401k Plan data: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. plan

THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 401k Plan overview

Plan Name	THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC.
Plan identification number	002

THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. Benefits

401k Plan Type

Defined Contribution Pension

Plan Features/Benefits

Age/Service Weighted or new comparability or similar plan - Age/Service Weighted Plan: Allocations are based on age, service, or age and service. New comparability or similar plan: Allocations are based on participant classifications and a classification(s) consists entirely or predominantly of highly compensated employees; or the plan provides an additional allocation rate on compensation above a specified threshold, and the theshold or additional rate exceeds the maximum threshold or rate allowed under the permitted disparity rules of section 401(l).
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.

401k Sponsoring company profile

NORTHERN ILLINOIS BLOOD BANK, INC. D/B/A ROCK RIVER VALLEY BLOOD CTR has sponsored the creation of one or more 401k plans.

Company Name: NORTHERN ILLINOIS BLOOD BANK, INC. D/B/A ROCK RIVER VALLEY BLOOD CTR

Employer identification number (EIN): 362334632

NAIC Classification: 621900

Form 5500 Filing Information

Submission information for form 5500 for 401k plan THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC.

Plan id# Filing Submission Date Name of Administrator Date Administrator Signed Name of Company Sponsor Date Sponsor Signed
002 2022-07-01 SHELLIE KNOX 2024-03-21
002 2021-07-01 SHELLIE KNOX 2023-02-24
002 2021-07-01 SHELLIE KNOX 2023-02-27
002 2020-07-01 SHELLIE KNOX 2021-12-24
002 2019-07-01
002 2018-07-01
002 2017-07-01 NICOLE KOBLESKY
002 2016-07-01 JENNIFER TOPPING
002 2015-07-01 JENNIFER TOPPING
002 2014-07-01 NICOLE KOBLSEKY
002 2013-07-01 LINDA GERBER
002 2012-07-01 LINDA GERBER

Plan id#	Filing Submission Date	Name of Administrator	Date Administrator Signed
002	2022-07-01	SHELLIE KNOX	2024-03-21
002	2021-07-01	SHELLIE KNOX	2023-02-24
002	2021-07-01	SHELLIE KNOX	2023-02-27
002	2020-07-01	SHELLIE KNOX	2021-12-24
002	2019-07-01
002	2018-07-01
002	2017-07-01	NICOLE KOBLESKY
002	2016-07-01	JENNIFER TOPPING
002	2015-07-01	JENNIFER TOPPING
002	2014-07-01	NICOLE KOBLSEKY
002	2013-07-01	LINDA GERBER
002	2012-07-01	LINDA GERBER

Plan Statistics for THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC.

401k plan membership statisitcs for THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC.

