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MSH 401(K) EMPLOYEE RETIREMENT PLAN 401k Plan overview

Plan NameMSH 401(K) EMPLOYEE RETIREMENT PLAN
Plan identification number 001

MSH 401(K) EMPLOYEE RETIREMENT 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) received services of leased employees, as defined in Code section 414(n), during the plan year.

401k Sponsoring company profile

MAIN STREET HUB, INC has sponsored the creation of one or more 401k plans.

Company Name:MAIN STREET HUB, INC
Employer identification number (EIN):270291076
NAIC Classification:519100

Form 5500 Filing Information

Submission information for form 5500 for 401k plan MSH 401(K) EMPLOYEE RETIREMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
0012018-01-01
0012017-01-01BRETT BOWMAN
0012016-01-01CORINNE ERVIN
0012015-02-15ERIN STANLEY

Plan Statistics for MSH 401(K) EMPLOYEE RETIREMENT PLAN

401k plan membership statisitcs for MSH 401(K) EMPLOYEE RETIREMENT PLAN

Measure Date Value
2018: MSH 401(K) EMPLOYEE RETIREMENT PLAN 2018 401k membership
Total participants, beginning-of-year2018-01-01410
Total number of active participants reported on line 7a of the Form 55002018-01-010
Number of retired or separated participants receiving benefits2018-01-010
Number of other retired or separated participants entitled to future benefits2018-01-010
Total of all active and inactive participants2018-01-010
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2018-01-010
Total participants2018-01-010
Number of participants with account balances2018-01-010
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2018-01-010
2017: MSH 401(K) EMPLOYEE RETIREMENT PLAN 2017 401k membership
Total participants, beginning-of-year2017-01-01330
Total number of active participants reported on line 7a of the Form 55002017-01-01410
Number of retired or separated participants receiving benefits2017-01-010
Number of other retired or separated participants entitled to future benefits2017-01-01182
Total of all active and inactive participants2017-01-01592
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2017-01-010
Total participants2017-01-01592
Number of participants with account balances2017-01-01587
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2017-01-010
2016: MSH 401(K) EMPLOYEE RETIREMENT PLAN 2016 401k membership
Total participants, beginning-of-year2016-01-01320
Total number of active participants reported on line 7a of the Form 55002016-01-01268
Number of retired or separated participants receiving benefits2016-01-010
Number of other retired or separated participants entitled to future benefits2016-01-0162
Total of all active and inactive participants2016-01-01330
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2016-01-010
Total participants2016-01-01330
Number of participants with account balances2016-01-01317
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2016-01-010
2015: MSH 401(K) EMPLOYEE RETIREMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-02-15137
Total number of active participants reported on line 7a of the Form 55002015-02-15227
Number of retired or separated participants receiving benefits2015-02-150
Number of other retired or separated participants entitled to future benefits2015-02-1530
Total of all active and inactive participants2015-02-15257
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits2015-02-150
Total participants2015-02-15257
Number of participants with account balances2015-02-15248
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested2015-02-150

