNEBCO
STONEBRIDGE LIFE INSURANCE (National Association of Insurance Commissioners NAIC id number: 65021 )
Policy contract numberS9579007
Policy instance 4
Insurance contract or identification numberS9579007
Number of Individuals Covered886
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $63,903
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $575,126
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $47,121
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?5
Insurance broker nameDIETRICH & ASSOCIATES
MONUMENTAL LIFE INSURANCE CO (National Association of Insurance Commissioners NAIC id number: 66281 )
Policy contract numberMZ0926153H0001A
Policy instance 5
Insurance contract or identification numberMZ0926153H0001A
Number of Individuals Covered942
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $348,686
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,589,369
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $169,744
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?5
Insurance broker nameWEB TPA
UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 )
Policy contract number2734
Policy instance 3
Insurance contract or identification number2734
Number of Individuals Covered1054
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $311,363
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $1,764,388
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 2
Insurance contract or identification number0135705
Number of Individuals Covered219
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $4,756
Total amount of fees paid to insurance companyUSD $511
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $95,492
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 )
Policy contract numberS 4802
Policy instance 1
Insurance contract or identification numberS 4802
Number of Individuals Covered992
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $141,753
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $1,335,825
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
STERLING LIFE (National Association of Insurance Commissioners NAIC id number: 77399 )
Policy contract numberS 4802
Policy instance 2
Insurance contract or identification numberS 4802
Number of Individuals Covered1086
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $162,987
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $773,941
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $135,234
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?5
Insurance broker nameDIETRICH & ASSOCIATES
METROPOLITAN LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 65978 )
Policy contract number0135705
Policy instance 3
Insurance contract or identification number0135705
Number of Individuals Covered243
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $4,788
Total amount of fees paid to insurance companyUSD $387
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Dental Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $92,840
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $4,788
Amount paid for insurance broker fees387
Additional information about fees paid to insurance brokerNON-MONETARY COMPENSATION
Insurance broker organization code?3
Insurance broker nameDIETRICH & ASSOCIATES
UNITED AMERICAN INSURANCE (National Association of Insurance Commissioners NAIC id number: 92916 )
Policy contract number2734
Policy instance 4
Insurance contract or identification number2734
Number of Individuals Covered1154
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $331,439
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Welfare Benefit Premiums Paid to CarrierUSD $1,878,153
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $220,959
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?5
Insurance broker nameDIETRICH & ASSOCIATES
HARTFORD LIFE AND ACCIDENT INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70815 )
Policy contract numberAGP 002427
Policy instance 1
Insurance contract or identification numberAGP 002427
Number of Individuals Covered0
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $21
Total amount of fees paid to insurance companyUSD $0
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Health Insurance Welfare BenefitYes
Welfare Benefit Premiums Paid to CarrierUSD $130
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $14
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerN/A
Insurance broker organization code?5
Insurance broker nameDIETRICH & ASSOCIATES

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