Measure Date Value
2019: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2019 401k membership
Total participants, beginning-of-year 2019-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2019-07-01 74
Number of retired or separated participants receiving benefits 2019-07-01 2
Number of other retired or separated participants entitled to future benefits 2019-07-01 17
Total of all active and inactive participants 2019-07-01 93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2019-07-01 0
Total participants 2019-07-01 93
Number of participants with account balances 2019-07-01 88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2019-07-01 4
2018: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2018 401k membership
Total participants, beginning-of-year 2018-07-01 105
Total number of active participants reported on line 7a of the Form 5500 2018-07-01 72
Number of retired or separated participants receiving benefits 2018-07-01 1
Number of other retired or separated participants entitled to future benefits 2018-07-01 24
Total of all active and inactive participants 2018-07-01 97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2018-07-01 0
Total participants 2018-07-01 97
Number of participants with account balances 2018-07-01 92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2018-07-01 4
2017: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2017 401k membership
Total participants, beginning-of-year 2017-07-01 100
Total number of active participants reported on line 7a of the Form 5500 2017-07-01 78
Number of retired or separated participants receiving benefits 2017-07-01 1
Number of other retired or separated participants entitled to future benefits 2017-07-01 21
Total of all active and inactive participants 2017-07-01 100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2017-07-01 0
Total participants 2017-07-01 100
Number of participants with account balances 2017-07-01 93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2017-07-01 4
2016: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2016 401k membership
Total participants, beginning-of-year 2016-07-01 102
Total number of active participants reported on line 7a of the Form 5500 2016-07-01 73
Number of retired or separated participants receiving benefits 2016-07-01 0
Number of other retired or separated participants entitled to future benefits 2016-07-01 22
Total of all active and inactive participants 2016-07-01 95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2016-07-01 0
Total participants 2016-07-01 95
Number of participants with account balances 2016-07-01 91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2016-07-01 2
2015: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2015 401k membership
Total participants, beginning-of-year 2015-07-01 112
Total number of active participants reported on line 7a of the Form 5500 2015-07-01 82
Number of retired or separated participants receiving benefits 2015-07-01 0
Number of other retired or separated participants entitled to future benefits 2015-07-01 15
Total of all active and inactive participants 2015-07-01 97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2015-07-01 0
Total participants 2015-07-01 97
Number of participants with account balances 2015-07-01 93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2015-07-01 0
2014: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2014 401k membership
Total participants, beginning-of-year 2014-07-01 128
Total number of active participants reported on line 7a of the Form 5500 2014-07-01 94
Number of retired or separated participants receiving benefits 2014-07-01 0
Number of other retired or separated participants entitled to future benefits 2014-07-01 12
Total of all active and inactive participants 2014-07-01 106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2014-07-01 0
Total participants 2014-07-01 106
Number of participants with account balances 2014-07-01 92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2014-07-01 2
2013: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2013 401k membership
Total participants, beginning-of-year 2013-07-01 122
Total number of active participants reported on line 7a of the Form 5500 2013-07-01 115
Number of retired or separated participants receiving benefits 2013-07-01 0
Number of other retired or separated participants entitled to future benefits 2013-07-01 11
Total of all active and inactive participants 2013-07-01 126
Total participants 2013-07-01 126
Number of participants with account balances 2013-07-01 113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2013-07-01 3
2012: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2012 401k membership
Total participants, beginning-of-year 2012-07-01 139
Total number of active participants reported on line 7a of the Form 5500 2012-07-01 111
Number of retired or separated participants receiving benefits 2012-07-01 0
Number of other retired or separated participants entitled to future benefits 2012-07-01 11
Total of all active and inactive participants 2012-07-01 122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits 2012-07-01 0
Total participants 2012-07-01 122
Number of participants with account balances 2012-07-01 112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested 2012-07-01 4

