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BOMBERGER'S STORE INC PROFIT SHARING PLAN 401k Plan overview

Plan NameBOMBERGER'S STORE INC PROFIT SHARING PLAN
Plan identification number 333

BOMBERGER'S STORE INC PROFIT SHARING PLAN Benefits

401k Plan TypeDefined Contribution Pension
Plan Features/Benefits
  • Profit-sharing
  • ERISA section 404(c) Plan - This plan, or any part of it is intended to meet the conditions of 29 CFR 2550.404c-1.
  • Total participant-directed account plan - Participants have the opportunity to direct the investment of all the assets allocated to their individual accounts, regardless of whether 29 CFR 2550.404c-1 is intended to be met.
  • Code section 401(k) feature - A cash or deferred arrangement described in Code section 401(k) that is part of a qualified defined contribution plan that provides for an election by employees to defer part of their compensation or receive these amounts in cash.
  • Code section 401(m) arrangement - Employee contributions are allocated to separate accounts under the plan or employer contributions are based, in whole or in part, on employee deferrals or contribtions to the plan. Not applicable if plan is 401(k) plan with only QNECs and/or QMACs. Also not applicable if Code section 403(b)(1), 403(b)(7) or 408 arrangements/accounts/annuities.
  • Plan provides for automatic enrollment in plan that has employee contributions deducted from payroll.
  • Total or partial participant-directed account plan - plan uses default investment account for participants who fail to direct assets in their account.
  • Master plan - A pension plan that is made available by a sponsor for adoption by employers; that is the subject of a favorable opinion letter; and for which a single funding medium (for example, a trust or custodial account) is established for the joint use of all adopting employers.
  • Plan sponsor(s) is (are) a member(s) of a controlled group (Code sections 414(b), (c), or (m)).
  • Life insurance

401k Sponsoring company profile

BOMBERGERS STORE INC has sponsored the creation of one or more 401k plans.

Company Name:BOMBERGERS STORE INC
Employer identification number (EIN):232002142
NAIC Classification:444110
NAIC Description:Home Centers

Form 5500 Filing Information

Submission information for form 5500 for 401k plan BOMBERGER'S STORE INC PROFIT SHARING PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
3332018-01-01
3332017-01-01
3332017-01-01
3332016-01-01ROY BOMBERGER
3332015-01-01ROY BOMBERGER
3332014-01-01ROY BOMBERGER
3332013-01-01ROY BOMBERGER
3332012-01-01ROY BOMBERGER
3332011-01-01ROY BOMBERGER
3332009-01-01ROY BOMBERGER