Financial Data on MSH 401(K) EMPLOYEE RETIREMENT PLAN

Measure Date Value
2018 : MSH 401(K) EMPLOYEE RETIREMENT PLAN 2018 401k financial data
Total unrealized appreciation/depreciation of assets2018-10-31$0
Total transfer of assets from this plan2018-10-31$2,848,881
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-10-31$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2018-10-31$0
Total income from all sources (including contributions)2018-10-31$1,327,666
Total loss/gain on sale of assets2018-10-31$0
Total of all expenses incurred2018-10-31$370,168
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2018-10-31$355,230
Total contributions o plan (from employers,participants, others, non cash contrinutions)2018-10-31$1,193,358
Value of total assets at end of year2018-10-31$0
Value of total assets at beginning of year2018-10-31$1,891,383
Total of administrative expenses incurred including professional, contract, advisory and management fees2018-10-31$14,938
Total interest from all sources2018-10-31$114
Total dividends received (eg from common stock, registered investment company shares)2018-10-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2018-10-31Yes
Value of any plan assets that reverted to the employer resulting from resoluton to terminate the plan2018-10-31$0
Was this plan covered by a fidelity bond2018-10-31Yes
Value of fidelity bond cover2018-10-31$5,000,000
If this is an individual account plan, was there a blackout period2018-10-31No
Were there any nonexempt tranactions with any party-in-interest2018-10-31No
Contributions received from participants2018-10-31$981,654
Income. Received or receivable in cash from other sources (including rollovers)2018-10-31$60,078
Administrative expenses (other) incurred2018-10-31$14,938
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser2018-10-31No
Value of net income/loss2018-10-31$957,498
Value of net assets at end of year (total assets less liabilities)2018-10-31$0
Value of net assets at beginning of year (total assets less liabilities)2018-10-31$1,891,383
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)2018-10-31No
Were any loans by the plan or fixed income obligations due to the plan in default2018-10-31No
Were any leases to which the plan was party in default or uncollectible2018-10-31No
Value of interest in registered invesment companies (eg mutual funds) at end of year2018-10-31$0
Value of interest in registered invesment companies (eg mutual funds) at beginning of year2018-10-31$1,889,392
Interest earned on other investments2018-10-31$114
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2018-10-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2018-10-31$1,991
Net investment gain/loss from pooled separate accounts2018-10-31$134,194
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets2018-10-31No
Was there a failure to transmit to the plan any participant contributions2018-10-31Yes
Has the plan failed to provide any benefit when due under the plan2018-10-31No
Contributions received in cash from employer2018-10-31$151,626
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2018-10-31$355,230
Did the plan have assets held for investment2018-10-31Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser2018-10-31No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC2018-10-31Yes
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)2018-10-31Yes
Opinion of an independent qualified public accountant for this plan2018-10-31Disclaimer
Accountancy firm name2018-10-31HOLTZMAN PARTNERS, LLP
Accountancy firm EIN2018-10-31743121060
2017 : MSH 401(K) EMPLOYEE RETIREMENT PLAN 2017 401k financial data
Total unrealized appreciation/depreciation of assets2017-12-31$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)2017-12-31$0
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$1,124,250
Total loss/gain on sale of assets2017-12-31$0
Total of all expenses incurred2017-12-31$243,385
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2017-12-31$238,885
Total contributions o plan (from employers,participants, others, non cash contrinutions)2017-12-31$881,428
Value of total assets at end of year2017-12-31$1,891,383
Value of total assets at beginning of year2017-12-31$1,010,518
Total of administrative expenses incurred including professional, contract, advisory and management fees2017-12-31$4,500
Total interest from all sources2017-12-31$-124
Total dividends received (eg from common stock, registered investment company shares)2017-12-31$0
Was this plan covered by a fidelity bond2017-12-31Yes
Value of fidelity bond cover2017-12-31$189,138
If this is an individual account plan, was there a blackout period2017-12-31No
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$854,964
Income. Received or receivable in cash from other sources (including rollovers)2017-12-31$26,464
Administrative expenses (other) incurred2017-12-31$4,500
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$880,865
Value of net assets at end of year (total assets less liabilities)2017-12-31$1,891,383
Value of net assets at beginning of year (total assets less liabilities)2017-12-31$1,010,518
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 end of year2017-12-31$1,889,392
Value of interest in pooled separate accounts at beginning of year2017-12-31$1,009,244
Interest earned on other investments2017-12-31$-124
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2017-12-31$1,991
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2017-12-31$1,274
Net investment gain/loss from pooled separate accounts2017-12-31$242,946
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 contributions2017-12-31Yes
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$238,885
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 name2017-12-31HOLTZMAN PARTNERS, LLP
Accountancy firm EIN2017-12-31743121060
2016 : MSH 401(K) EMPLOYEE RETIREMENT 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$681,392
Total loss/gain on sale of assets2016-12-31$0
Total of all expenses incurred2016-12-31$163,288
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2016-12-31$155,638
Total contributions o plan (from employers,participants, others, non cash contrinutions)2016-12-31$610,130
Value of total assets at end of year2016-12-31$1,010,518
Value of total assets at beginning of year2016-12-31$492,414
Total of administrative expenses incurred including professional, contract, advisory and management fees2016-12-31$7,650
Total interest from all sources2016-12-31$3
Total dividends received (eg from common stock, registered investment company shares)2016-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2016-12-31No
Was this plan covered by a fidelity bond2016-12-31Yes
Value of fidelity bond cover2016-12-31$101,051
If this is an individual account plan, was there a blackout period2016-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2016-12-31$0
Were there any nonexempt tranactions with any party-in-interest2016-12-31No
Contributions received from participants2016-12-31$610,130
Participant contributions at end of year2016-12-31$0
Participant contributions at beginning of year2016-12-31$8,563
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$518,104
Value of net assets at end of year (total assets less liabilities)2016-12-31$1,010,518
Value of net assets at beginning of year (total assets less liabilities)2016-12-31$492,414
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 pooled separate accounts at end of year2016-12-31$1,009,244
Value of interest in pooled separate accounts at beginning of year2016-12-31$483,780
Interest on participant loans2016-12-31$0
Income. Interest from loans (other than to participants)2016-12-31$0
Interest earned on other investments2016-12-31$3
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2016-12-31$1,274
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2016-12-31$71
Net investment gain/loss from pooled separate accounts2016-12-31$71,259
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2016-12-31$155,638
Contract administrator fees2016-12-31$7,650
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 name2016-12-31HOLTZMAN PARTNERS
Accountancy firm EIN2016-12-31743121060
2015 : MSH 401(K) EMPLOYEE RETIREMENT 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$651,915
Total loss/gain on sale of assets2015-12-31$0
Total of all expenses incurred2015-12-31$159,501
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others2015-12-31$155,851
Total contributions o plan (from employers,participants, others, non cash contrinutions)2015-12-31$673,461
Value of total assets at end of year2015-12-31$492,414
Value of total assets at beginning of year2015-12-31$0
Total of administrative expenses incurred including professional, contract, advisory and management fees2015-12-31$3,650
Total interest from all sources2015-12-31$0
Total dividends received (eg from common stock, registered investment company shares)2015-12-31$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year2015-12-31No
Was this plan covered by a fidelity bond2015-12-31Yes
Value of fidelity bond cover2015-12-31$48,385
If this is an individual account plan, was there a blackout period2015-12-31No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities2015-12-31$0
Funding deficiency by the employer to the plan for this plan year2015-12-31$0
Minimum employer required contribution for this plan year2015-12-31$0
Amount contributed by the employer to the plan for this plan year2015-12-31$0
Were there any nonexempt tranactions with any party-in-interest2015-12-31No
Contributions received from participants2015-12-31$359,960
Participant contributions at end of year2015-12-31$8,563
Participant contributions at beginning of year2015-12-31$0
Income. Received or receivable in cash from other sources (including rollovers)2015-12-31$313,501
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$492,414
Value of net assets at end of year (total assets less liabilities)2015-12-31$492,414
Value of net assets at beginning of year (total assets less liabilities)2015-12-31$0
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 pooled separate accounts at end of year2015-12-31$483,780
Value of interest in pooled separate accounts at beginning of year2015-12-31$0
Interest on participant loans2015-12-31$0
Income. Interest from loans (other than to participants)2015-12-31$0
Value of funds held in insurance company general accounts (unallocated contracts) at end of year2015-12-31$71
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year2015-12-31$0
Net investment gain/loss from pooled separate accounts2015-12-31$-21,546
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
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers2015-12-31$155,851
Contract administrator fees2015-12-31$3,650
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 name2015-12-31HOLTZMAN PARTNERS
Accountancy firm EIN2015-12-31743121060