Measure	Date	Value
2019: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2019 401k membership
Total participants, beginning-of-year	2019-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2019-07-01	74
Number of retired or separated participants receiving benefits	2019-07-01	2
Number of other retired or separated participants entitled to future benefits	2019-07-01	17
Total of all active and inactive participants	2019-07-01	93
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2019-07-01	0
Total participants	2019-07-01	93
Number of participants with account balances	2019-07-01	88
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2019-07-01	4
2018: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2018 401k membership
Total participants, beginning-of-year	2018-07-01	105
Total number of active participants reported on line 7a of the Form 5500	2018-07-01	72
Number of retired or separated participants receiving benefits	2018-07-01	1
Number of other retired or separated participants entitled to future benefits	2018-07-01	24
Total of all active and inactive participants	2018-07-01	97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2018-07-01	0
Total participants	2018-07-01	97
Number of participants with account balances	2018-07-01	92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2018-07-01	4
2017: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2017 401k membership
Total participants, beginning-of-year	2017-07-01	100
Total number of active participants reported on line 7a of the Form 5500	2017-07-01	78
Number of retired or separated participants receiving benefits	2017-07-01	1
Number of other retired or separated participants entitled to future benefits	2017-07-01	21
Total of all active and inactive participants	2017-07-01	100
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2017-07-01	0
Total participants	2017-07-01	100
Number of participants with account balances	2017-07-01	93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2017-07-01	4
2016: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2016 401k membership
Total participants, beginning-of-year	2016-07-01	102
Total number of active participants reported on line 7a of the Form 5500	2016-07-01	73
Number of retired or separated participants receiving benefits	2016-07-01	0
Number of other retired or separated participants entitled to future benefits	2016-07-01	22
Total of all active and inactive participants	2016-07-01	95
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2016-07-01	0
Total participants	2016-07-01	95
Number of participants with account balances	2016-07-01	91
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2016-07-01	2
2015: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2015 401k membership
Total participants, beginning-of-year	2015-07-01	112
Total number of active participants reported on line 7a of the Form 5500	2015-07-01	82
Number of retired or separated participants receiving benefits	2015-07-01	0
Number of other retired or separated participants entitled to future benefits	2015-07-01	15
Total of all active and inactive participants	2015-07-01	97
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2015-07-01	0
Total participants	2015-07-01	97
Number of participants with account balances	2015-07-01	93
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2015-07-01	0
2014: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2014 401k membership
Total participants, beginning-of-year	2014-07-01	128
Total number of active participants reported on line 7a of the Form 5500	2014-07-01	94
Number of retired or separated participants receiving benefits	2014-07-01	0
Number of other retired or separated participants entitled to future benefits	2014-07-01	12
Total of all active and inactive participants	2014-07-01	106
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2014-07-01	0
Total participants	2014-07-01	106
Number of participants with account balances	2014-07-01	92
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2014-07-01	2
2013: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2013 401k membership
Total participants, beginning-of-year	2013-07-01	122
Total number of active participants reported on line 7a of the Form 5500	2013-07-01	115
Number of retired or separated participants receiving benefits	2013-07-01	0
Number of other retired or separated participants entitled to future benefits	2013-07-01	11
Total of all active and inactive participants	2013-07-01	126
Total participants	2013-07-01	126
Number of participants with account balances	2013-07-01	113
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2013-07-01	3
2012: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2012 401k membership
Total participants, beginning-of-year	2012-07-01	139
Total number of active participants reported on line 7a of the Form 5500	2012-07-01	111
Number of retired or separated participants receiving benefits	2012-07-01	0
Number of other retired or separated participants entitled to future benefits	2012-07-01	11
Total of all active and inactive participants	2012-07-01	122
Number of deceased participants whose beneficiaries are receiving or are entitled to receive benefits	2012-07-01	0
Total participants	2012-07-01	122
Number of participants with account balances	2012-07-01	112
Participants that terminated employment during the plan year with accrued benefits that were less than 100% vested	2012-07-01	4

Financial Data on THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC.

