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INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 401k Plan overview

Plan NameINDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN
Plan identification number 505

INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN Benefits

401k Plan TypeWelfare Benefit
Plan Features/Benefits
  • Death benefits (include travel accident but not life insurance)

401k Sponsoring company profile

INDIAN INDUSTRIES INC has sponsored the creation of one or more 401k plans.

Company Name:INDIAN INDUSTRIES INC
Employer identification number (EIN):351290268
NAIC Classification:339900

Additional information about INDIAN INDUSTRIES INC

Jurisdiction of Incorporation: California Department of State
Incorporation Date:
Company Identification Number: C0688515

More information about INDIAN INDUSTRIES INC

Form 5500 Filing Information

Submission information for form 5500 for 401k plan INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator SignedName of Company SponsorDate Sponsor Signed
5052015-04-01JEFF DOOLEY
5052014-04-01JEFF DOOLEY
5052013-04-01JEFF DOOLEY
5052012-04-01JEFF DOOLEY
5052011-04-01ALICIA MEHRINGER
5052010-04-01ALICIA MEHRINGER
5052009-04-01ALICIA MEHRINGER

Plan Statistics for INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

401k plan membership statisitcs for INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

Measure Date Value
2015: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2015 401k membership
Total participants, beginning-of-year2015-04-01367
Total number of active participants reported on line 7a of the Form 55002015-04-010
Number of retired or separated participants receiving benefits2015-04-010
Number of other retired or separated participants entitled to future benefits2015-04-010
Total of all active and inactive participants2015-04-010
2014: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2014 401k membership
Total participants, beginning-of-year2014-04-01323
Total number of active participants reported on line 7a of the Form 55002014-04-01367
Total of all active and inactive participants2014-04-01367
Total participants2014-04-01367
2013: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2013 401k membership
Total participants, beginning-of-year2013-04-01298
Total number of active participants reported on line 7a of the Form 55002013-04-01323
Total of all active and inactive participants2013-04-01323
Total participants2013-04-01323
2012: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2012 401k membership
Total participants, beginning-of-year2012-04-01255
Total number of active participants reported on line 7a of the Form 55002012-04-01298
Total of all active and inactive participants2012-04-01298
Total participants2012-04-01298
2011: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2011 401k membership
Total participants, beginning-of-year2011-04-01233
Total number of active participants reported on line 7a of the Form 55002011-04-01255
Total of all active and inactive participants2011-04-01255
Total participants2011-04-01255
2010: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2010 401k membership
Total participants, beginning-of-year2010-04-01229
Total number of active participants reported on line 7a of the Form 55002010-04-01233
Total of all active and inactive participants2010-04-01233
Total participants2010-04-01233
2009: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2009 401k membership
Total participants, beginning-of-year2009-04-01295
Total number of active participants reported on line 7a of the Form 55002009-04-01229
Total of all active and inactive participants2009-04-01229
Total participants2009-04-01229

Form 5500 Responses for INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN

2015: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2015 form 5500 responses
2015-04-01Type of plan entitySingle employer plan
2015-04-01Submission has been amendedNo
2015-04-01This submission is the final filingYes
2015-04-01This return/report is a short plan year return/report (less than 12 months)Yes
2015-04-01Plan is a collectively bargained planNo
2015-04-01Plan funding arrangement – InsuranceYes
2015-04-01Plan benefit arrangement – InsuranceYes
2014: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2014 form 5500 responses
2014-04-01Type of plan entitySingle employer plan
2014-04-01First time form 5500 has been submittedYes
2014-04-01Submission has been amendedNo
2014-04-01This submission is the final filingNo
2014-04-01This return/report is a short plan year return/report (less than 12 months)No
2014-04-01Plan is a collectively bargained planYes
2014-04-01Plan funding arrangement – InsuranceYes
2014-04-01Plan benefit arrangement – InsuranceYes
2013: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2013 form 5500 responses
2013-04-01Type of plan entitySingle employer plan
2013-04-01First time form 5500 has been submittedYes
2013-04-01Submission has been amendedNo
2013-04-01This submission is the final filingNo
2013-04-01This return/report is a short plan year return/report (less than 12 months)No
2013-04-01Plan is a collectively bargained planYes
2013-04-01Plan funding arrangement – InsuranceYes
2013-04-01Plan benefit arrangement – InsuranceYes
2012: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2012 form 5500 responses
2012-04-01Type of plan entitySingle employer plan
2012-04-01Submission has been amendedNo
2012-04-01This submission is the final filingNo
2012-04-01This return/report is a short plan year return/report (less than 12 months)No
2012-04-01Plan is a collectively bargained planYes
2012-04-01Plan funding arrangement – InsuranceYes
2012-04-01Plan benefit arrangement – InsuranceYes
2011: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2011 form 5500 responses
2011-04-01Type of plan entitySingle employer plan
2011-04-01Submission has been amendedNo
2011-04-01This submission is the final filingNo
2011-04-01This return/report is a short plan year return/report (less than 12 months)No
2011-04-01Plan is a collectively bargained planYes
2011-04-01Plan funding arrangement – InsuranceYes
2011-04-01Plan benefit arrangement – InsuranceYes
2010: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2010 form 5500 responses
2010-04-01Type of plan entitySingle employer plan
2010-04-01Submission has been amendedNo
2010-04-01This submission is the final filingNo
2010-04-01This return/report is a short plan year return/report (less than 12 months)No
2010-04-01Plan is a collectively bargained planYes
2010-04-01Plan funding arrangement – InsuranceYes
2010-04-01Plan benefit arrangement – InsuranceYes
2009: INDIAN INDUSTRIES INC ACCIDENTAL DEATH AND DISMEMBERMENT PLAN 2009 form 5500 responses
2009-04-01Type of plan entitySingle employer plan
2009-04-01Submission has been amendedNo
2009-04-01This submission is the final filingNo
2009-04-01This return/report is a short plan year return/report (less than 12 months)No
2009-04-01Plan is a collectively bargained planYes
2009-04-01Plan funding arrangement – InsuranceYes
2009-04-01Plan benefit arrangement – InsuranceYes