Plan Statistics for BOMBERGER'S STORE INC PROFIT SHARING PLAN

401k plan membership statisitcs for BOMBERGER'S STORE INC PROFIT SHARING PLAN

Measure Date Value
2017: BOMBERGER'S STORE INC PROFIT SHARING PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01155
Total number of active participants reported on line 7a of the Form 55002017-01-01125
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-017
Total of all active and inactive participants2017-01-01132
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-011
Total participants2017-01-01133
Number of participants with account balances2017-01-0139
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: BOMBERGER'S STORE INC PROFIT SHARING PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01145
Total number of active participants reported on line 7a of the Form 55002016-01-01128
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0122
Total of all active and inactive participants2016-01-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01150
Number of participants with account balances2016-01-01137
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-015
2015: BOMBERGER'S STORE INC PROFIT SHARING PLAN 2015 401k membership
Total participants, beginning-of-year2015-01-01139
Total number of active participants reported on line 7a of the Form 55002015-01-01125
Number of retired or separated participants receiving benefits2015-01-010
Number of other retired or separated participants entitled to future benefits2015-01-0117
Total of all active and inactive participants2015-01-01142
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-01-010
Total participants2015-01-01142
Number of participants with account balances2015-01-01135
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-01-015
2014: BOMBERGER'S STORE INC PROFIT SHARING PLAN 2014 401k membership
Total participants, beginning-of-year2014-01-01141
Total number of active participants reported on line 7a of the Form 55002014-01-01122
Number of retired or separated participants receiving benefits2014-01-010
Number of other retired or separated participants entitled to future benefits2014-01-0111
Total of all active and inactive participants2014-01-01133
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2014-01-011
Total participants2014-01-01134
Number of participants with account balances2014-01-01102
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2014-01-011
2013: BOMBERGER'S STORE INC PROFIT SHARING PLAN 2013 401k membership
Total participants, beginning-of-year2013-01-01137
Total number of active participants reported on line 7a of the Form 55002013-01-01127
Number of retired or separated participants receiving benefits2013-01-010
Number of other retired or separated participants entitled to future benefits2013-01-0111
Total of all active and inactive participants2013-01-01138
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2013-01-010
Total participants2013-01-01138
Number of participants with account balances2013-01-01107
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2013-01-013
2012: BOMBERGER'S STORE INC PROFIT SHARING PLAN 2012 401k membership
Total participants, beginning-of-year2012-01-01145
Total number of active participants reported on line 7a of the Form 55002012-01-01124
Number of retired or separated participants receiving benefits2012-01-010
Number of other retired or separated participants entitled to future benefits2012-01-0112
Total of all active and inactive participants2012-01-01136
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2012-01-010
Total participants2012-01-01136
Number of participants with account balances2012-01-01112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2012-01-012
2011: BOMBERGER'S STORE INC PROFIT SHARING PLAN 2011 401k membership
Total participants, beginning-of-year2011-01-01149
Total number of active participants reported on line 7a of the Form 55002011-01-01131
Number of retired or separated participants receiving benefits2011-01-010
Number of other retired or separated participants entitled to future benefits2011-01-0112
Total of all active and inactive participants2011-01-01143
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2011-01-010
Total participants2011-01-01143
Number of participants with account balances2011-01-01117
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2011-01-012
2009: BOMBERGER'S STORE INC PROFIT SHARING PLAN 2009 401k membership
Total participants, beginning-of-year2009-01-01150
Total number of active participants reported on line 7a of the Form 55002009-01-01140
Number of retired or separated participants receiving benefits2009-01-010
Number of other retired or separated participants entitled to future benefits2009-01-0110
Total of all active and inactive participants2009-01-01150
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2009-01-010
Total participants2009-01-01150
Number of participants with account balances2009-01-01125
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2009-01-010