Measure	Date	Value
2020 : THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2020 401k financial data
Total income from all sources (including contributions)	2020-06-30	$348,530
Total of all expenses incurred	2020-06-30	$940,681
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2020-06-30	$933,755
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2020-06-30	$187,376
Value of total assets at end of year	2020-06-30	$2,694,761
Value of total assets at beginning of year	2020-06-30	$3,286,912
Total of administrative expenses incurred including professional, contract, advisory and management fees	2020-06-30	$6,926
Total interest from all sources	2020-06-30	$213
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2020-06-30	No
Was this plan covered by a fidelity bond	2020-06-30	Yes
Value of fidelity bond cover	2020-06-30	$500,000
If this is an individual account plan, was there a blackout period	2020-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2020-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2020-06-30	No
Contributions received from participants	2020-06-30	$136,269
Administrative expenses (other) incurred	2020-06-30	$6,926
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Value of net income/loss	2020-06-30	$-592,151
Value of net assets at end of year (total assets less liabilities)	2020-06-30	$2,694,761
Value of net assets at beginning of year (total assets less liabilities)	2020-06-30	$3,286,912
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2020-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2020-06-30	No
Were any leases to which the plan was party in default or uncollectible	2020-06-30	No
Value of interest in pooled separate accounts at end of year	2020-06-30	$2,681,809
Value of interest in pooled separate accounts at beginning of year	2020-06-30	$3,265,153
Interest earned on other investments	2020-06-30	$213
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2020-06-30	$12,952
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2020-06-30	$21,759
Net investment gain/loss from pooled separate accounts	2020-06-30	$160,941
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2020-06-30	No
Was there a failure to transmit to the plan any participant contributions	2020-06-30	No
Has the plan failed to provide any benefit when due under the plan	2020-06-30	No
Contributions received in cash from employer	2020-06-30	$51,107
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2020-06-30	$933,755
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2020-06-30	No
Did the plan have assets held for investment	2020-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2020-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2020-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2020-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2020-06-30	Disclaimer
Accountancy firm name	2020-06-30	WIPFLI LLP
Accountancy firm EIN	2020-06-30	390758449
2019 : THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2019 401k financial data
Total income from all sources (including contributions)	2019-06-30	$523,516
Total of all expenses incurred	2019-06-30	$882,348
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2019-06-30	$873,760
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2019-06-30	$319,236
Value of total assets at end of year	2019-06-30	$3,286,912
Value of total assets at beginning of year	2019-06-30	$3,645,744
Total of administrative expenses incurred including professional, contract, advisory and management fees	2019-06-30	$8,588
Total interest from all sources	2019-06-30	$331
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2019-06-30	No
Was this plan covered by a fidelity bond	2019-06-30	Yes
Value of fidelity bond cover	2019-06-30	$500,000
If this is an individual account plan, was there a blackout period	2019-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2019-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2019-06-30	No
Contributions received from participants	2019-06-30	$165,882
Income. Received or receivable in cash from other sources (including rollovers)	2019-06-30	$93,946
Administrative expenses (other) incurred	2019-06-30	$8,588
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Value of net income/loss	2019-06-30	$-358,832
Value of net assets at end of year (total assets less liabilities)	2019-06-30	$3,286,912
Value of net assets at beginning of year (total assets less liabilities)	2019-06-30	$3,645,744
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2019-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2019-06-30	No
Were any leases to which the plan was party in default or uncollectible	2019-06-30	No
Value of interest in pooled separate accounts at end of year	2019-06-30	$3,265,153
Value of interest in pooled separate accounts at beginning of year	2019-06-30	$3,614,499
Interest earned on other investments	2019-06-30	$331
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2019-06-30	$21,759
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2019-06-30	$31,245
Net investment gain/loss from pooled separate accounts	2019-06-30	$203,949
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2019-06-30	No
Was there a failure to transmit to the plan any participant contributions	2019-06-30	No
Has the plan failed to provide any benefit when due under the plan	2019-06-30	No
Contributions received in cash from employer	2019-06-30	$59,408
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2019-06-30	$873,760
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2019-06-30	No
Did the plan have assets held for investment	2019-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2019-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2019-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2019-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2019-06-30	Disclaimer
Accountancy firm name	2019-06-30	WIPFLI LLP
Accountancy firm EIN	2019-06-30	390758449
