401k Plan data: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN plan

KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 401k Plan overview

Plan Name	KIWANIS INTERNATIONAL LIFE INSURANCE PLAN
Plan identification number	503

KIWANIS INTERNATIONAL LIFE INSURANCE PLAN Benefits

401k Plan Type	Welfare Benefit
Plan Features/Benefits	Life insurance Death benefits (include travel accident but not life insurance) Other welfare benefit cover

401k Sponsoring company profile

KIWANIS INTERNATIONAL has sponsored the creation of one or more 401k plans.

Company Name: KIWANIS INTERNATIONAL

Employer identification number (EIN): 361327510

NAIC Classification: 813000
NAIC Description: Religious, Grantmaking, Civic, Professional, and Similar Organizations

Form 5500 Filing Information

Submission information for form 5500 for 401k plan KIWANIS INTERNATIONAL LIFE INSURANCE PLAN

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
503 2017-01-01 LISA HEINDRICKS
503 2016-01-01
503 2015-01-01
503 2014-01-01
503 2013-05-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2014-08-20
503 2012-05-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2013-11-08
503 2011-05-01 STEVEN J. KRITZMIRE STEVEN J. KRITZMIRE 2012-09-10
503 2009-05-01 LISA M. HEINDRICKS STANTON SODERSTROM 2010-08-18

Plan id#	Filing Submission Date	Name of Administrator	Name of Company Sponsor	Date Sponsor Signed
503	2017-01-01	LISA HEINDRICKS
503	2016-01-01
503	2015-01-01
503	2014-01-01
503	2013-05-01	STEVEN J. KRITZMIRE	STEVEN J. KRITZMIRE	2014-08-20
503	2012-05-01	STEVEN J. KRITZMIRE	STEVEN J. KRITZMIRE	2013-11-08
503	2011-05-01	STEVEN J. KRITZMIRE	STEVEN J. KRITZMIRE	2012-09-10
503	2009-05-01	LISA M. HEINDRICKS	STANTON SODERSTROM	2010-08-18

Plan Statistics for KIWANIS INTERNATIONAL LIFE INSURANCE PLAN

401k plan membership statisitcs for KIWANIS INTERNATIONAL LIFE INSURANCE PLAN

Measure Date Value
2017: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year 2017-01-01 110
Total number of active participants reported on line 7a of the Form 5500 2017-01-01 0
Number of retired or separated participants receiving benefits 2017-01-01 0
Number of other retired or separated participants entitled to future benefits 2017-01-01 0
Total of all active and inactive participants 2017-01-01 0
2016: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year 2016-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2016-01-01 108
Total of all active and inactive participants 2016-01-01 108
Total participants 2016-01-01 108
2015: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year 2015-01-01 111
Total number of active participants reported on line 7a of the Form 5500 2015-01-01 110
Total of all active and inactive participants 2015-01-01 110
Total participants 2015-01-01 110
2014: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year 2014-01-01 112
Total number of active participants reported on line 7a of the Form 5500 2014-01-01 112
Total of all active and inactive participants 2014-01-01 112
Total participants 2014-01-01 112
2013: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year 2013-05-01 110
Total number of active participants reported on line 7a of the Form 5500 2013-05-01 104
Total of all active and inactive participants 2013-05-01 104
Total participants 2013-05-01 104
2012: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year 2012-05-01 109
Total number of active participants reported on line 7a of the Form 5500 2012-05-01 109
Total of all active and inactive participants 2012-05-01 109
Total participants 2012-05-01 109
2011: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year 2011-05-01 119
Total number of active participants reported on line 7a of the Form 5500 2011-05-01 109
Total of all active and inactive participants 2011-05-01 109
Total participants 2011-05-01 109
2009: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year 2009-05-01 141
Total number of active participants reported on line 7a of the Form 5500 2009-05-01 141
Number of retired or separated participants receiving benefits 2009-05-01 0
Number of other retired or separated participants entitled to future benefits 2009-05-01 0
Total of all active and inactive participants 2009-05-01 141