Financial Data on BOMBERGER'S STORE INC PROFIT SHARING PLAN

Measure Date Value
2017 : BOMBERGER'S STORE INC PROFIT SHARING PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total transfer of assets from this plan2017-12-31$5,328,468
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$987
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
Total income from all sources (including contributions)2017-12-31$777,158
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$1,454,753
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$1,423,298
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$238,182
Value of total assets at end of year2017-12-31$923,480
Value of total assets at beginning of year2017-12-31$6,928,556
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$31,455
Total interest from all sources2017-12-31$2,150
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$27,688
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2017-12-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2017-12-31$0
Total dividends received from registered investment company shares (eg mutual funds)2017-12-31$27,688
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 period2017-12-31Yes
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2017-12-31$0
Were there any nonexempt tranactions with any party-in-interest2017-12-31No
Contributions received from participants2017-12-31$168,552
Participant contributions at beginning of year2017-12-31$103,548
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$69,630
Value of other receiveables (less allowance for doubtful accounts) at end of year2017-12-31$486
Liabilities. Value of operating payables at end of year2017-12-31$987
Total non interest bearing cash at end of year2017-12-31$987
Total non interest bearing cash at beginning of year2017-12-31$711
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2017-12-31No
Value of net income/loss2017-12-31$-677,595
Value of net assets at end of year (total assets less liabilities)2017-12-31$922,493
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$6,928,556
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
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2017-12-31$4,742,371
Interest on participant loans2017-12-31$2,150
Value of interest in common/collective trusts at end of year2017-12-31$922,007
Value of interest in common/collective trusts at beginning of year2017-12-31$1,994,391
Net investment gain/loss from registered investment companies (e.g. mutual funds)2017-12-31$426,027
Net investment gain or loss from common/collective trusts2017-12-31$83,111
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2017-12-31No
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
Employer contributions (assets) at beginning of year2017-12-31$87,535
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2017-12-31$1,423,298
Contract administrator fees2017-12-31$31,455
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-32017-12-31Yes
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
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 name2017-12-31SIMON LEVER, LLP
Accountancy firm EIN2017-12-31231692578
2016 : BOMBERGER'S STORE INC PROFIT SHARING PLAN 2016 401k financial data
Total unrealized appreciation/depreciation of assets2016-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2016-12-31$0
Total income from all sources (including contributions)2016-12-31$754,607
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$297,859
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$251,124
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$401,340
Value of total assets at end of year2016-12-31$6,928,556
Value of total assets at beginning of year2016-12-31$6,471,808
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$46,735
Total interest from all sources2016-12-31$4,904
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$189,166
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2016-12-31$189,166
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
Contributions received from participants2016-12-31$313,095
Participant contributions at end of year2016-12-31$103,548
Participant contributions at beginning of year2016-12-31$99,700
Total non interest bearing cash at end of year2016-12-31$711
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$456,748
Value of net assets at end of year (total assets less liabilities)2016-12-31$6,928,556
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$6,471,808
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2016-12-31$4,742,371
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2016-12-31$4,507,359
Interest on participant loans2016-12-31$4,904
Value of interest in common/collective trusts at end of year2016-12-31$1,994,391
Value of interest in common/collective trusts at beginning of year2016-12-31$1,781,418
Net investment gain/loss from registered investment companies (e.g. mutual funds)2016-12-31$78,092
Net investment gain or loss from common/collective trusts2016-12-31$81,105
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2016-12-31No
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
Contributions received in cash from employer2016-12-31$88,245
Employer contributions (assets) at end of year2016-12-31$87,535
Employer contributions (assets) at beginning of year2016-12-31$83,331
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$251,124
Contract administrator fees2016-12-31$46,735
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
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 name2016-12-31REINSEL KINTZ LESHER LLP
Accountancy firm EIN2016-12-31232108173
2015 : BOMBERGER'S STORE INC PROFIT SHARING PLAN 2015 401k financial data
Total unrealized appreciation/depreciation of assets2015-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2015-12-31$0
Total income from all sources (including contributions)2015-12-31$369,580
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$173,737
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$132,302
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$372,957
Value of total assets at end of year2015-12-31$6,471,808
Value of total assets at beginning of year2015-12-31$6,275,965
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$41,435
Total interest from all sources2015-12-31$5,291
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$79,667
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2015-12-31$79,667
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
Contributions received from participants2015-12-31$277,238
Participant contributions at end of year2015-12-31$99,700