2018 : THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2018 401k financial data
Total income from all sources (including contributions)	2018-06-30	$515,027
Total of all expenses incurred	2018-06-30	$443,461
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2018-06-30	$434,294
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2018-06-30	$235,427
Value of total assets at end of year	2018-06-30	$3,645,744
Value of total assets at beginning of year	2018-06-30	$3,574,178
Total of administrative expenses incurred including professional, contract, advisory and management fees	2018-06-30	$9,167
Total interest from all sources	2018-06-30	$454
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2018-06-30	No
Was this plan covered by a fidelity bond	2018-06-30	Yes
Value of fidelity bond cover	2018-06-30	$357,000
If this is an individual account plan, was there a blackout period	2018-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2018-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2018-06-30	No
Contributions received from participants	2018-06-30	$178,050
Administrative expenses (other) incurred	2018-06-30	$9,167
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Value of net income/loss	2018-06-30	$71,566
Value of net assets at end of year (total assets less liabilities)	2018-06-30	$3,645,744
Value of net assets at beginning of year (total assets less liabilities)	2018-06-30	$3,574,178
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2018-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2018-06-30	No
Were any leases to which the plan was party in default or uncollectible	2018-06-30	No
Value of interest in pooled separate accounts at end of year	2018-06-30	$3,614,499
Value of interest in pooled separate accounts at beginning of year	2018-06-30	$3,538,472
Interest earned on other investments	2018-06-30	$454
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2018-06-30	$31,245
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2018-06-30	$35,706
Net investment gain/loss from pooled separate accounts	2018-06-30	$279,146
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2018-06-30	No
Was there a failure to transmit to the plan any participant contributions	2018-06-30	No
Has the plan failed to provide any benefit when due under the plan	2018-06-30	No
Contributions received in cash from employer	2018-06-30	$57,377
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2018-06-30	$434,294
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2018-06-30	No
Did the plan have assets held for investment	2018-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2018-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2018-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2018-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2018-06-30	Disclaimer
Accountancy firm name	2018-06-30	WIPFLI LLP
Accountancy firm EIN	2018-06-30	390758449
2017 : THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2017 401k financial data
Total income from all sources (including contributions)	2017-06-30	$654,644
Total of all expenses incurred	2017-06-30	$167,571
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2017-06-30	$158,765
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2017-06-30	$247,426
Value of total assets at end of year	2017-06-30	$3,574,178
Value of total assets at beginning of year	2017-06-30	$3,087,105
Total of administrative expenses incurred including professional, contract, advisory and management fees	2017-06-30	$8,806
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2017-06-30	No
Was this plan covered by a fidelity bond	2017-06-30	Yes
Value of fidelity bond cover	2017-06-30	$309,000
If this is an individual account plan, was there a blackout period	2017-06-30	No
Were there any nonexempt tranactions with any party-in-interest	2017-06-30	No
Contributions received from participants	2017-06-30	$159,758
Income. Received or receivable in cash from other sources (including rollovers)	2017-06-30	$29,622
Other income not declared elsewhere	2017-06-30	$471
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Value of net income/loss	2017-06-30	$487,073
Value of net assets at end of year (total assets less liabilities)	2017-06-30	$3,574,178
Value of net assets at beginning of year (total assets less liabilities)	2017-06-30	$3,087,105
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2017-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2017-06-30	No
Were any leases to which the plan was party in default or uncollectible	2017-06-30	No
Value of interest in pooled separate accounts at end of year	2017-06-30	$3,538,472
Value of interest in pooled separate accounts at beginning of year	2017-06-30	$3,052,171
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2017-06-30	$35,706
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2017-06-30	$34,934
Net investment gain/loss from pooled separate accounts	2017-06-30	$406,747
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2017-06-30	No
Was there a failure to transmit to the plan any participant contributions	2017-06-30	No
Has the plan failed to provide any benefit when due under the plan	2017-06-30	No
Contributions received in cash from employer	2017-06-30	$58,046
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2017-06-30	$158,765
Contract administrator fees	2017-06-30	$8,806
Did the plan have assets held for investment	2017-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2017-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2017-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2017-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2017-06-30	Disclaimer
Accountancy firm name	2017-06-30	WIPFLI LLP
Accountancy firm EIN	2017-06-30	390758449
2016 : THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2016 401k financial data
Total income from all sources (including contributions)	2016-06-30	$296,305
Total of all expenses incurred	2016-06-30	$185,960