Measure	Date	Value
2017: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2017 401k membership
Total participants, beginning-of-year	2017-01-01	110
Total number of active participants reported on line 7a of the Form 5500	2017-01-01	0
Number of retired or separated participants receiving benefits	2017-01-01	0
Number of other retired or separated participants entitled to future benefits	2017-01-01	0
Total of all active and inactive participants	2017-01-01	0
2016: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2016 401k membership
Total participants, beginning-of-year	2016-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2016-01-01	108
Total of all active and inactive participants	2016-01-01	108
Total participants	2016-01-01	108
2015: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2015 401k membership
Total participants, beginning-of-year	2015-01-01	111
Total number of active participants reported on line 7a of the Form 5500	2015-01-01	110
Total of all active and inactive participants	2015-01-01	110
Total participants	2015-01-01	110
2014: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2014 401k membership
Total participants, beginning-of-year	2014-01-01	112
Total number of active participants reported on line 7a of the Form 5500	2014-01-01	112
Total of all active and inactive participants	2014-01-01	112
Total participants	2014-01-01	112
2013: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2013 401k membership
Total participants, beginning-of-year	2013-05-01	110
Total number of active participants reported on line 7a of the Form 5500	2013-05-01	104
Total of all active and inactive participants	2013-05-01	104
Total participants	2013-05-01	104
2012: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2012 401k membership
Total participants, beginning-of-year	2012-05-01	109
Total number of active participants reported on line 7a of the Form 5500	2012-05-01	109
Total of all active and inactive participants	2012-05-01	109
Total participants	2012-05-01	109
2011: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2011 401k membership
Total participants, beginning-of-year	2011-05-01	119
Total number of active participants reported on line 7a of the Form 5500	2011-05-01	109
Total of all active and inactive participants	2011-05-01	109
Total participants	2011-05-01	109
2009: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2009 401k membership
Total participants, beginning-of-year	2009-05-01	141
Total number of active participants reported on line 7a of the Form 5500	2009-05-01	141
Number of retired or separated participants receiving benefits	2009-05-01	0
Number of other retired or separated participants entitled to future benefits	2009-05-01	0
Total of all active and inactive participants	2009-05-01	141

Form 5500 Responses for KIWANIS INTERNATIONAL LIFE INSURANCE PLAN

2017: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2017 form 5500 responses
2017-01-01	Type of plan entity	Single employer plan
2017-01-01	Submission has been amended	No
2017-01-01	This submission is the final filing	Yes
2017-01-01	This return/report is a short plan year return/report (less than 12 months)	No
2017-01-01	Plan is a collectively bargained plan	No
2017-01-01	Plan funding arrangement – Insurance	Yes
2017-01-01	Plan benefit arrangement – Insurance	Yes
2016: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2016 form 5500 responses
2016-01-01	Type of plan entity	Single employer plan
2016-01-01	Plan funding arrangement – Insurance	Yes
2016-01-01	Plan benefit arrangement – Insurance	Yes
2015: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2015 form 5500 responses
2015-01-01	Type of plan entity	Single employer plan
2015-01-01	Plan funding arrangement – Insurance	Yes
2015-01-01	Plan benefit arrangement – Insurance	Yes
2014: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2014 form 5500 responses
2014-01-01	Type of plan entity	Single employer plan
2014-01-01	Plan funding arrangement – Insurance	Yes
2014-01-01	Plan benefit arrangement – Insurance	Yes
2013: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2013 form 5500 responses
2013-05-01	Type of plan entity	Single employer plan
2013-05-01	This return/report is a short plan year return/report (less than 12 months)	Yes
2013-05-01	Plan funding arrangement – Insurance	Yes
2013-05-01	Plan benefit arrangement – Insurance	Yes
2012: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2012 form 5500 responses
2012-05-01	Type of plan entity	Single employer plan
2012-05-01	Plan funding arrangement – Insurance	Yes
2012-05-01	Plan benefit arrangement – Insurance	Yes
2011: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2011 form 5500 responses
2011-05-01	Type of plan entity	Single employer plan
2011-05-01	Plan funding arrangement – Insurance	Yes
2011-05-01	Plan benefit arrangement – Insurance	Yes
2009: KIWANIS INTERNATIONAL LIFE INSURANCE PLAN 2009 form 5500 responses
2009-05-01	Type of plan entity	Single employer plan
2009-05-01	Submission has been amended	No
2009-05-01	This submission is the final filing	No
2009-05-01	This return/report is a short plan year return/report (less than 12 months)	No
2009-05-01	Plan is a collectively bargained plan	No
2009-05-01	Plan funding arrangement – Insurance	Yes
2009-05-01	Plan benefit arrangement – Insurance	Yes