Participant contributions at beginning of year2015-12-31$101,066
Participant contributions at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$12,388
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2015-12-31$0
Total non interest bearing cash at beginning of year2015-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2015-12-31No
Value of net income/loss2015-12-31$195,843
Value of net assets at end of year (total assets less liabilities)2015-12-31$6,471,808
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$6,275,965
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2015-12-31$4,507,359
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2015-12-31$4,513,433
Interest on participant loans2015-12-31$5,291
Value of interest in common/collective trusts at end of year2015-12-31$1,781,418
Value of interest in common/collective trusts at beginning of year2015-12-31$1,586,466
Net investment gain/loss from registered investment companies (e.g. mutual funds)2015-12-31$-83,428
Net investment gain or loss from common/collective trusts2015-12-31$-4,907
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2015-12-31No
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
Contributions received in cash from employer2015-12-31$83,331
Employer contributions (assets) at end of year2015-12-31$83,331
Employer contributions (assets) at beginning of year2015-12-31$75,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$132,302
Contract administrator fees2015-12-31$41,435
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
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 name2015-12-31REINSEL KUNTZ LESHER
Accountancy firm EIN2015-12-31232108173
2014 : BOMBERGER'S STORE INC PROFIT SHARING PLAN 2014 401k financial data
Total unrealized appreciation/depreciation of assets2014-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2014-12-31$7,613
Total income from all sources (including contributions)2014-12-31$786,113
Total loss/gain on sale of assets2014-12-31$0
Total of all expenses incurred2014-12-31$1,093,497
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2014-12-31$1,062,863
Total contributions o plan (from employers,participants, others, non cash contrinutions)2014-12-31$403,553
Value of total assets at end of year2014-12-31$6,275,965
Value of total assets at beginning of year2014-12-31$6,590,962
Total of administrative expenses incurred including professional, contract, advisory and management fees2014-12-31$30,634
Total interest from all sources2014-12-31$5,544
Total dividends received (eg from common stock, registered investment company shares)2014-12-31$309,293
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2014-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2014-12-31$309,293
Administrative expenses professional fees incurred2014-12-31$30,634
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
Contributions received from participants2014-12-31$235,947
Participant contributions at end of year2014-12-31$101,066
Participant contributions at beginning of year2014-12-31$121,559
Participant contributions at end of year2014-12-31$0
Participant contributions at beginning of year2014-12-31$6,565
Income. Received or receivable in cash from other sources (including rollovers)2014-12-31$92,606
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2014-12-31$0
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at beginning of year2014-12-31$7,613
Total non interest bearing cash at end of year2014-12-31$0
Total non interest bearing cash at beginning of year2014-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2014-12-31No
Value of net income/loss2014-12-31$-307,384
Value of net assets at end of year (total assets less liabilities)2014-12-31$6,275,965
Value of net assets at beginning of year (total assets less liabilities)2014-12-31$6,583,349
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2014-12-31$4,513,433
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2014-12-31$4,849,670
Interest on participant loans2014-12-31$5,544
Value of interest in common/collective trusts at end of year2014-12-31$1,586,466
Value of interest in common/collective trusts at beginning of year2014-12-31$1,564,168
Net investment gain/loss from registered investment companies (e.g. mutual funds)2014-12-31$22,797
Net investment gain or loss from common/collective trusts2014-12-31$44,926
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2014-12-31No
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
Contributions received in cash from employer2014-12-31$75,000
Employer contributions (assets) at end of year2014-12-31$75,000
Employer contributions (assets) at beginning of year2014-12-31$49,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2014-12-31$1,062,863
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 name2014-12-31REINSEL KUNTZ LESHER
Accountancy firm EIN2014-12-31232108173
2013 : BOMBERGER'S STORE INC PROFIT SHARING PLAN 2013 401k financial data
Total unrealized appreciation/depreciation of assets2013-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$7,613
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2013-12-31$0
Total income from all sources (including contributions)2013-12-31$1,372,522
Total loss/gain on sale of assets2013-12-31$0
Total of all expenses incurred2013-12-31$794,880
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2013-12-31$767,331
Total contributions o plan (from employers,participants, others, non cash contrinutions)2013-12-31$312,433
Value of total assets at end of year2013-12-31$6,590,962
Value of total assets at beginning of year2013-12-31$6,005,707
Total of administrative expenses incurred including professional, contract, advisory and management fees2013-12-31$27,549
Total interest from all sources2013-12-31$5,808
Total dividends received (eg from common stock, registered investment company shares)2013-12-31$205,670
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2013-12-31No
Total dividends received from registered investment company shares (eg mutual funds)2013-12-31$205,670
Administrative expenses professional fees incurred2013-12-31$27,549
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
Contributions received from participants2013-12-31$228,430
Participant contributions at end of year2013-12-31$121,559
Participant contributions at beginning of year2013-12-31$118,713
Participant contributions at end of year2013-12-31$6,565
Participant contributions at beginning of year2013-12-31$9,253
Income. Received or receivable in cash from other sources (including rollovers)2013-12-31$35,003
Other liabilities (not benefit claims, operating payabales oe acquisition indebtedness) at end of year2013-12-31$7,613