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2016-06-30	$178,313
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2016-06-30	$309,481
Value of total assets at end of year	2016-06-30	$3,087,105
Value of total assets at beginning of year	2016-06-30	$2,976,760
Total of administrative expenses incurred including professional, contract, advisory and management fees	2016-06-30	$7,647
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2016-06-30	No
Was this plan covered by a fidelity bond	2016-06-30	Yes
Value of fidelity bond cover	2016-06-30	$307,000
If this is an individual account plan, was there a blackout period	2016-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2016-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2016-06-30	No
Contributions received from participants	2016-06-30	$175,679
Other income not declared elsewhere	2016-06-30	$495
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Value of net income/loss	2016-06-30	$110,345
Value of net assets at end of year (total assets less liabilities)	2016-06-30	$3,087,105
Value of net assets at beginning of year (total assets less liabilities)	2016-06-30	$2,976,760
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2016-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2016-06-30	No
Were any leases to which the plan was party in default or uncollectible	2016-06-30	No
Value of interest in pooled separate accounts at end of year	2016-06-30	$3,052,171
Value of interest in pooled separate accounts at beginning of year	2016-06-30	$2,941,854
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2016-06-30	$34,934
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2016-06-30	$34,906
Expenses. Payments to insurance carriers foe the provision of benefits	2016-06-30	$178,313
Net investment gain/loss from pooled separate accounts	2016-06-30	$-13,671
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2016-06-30	No
Was there a failure to transmit to the plan any participant contributions	2016-06-30	No
Has the plan failed to provide any benefit when due under the plan	2016-06-30	No
Contributions received in cash from employer	2016-06-30	$133,802
Contract administrator fees	2016-06-30	$7,647
Did the plan have assets held for investment	2016-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2016-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2016-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2016-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2016-06-30	Disclaimer
Accountancy firm name	2016-06-30	WIPFLI LLP
Accountancy firm EIN	2016-06-30	390758449
2015 : THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2015 401k financial data
Total income from all sources (including contributions)	2015-06-30	$320,544
Total of all expenses incurred	2015-06-30	$332,832
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2015-06-30	$324,981
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2015-06-30	$226,081
Value of total assets at end of year	2015-06-30	$2,976,760
Value of total assets at beginning of year	2015-06-30	$2,989,048
Total of administrative expenses incurred including professional, contract, advisory and management fees	2015-06-30	$7,851
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2015-06-30	No
Was this plan covered by a fidelity bond	2015-06-30	Yes
Value of fidelity bond cover	2015-06-30	$299,000
If this is an individual account plan, was there a blackout period	2015-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2015-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2015-06-30	No
Contributions received from participants	2015-06-30	$173,594
Other income not declared elsewhere	2015-06-30	$614
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Value of net income/loss	2015-06-30	$-12,288
Value of net assets at end of year (total assets less liabilities)	2015-06-30	$2,976,760
Value of net assets at beginning of year (total assets less liabilities)	2015-06-30	$2,989,048
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2015-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2015-06-30	No
Were any leases to which the plan was party in default or uncollectible	2015-06-30	No
Value of interest in pooled separate accounts at end of year	2015-06-30	$2,941,854
Value of interest in pooled separate accounts at beginning of year	2015-06-30	$2,938,891
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2015-06-30	$34,906
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2015-06-30	$50,157
Net investment gain/loss from pooled separate accounts	2015-06-30	$93,849
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2015-06-30	No
Was there a failure to transmit to the plan any participant contributions	2015-06-30	No
Has the plan failed to provide any benefit when due under the plan	2015-06-30	No
Contributions received in cash from employer	2015-06-30	$52,487
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2015-06-30	$324,981
Contract administrator fees	2015-06-30	$7,851
Did the plan have assets held for investment	2015-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2015-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2015-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2015-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2015-06-30	Disclaimer
Accountancy firm name	2015-06-30	WIPFLI LLP
Accountancy firm EIN	2015-06-30	390758449
2014 : THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2014 401k financial data
Total income from all sources (including contributions)	2014-06-30	$675,664
Total of all expenses incurred	2014-06-30	$205,972
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2014-06-30	$199,082
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2014-06-30	$219,008
Value of total assets at end of year	2014-06-30	$2,989,048
Value of total assets at beginning of year	2014-06-30	$2,519,356
Total of administrative expenses incurred including professional, contract, advisory and management fees	2014-06-30	$6,890