Insurance Providers Used on plan

MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AGCF
Policy instance 1
Insurance contract or identification numberGLUG0AGCF
Number of Individuals Covered367
Insurance policy start date2014-06-01
Insurance policy end date2015-05-31
Total amount of commissions paid to insurance brokerUSD $3,845
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $38,452
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $3,845
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberGLUG0AGCF
Policy instance 2
Insurance contract or identification numberGLUG0AGCF
Number of Individuals Covered401
Insurance policy start date2015-06-01
Insurance policy end date2015-12-31
Total amount of commissions paid to insurance brokerUSD $2,422
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
Other welfare benefits providedACCIDENTAL DEATH AND DISMEMBERMENT
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 $24,218
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $2,422
Insurance broker organization code?3
Insurance broker nameUSI INSURANCE SERVICES, LLC
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AGCF
Policy instance 1
Insurance contract or identification numberG000AGCF
Number of Individuals Covered367
Insurance policy start date2014-06-01
Insurance policy end date2015-06-01
Total amount of commissions paid to insurance brokerUSD $731
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $7,196
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $731
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Insurance broker nameUSI OF SO CALIFORNIA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AGCF
Policy instance 1
Insurance contract or identification numberG000AGCF
Number of Individuals Covered323
Insurance policy start date2013-01-01
Insurance policy end date2013-12-31
Total amount of commissions paid to insurance brokerUSD $626
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 BenefitNo
Temporary Disability Insurance Welfare BenefitNo
Long Term Disability Insurance Welfare BenefitNo
Unemployment Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
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 $6,113
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $626
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD
Insurance broker organization code?3
Insurance broker nameUSI OF SO CALIFORNIA
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AGCF
Policy instance 1
Insurance contract or identification numberG000AGCF
Number of Individuals Covered298
Insurance policy start date2012-01-01
Insurance policy end date2012-12-31
Total amount of commissions paid to insurance brokerUSD $545
Total amount of fees paid to insurance companyUSD $181
Life Insurance Welfare BenefitNo
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $5,413
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $354
Amount paid for insurance broker fees181
Additional information about fees paid to insurance brokerAGENT OR BROKER OF RECORD OTHER COMPENSATION
Insurance broker organization code?3
Insurance broker nameUSI OF SO CALIFORNIA INS SVCS INC.
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AGCF
Policy instance 1
Insurance contract or identification numberG000AGCF
Number of Individuals Covered255
Insurance policy start date2011-01-01
Insurance policy end date2011-12-31
Total amount of commissions paid to insurance brokerUSD $632
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,943
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
MUTUAL OF OMAHA (National Association of Insurance Commissioners NAIC id number: 69868 )
Policy contract numberG000AGCF
Policy instance 1
Insurance contract or identification numberG000AGCF
Number of Individuals Covered233
Insurance policy start date2010-01-01
Insurance policy end date2010-12-31
Total amount of commissions paid to insurance brokerUSD $605
Other welfare benefits providedACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to CarrierUSD $4,667
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?No
Commission paid to Insurance BrokerUSD $605
Amount paid for insurance broker fees0
Additional information about fees paid to insurance brokerBONUS
Insurance broker organization code?3
Insurance broker nameNEACE & ASSOCIATES INC

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