Total non interest bearing cash at end of year2013-12-31$0
Total non interest bearing cash at beginning of year2013-12-31$79
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$577,642
Value of net assets at end of year (total assets less liabilities)2013-12-31$6,583,349
Value of net assets at beginning of year (total assets less liabilities)2013-12-31$6,005,707
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
Value of interest in registered invesment companies (eg mutual funds) at end of year2013-12-31$4,849,670
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2013-12-31$4,224,307
Interest on participant loans2013-12-31$5,808
Value of interest in common/collective trusts at end of year2013-12-31$1,564,168
Value of interest in common/collective trusts at beginning of year2013-12-31$1,586,355
Net investment gain/loss from registered investment companies (e.g. mutual funds)2013-12-31$768,881
Net investment gain or loss from common/collective trusts2013-12-31$79,730
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
Contributions received in cash from employer2013-12-31$49,000
Employer contributions (assets) at end of year2013-12-31$49,000
Employer contributions (assets) at beginning of year2013-12-31$67,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2013-12-31$767,331
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 name2013-12-31REINSEL KUNTZ LESHER
Accountancy firm EIN2013-12-31232108173
2012 : BOMBERGER'S STORE INC PROFIT SHARING PLAN 2012 401k financial data
Total unrealized appreciation/depreciation of assets2012-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2012-12-31$0
Total income from all sources (including contributions)2012-12-31$926,155
Total loss/gain on sale of assets2012-12-31$0
Total of all expenses incurred2012-12-31$551,592
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2012-12-31$528,673
Expenses. Certain deemed distributions of participant loans2012-12-31$446
Total contributions o plan (from employers,participants, others, non cash contrinutions)2012-12-31$302,572
Value of total assets at end of year2012-12-31$6,005,707
Value of total assets at beginning of year2012-12-31$5,631,144
Total of administrative expenses incurred including professional, contract, advisory and management fees2012-12-31$22,473
Total interest from all sources2012-12-31$6,318
Total dividends received (eg from common stock, registered investment company shares)2012-12-31$186,305
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$186,305
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
Contributions received from participants2012-12-31$235,572
Participant contributions at end of year2012-12-31$118,713
Participant contributions at beginning of year2012-12-31$142,887
Participant contributions at end of year2012-12-31$9,253
Participant contributions at beginning of year2012-12-31$8,748
Assets. Other investments not covered elsewhere at beginning of year2012-12-31$0
Other income not declared elsewhere2012-12-31$37
Total non interest bearing cash at end of year2012-12-31$79
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$374,563
Value of net assets at end of year (total assets less liabilities)2012-12-31$6,005,707
Value of net assets at beginning of year (total assets less liabilities)2012-12-31$5,631,144
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$22,473
Value of interest in registered invesment companies (eg mutual funds) at end of year2012-12-31$4,224,307
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2012-12-31$3,932,781
Interest on participant loans2012-12-31$6,318
Value of interest in common/collective trusts at end of year2012-12-31$1,586,355
Value of interest in common/collective trusts at beginning of year2012-12-31$1,493,728
Net investment gain/loss from registered investment companies (e.g. mutual funds)2012-12-31$401,800
Net investment gain or loss from common/collective trusts2012-12-31$29,123
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2012-12-31No
Was there a failure to transmit to the plan any participant contributions2012-12-31Yes
Has the plan failed to provide any benefit when due under the plan2012-12-31No
Contributions received in cash from employer2012-12-31$67,000
Employer contributions (assets) at end of year2012-12-31$67,000
Employer contributions (assets) at beginning of year2012-12-31$53,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2012-12-31$528,673
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
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 name2012-12-31REINSEL KUNTZ LESHER
Accountancy firm EIN2012-12-31232108173
2011 : BOMBERGER'S STORE INC PROFIT SHARING PLAN 2011 401k financial data
Total unrealized appreciation/depreciation of assets2011-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2011-12-31$0
Total income from all sources (including contributions)2011-12-31$201,863
Total loss/gain on sale of assets2011-12-31$0
Total of all expenses incurred2011-12-31$206,171
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2011-12-31$187,280
Total contributions o plan (from employers,participants, others, non cash contrinutions)2011-12-31$278,337
Value of total assets at end of year2011-12-31$5,631,144
Value of total assets at beginning of year2011-12-31$5,635,452
Total of administrative expenses incurred including professional, contract, advisory and management fees2011-12-31$18,891
Total interest from all sources2011-12-31$8,208
Total dividends received (eg from common stock, registered investment company shares)2011-12-31$143,671
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$143,671
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
Contributions received from participants2011-12-31$225,337
Participant contributions at end of year2011-12-31$142,887
Participant contributions at beginning of year2011-12-31$160,949
Participant contributions at end of year2011-12-31$8,748
Participant contributions at beginning of year2011-12-31$5,046
Assets. Other investments not covered elsewhere at end of year2011-12-31$0
Assets. Other investments not covered elsewhere at beginning of year2011-12-31$5,296
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2011-12-31$0
Other income not declared elsewhere2011-12-31$-11
Total non interest bearing cash at beginning of year2011-12-31$0
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2011-12-31No
Value of net income/loss2011-12-31$-4,308
Value of net assets at end of year (total assets less liabilities)2011-12-31$5,631,144
Value of net assets at beginning of year (total assets less liabilities)2011-12-31$5,635,452