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2014-06-30	No
Was this plan covered by a fidelity bond	2014-06-30	Yes
Value of fidelity bond cover	2014-06-30	$252,000
If this is an individual account plan, was there a blackout period	2014-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2014-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2014-06-30	No
Contributions received from participants	2014-06-30	$164,079
Other income not declared elsewhere	2014-06-30	$772
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Value of net income/loss	2014-06-30	$469,692
Value of net assets at end of year (total assets less liabilities)	2014-06-30	$2,989,048
Value of net assets at beginning of year (total assets less liabilities)	2014-06-30	$2,519,356
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2014-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2014-06-30	No
Were any leases to which the plan was party in default or uncollectible	2014-06-30	No
Value of interest in pooled separate accounts at end of year	2014-06-30	$2,938,891
Value of interest in pooled separate accounts at beginning of year	2014-06-30	$2,455,501
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2014-06-30	$50,157
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2014-06-30	$63,855
Net investment gain/loss from pooled separate accounts	2014-06-30	$455,884
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2014-06-30	No
Was there a failure to transmit to the plan any participant contributions	2014-06-30	No
Has the plan failed to provide any benefit when due under the plan	2014-06-30	No
Contributions received in cash from employer	2014-06-30	$54,929
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2014-06-30	$199,082
Contract administrator fees	2014-06-30	$6,890
Did the plan have assets held for investment	2014-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2014-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2014-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2014-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2014-06-30	Disclaimer
Accountancy firm name	2014-06-30	WIPFLI LLP
Accountancy firm EIN	2014-06-30	390758449
2013 : THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2013 401k financial data
Total unrealized appreciation/depreciation of assets	2013-06-30	$0
Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities)	2013-06-30	$0
Total income from all sources (including contributions)	2013-06-30	$721,285
Total loss/gain on sale of assets	2013-06-30	$0
Total of all expenses incurred	2013-06-30	$688,568
Benefit payments and payments to participlants,beneficiaries,insurance carriers and others	2013-06-30	$682,418
Total contributions o plan (from employers,participants, others, non cash contrinutions)	2013-06-30	$417,661
Value of total assets at end of year	2013-06-30	$2,519,356
Value of total assets at beginning of year	2013-06-30	$2,486,639
Total of administrative expenses incurred including professional, contract, advisory and management fees	2013-06-30	$6,150
Total interest from all sources	2013-06-30	$0
Total dividends received (eg from common stock, registered investment company shares)	2013-06-30	$0
Has a resolution to terminate the plan been adopted during the plan year or any prior plan year	2013-06-30	No
Was this plan covered by a fidelity bond	2013-06-30	Yes
Value of fidelity bond cover	2013-06-30	$230,000
If this is an individual account plan, was there a blackout period	2013-06-30	No
Total value of distributions paid in property other than in cash, annuity contracts, or publicly traded employer securities	2013-06-30	$0
Were there any nonexempt tranactions with any party-in-interest	2013-06-30	No
Contributions received from participants	2013-06-30	$185,555
Other income not declared elsewhere	2013-06-30	$1,376
Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Value of net income/loss	2013-06-30	$32,717
Value of net assets at end of year (total assets less liabilities)	2013-06-30	$2,519,356
Value of net assets at beginning of year (total assets less liabilities)	2013-06-30	$2,486,639
Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond)	2013-06-30	No
Were any loans by the plan or fixed income obligations due to the plan in default	2013-06-30	No
Were any leases to which the plan was party in default or uncollectible	2013-06-30	No
Value of interest in pooled separate accounts at end of year	2013-06-30	$2,455,501
Value of interest in pooled separate accounts at beginning of year	2013-06-30	$2,371,259
Value of funds held in insurance company general accounts (unallocated contracts) at end of year	2013-06-30	$63,855
Value of funds held in insurance company general accounts (unallocated contracts) at beginning of year	2013-06-30	$115,380
Net investment gain/loss from pooled separate accounts	2013-06-30	$302,248
Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets	2013-06-30	No
Was there a failure to transmit to the plan any participant contributions	2013-06-30	No
Has the plan failed to provide any benefit when due under the plan	2013-06-30	No
Contributions received in cash from employer	2013-06-30	$232,106
Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers	2013-06-30	$682,418
Contract administrator fees	2013-06-30	$6,150
Was the provided the required notice or one of the exceptions to providing the black out period notice applied under 29 CFR 2520.101-3	2013-06-30	No
Did the plan have assets held for investment	2013-06-30	Yes
Did the plan hold any assets whose current value was neither redily determinable on an established market nor set by an independent third party appraiser	2013-06-30	No
Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC	2013-06-30	No
Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d)	2013-06-30	Yes
Opinion of an independent qualified public accountant for this plan	2013-06-30	Disclaimer
Accountancy firm name	2013-06-30	WIPFLI LLP
Accountancy firm EIN	2013-06-30	390758449