Form 5500 Responses for MSH 401(K) EMPLOYEE RETIREMENT PLAN

2018: MSH 401(K) EMPLOYEE RETIREMENT PLAN 2018 form 5500 responses
2018-01-01Type of plan entitySingle employer plan
2018-01-01Submission has been amendedNo
2018-01-01This submission is the final filingYes
2018-01-01This return/report is a short plan year return/report (less than 12 months)Yes
2018-01-01Plan is a collectively bargained planNo
2018-01-01Plan funding arrangement – InsuranceYes
2018-01-01Plan funding arrangement – TrustYes
2018-01-01Plan benefit arrangement – InsuranceYes
2017: MSH 401(K) EMPLOYEE RETIREMENT PLAN 2017 form 5500 responses
2017-01-01Type of plan entitySingle employer plan
2017-01-01Submission has been amendedNo
2017-01-01This submission is the final filingNo
2017-01-01This return/report is a short plan year return/report (less than 12 months)No
2017-01-01Plan is a collectively bargained planNo
2017-01-01Plan funding arrangement – InsuranceYes
2017-01-01Plan funding arrangement – TrustYes
2017-01-01Plan benefit arrangement – InsuranceYes
2016: MSH 401(K) EMPLOYEE RETIREMENT PLAN 2016 form 5500 responses
2016-01-01Type of plan entitySingle employer plan
2016-01-01Submission has been amendedNo
2016-01-01This submission is the final filingNo
2016-01-01This return/report is a short plan year return/report (less than 12 months)No
2016-01-01Plan is a collectively bargained planNo
2016-01-01Plan funding arrangement – InsuranceYes
2016-01-01Plan funding arrangement – TrustYes
2016-01-01Plan benefit arrangement – InsuranceYes
2016-01-01Plan benefit arrangement - TrustYes
2015: MSH 401(K) EMPLOYEE RETIREMENT PLAN 2015 form 5500 responses
2015-02-15Type of plan entitySingle employer plan
2015-02-15First time form 5500 has been submittedYes
2015-02-15Submission has been amendedNo
2015-02-15This submission is the final filingNo
2015-02-15This return/report is a short plan year return/report (less than 12 months)Yes
2015-02-15Plan is a collectively bargained planNo
2015-02-15Plan funding arrangement – InsuranceYes
2015-02-15Plan funding arrangement – TrustYes
2015-02-15Plan benefit arrangement – InsuranceYes
2015-02-15Plan benefit arrangement - TrustYes

Insurance Providers Used on plan

HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-842327
Policy instance 1
Insurance contract or identification numberGA-842327
Insurance policy start date2018-01-01
Insurance policy end date2018-10-31
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?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
HARTFORD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 88072 )
Policy contract numberGA-842327
Policy instance 1
Insurance contract or identification numberGA-842327
Number of Individuals Covered587
Insurance policy start date2017-01-01
Insurance policy end date2017-12-31
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?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
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract number19559
Policy instance 1
Insurance contract or identification number19559
Number of Individuals Covered248
Insurance policy start date2015-01-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $7,450
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?Yes
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?No
Health Insurance Welfare BenefitNo
Dental Insurance Welfare BenefitNo
Vision Insurance Welfare BenefitNo
Life Insurance Welfare BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Were dividends or retroactive rate refunds paid in cash?No
Were dividends or retroactive rate refunds paid as a credit?No
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $7,450
Insurance broker organization code?3
Insurance broker nameAXA NETWORK LLC

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