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$18,891
Value of interest in registered invesment companies (eg mutual funds) at end of year2011-12-31$3,932,781
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2011-12-31$4,058,699
Interest on participant loans2011-12-31$8,208
Value of interest in common/collective trusts at end of year2011-12-31$1,493,728
Value of interest in common/collective trusts at beginning of year2011-12-31$1,379,462
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2011-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2011-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2011-12-31$-230,064
Net investment gain or loss from common/collective trusts2011-12-31$1,722
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2011-12-31No
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
Contributions received in cash from employer2011-12-31$53,000
Employer contributions (assets) at end of year2011-12-31$53,000
Employer contributions (assets) at beginning of year2011-12-31$26,000
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2011-12-31$187,280
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
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 name2011-12-31REINSEL KUNTZ LESHER
Accountancy firm EIN2011-12-31232108173
2010 : BOMBERGER'S STORE INC PROFIT SHARING PLAN 2010 401k financial data
Total unrealized appreciation/depreciation of assets2010-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2010-12-31$0
Total income from all sources (including contributions)2010-12-31$845,214
Total loss/gain on sale of assets2010-12-31$0
Total of all expenses incurred2010-12-31$233,916
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2010-12-31$208,444
Total contributions o plan (from employers,participants, others, non cash contrinutions)2010-12-31$261,639
Value of total assets at end of year2010-12-31$5,635,452
Value of total assets at beginning of year2010-12-31$5,024,154
Total of administrative expenses incurred including professional, contract, advisory and management fees2010-12-31$25,472
Total interest from all sources2010-12-31$8,173
Total dividends received (eg from common stock, registered investment company shares)2010-12-31$89,483
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$89,483
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
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2010-12-31$0
Were there any nonexempt tranactions with any party-in-interest2010-12-31No
Contributions received from participants2010-12-31$235,639
Participant contributions at end of year2010-12-31$160,949
Participant contributions at beginning of year2010-12-31$88,838
Participant contributions at end of year2010-12-31$5,046
Participant contributions at beginning of year2010-12-31$6,629
Assets. Other investments not covered elsewhere at end of year2010-12-31$5,296
Assets. Other investments not covered elsewhere at beginning of year2010-12-31$5,414
Value of other receiveables (less allowance for doubtful accounts) at end of year2010-12-31$0
Value of other receiveables (less allowance for doubtful accounts) at beginning of year2010-12-31$0
Other income not declared elsewhere2010-12-31$-118
Administrative expenses (other) incurred2010-12-31$2,031
Total non interest bearing cash at end of year2010-12-31$0
Total non interest bearing cash at beginning of year2010-12-31$634
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$611,298
Value of net assets at end of year (total assets less liabilities)2010-12-31$5,635,452
Value of net assets at beginning of year (total assets less liabilities)2010-12-31$5,024,154
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$23,441
Value of interest in registered invesment companies (eg mutual funds) at end of year2010-12-31$4,058,699
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2010-12-31$3,595,884
Interest on participant loans2010-12-31$8,173
Value of interest in common/collective trusts at end of year2010-12-31$1,379,462
Value of interest in common/collective trusts at beginning of year2010-12-31$1,321,655
Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year2010-12-31$0
Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year2010-12-31$0
Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year2010-12-31$0
Net investment gain/loss from registered investment companies (e.g. mutual funds)2010-12-31$432,172
Net investment gain or loss from common/collective trusts2010-12-31$53,865
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2010-12-31No
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
Contributions received in cash from employer2010-12-31$26,000
Employer contributions (assets) at end of year2010-12-31$26,000
Employer contributions (assets) at beginning of year2010-12-31$5,100
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2010-12-31$208,444
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 name2010-12-31REINSEL KUNTZ LESHER
Accountancy firm EIN2010-12-31232108173
2009 : BOMBERGER'S STORE INC PROFIT SHARING PLAN 2009 401k financial data
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2009-12-31$0

Form 5500 Responses for BOMBERGER'S STORE INC PROFIT SHARING PLAN

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

Insurance Providers Used on plan

WAHINGTON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65900 )
Policy contract number10P0260510
Policy instance 1
Insurance contract or identification number10P0260510
Number of Individuals Covered0
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
WAHINGTON NATIONAL (National Association of Insurance Commissioners NAIC id number: 65900 )
Policy contract number10P0260510
Policy instance 1
Insurance contract or identification number10P0260510
Number of Individuals Covered1
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $0
Total amount of fees paid to insurance companyUSD $0
Are there contracts with allocated funds for individual policies?No
Are there contracts with allocated funds for group deferred annuity?No
Are there contracts with allocated funds for types other than group deferred annuity or individual?No
Contract purchased, in whole or in part, to distribute benefits from a terminating planNo
Contracts With Unallocated Funds Deposit Administration0
Are there contracts with unallocated funds for contracts of type immediate participation guarantee?No
Are there contracts with unallocated funds for contracts of type guaranteed investment?No
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitYes
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No

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