Insurance Providers Used on plan

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM604722

Policy instance

Insurance contract or identification number	SGM604722
Number of Individuals Covered	124
Insurance policy start date	2017-01-01
Insurance policy end date	2017-12-31
Total amount of commissions paid to insurance broker	USD $4,809
Total amount of fees paid to insurance company	USD $608
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 plan	No
Contracts With Unallocated Funds Deposit Administration	0
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 Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	Yes
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Other welfare benefits provided	VOLUNTARY LIFE, ACCIDENTAL 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 Carrier	USD $32,061
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,809
Amount paid for insurance broker fees	608
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM604722

Policy instance

Insurance contract or identification number	SGM604722
Number of Individuals Covered	111
Insurance policy start date	2016-01-01
Insurance policy end date	2016-12-31
Total amount of commissions paid to insurance broker	USD $4,919
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $32,789
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,919
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM604722

Policy instance

Insurance contract or identification number	SGM604722
Number of Individuals Covered	110
Insurance policy start date	2015-01-01
Insurance policy end date	2015-12-31
Total amount of commissions paid to insurance broker	USD $3,923
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $26,150
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,923
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

LIFE INSURANCE COMPANY OF NORTH AMERICA (National Association of Insurance Commissioners NAIC id number: 65498 )

Policy contract number

SGM604722

Policy instance

Insurance contract or identification number	SGM604722
Number of Individuals Covered	112
Insurance policy start date	2014-01-01
Insurance policy end date	2014-12-31
Total amount of commissions paid to insurance broker	USD $3,936
Total amount of fees paid to insurance company	USD $1,024
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $26,243
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,936
Amount paid for insurance broker fees	1024
Additional information about fees paid to insurance broker	OVERRIDE
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 125833

Policy instance

Insurance contract or identification number	GL 125833
Number of Individuals Covered	110
Insurance policy start date	2013-05-01
Insurance policy end date	2013-12-31
Total amount of commissions paid to insurance broker	USD $240
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $2,246
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $240
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 125833

Policy instance

Insurance contract or identification number	GL 125833
Number of Individuals Covered	110
Insurance policy start date	2012-05-01
Insurance policy end date	2013-04-30
Total amount of commissions paid to insurance broker	USD $359
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,318
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $359
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 125833

Policy instance

Insurance contract or identification number	GL 125833
Number of Individuals Covered	108
Insurance policy start date	2011-05-01
Insurance policy end date	2012-04-30
Total amount of commissions paid to insurance broker	USD $354
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,261
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No

RELIANCE STANDARD LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 68381 )

Policy contract number

GL 125833

Policy instance

Insurance contract or identification number	GL 125833
Number of Individuals Covered	112
Insurance policy start date	2010-05-01
Insurance policy end date	2011-04-30
Total amount of commissions paid to insurance broker	USD $352
Total amount of fees paid to insurance company	USD $0
Life Insurance Welfare Benefit	Yes
Other welfare benefits provided	ACCIDENTAL DEATH & DISMEMBERMENT
Welfare Benefit Premiums Paid to Carrier	USD $3,247
Commission paid to Insurance Broker	USD $352
Insurance broker organization code?	3
Insurance broker name	HYLANT GROUP INC

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Company Name:	KIWANIS INTERNATIONAL
Employer identification number (EIN):	361327510
NAIC Classification:	813000
NAIC Description:	Religious, Grantmaking, Civic, Professional, and Similar Organizations