Form 5500 Responses for THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC.

2019: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2019 form 5500 responses
2019-07-01	Type of plan entity	Single employer plan
2019-07-01	Plan funding arrangement – Insurance	Yes
2019-07-01	Plan funding arrangement – Trust	Yes
2019-07-01	Plan benefit arrangement – Insurance	Yes
2019-07-01	Plan benefit arrangement - Trust	Yes
2018: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2018 form 5500 responses
2018-07-01	Type of plan entity	Single employer plan
2018-07-01	Plan funding arrangement – Insurance	Yes
2018-07-01	Plan funding arrangement – Trust	Yes
2018-07-01	Plan benefit arrangement – Insurance	Yes
2018-07-01	Plan benefit arrangement - Trust	Yes
2017: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2017 form 5500 responses
2017-07-01	Type of plan entity	Single employer plan
2017-07-01	Plan funding arrangement – Insurance	Yes
2017-07-01	Plan funding arrangement – Trust	Yes
2017-07-01	Plan benefit arrangement – Insurance	Yes
2017-07-01	Plan benefit arrangement - Trust	Yes
2016: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2016 form 5500 responses
2016-07-01	Type of plan entity	Single employer plan
2016-07-01	Plan funding arrangement – Insurance	Yes
2016-07-01	Plan funding arrangement – Trust	Yes
2016-07-01	Plan benefit arrangement – Insurance	Yes
2016-07-01	Plan benefit arrangement - Trust	Yes
2015: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2015 form 5500 responses
2015-07-01	Type of plan entity	Single employer plan
2015-07-01	Plan funding arrangement – Insurance	Yes
2015-07-01	Plan funding arrangement – Trust	Yes
2015-07-01	Plan benefit arrangement – Insurance	Yes
2015-07-01	Plan benefit arrangement - Trust	Yes
2014: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2014 form 5500 responses
2014-07-01	Type of plan entity	Single employer plan
2014-07-01	Plan funding arrangement – Insurance	Yes
2014-07-01	Plan funding arrangement – Trust	Yes
2014-07-01	Plan benefit arrangement – Insurance	Yes
2014-07-01	Plan benefit arrangement - Trust	Yes
2013: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2013 form 5500 responses
2013-07-01	Type of plan entity	Single employer plan
2013-07-01	Plan funding arrangement – Insurance	Yes
2013-07-01	Plan funding arrangement – Trust	Yes
2013-07-01	Plan benefit arrangement – Insurance	Yes
2013-07-01	Plan benefit arrangement - Trust	Yes
2012: THE RETIREMENT PLAN OF NORTHERN ILLINOIS BLOOD BANK, INC. 2012 form 5500 responses
2012-07-01	Type of plan entity	Single employer plan
2012-07-01	Submission has been amended	No
2012-07-01	This submission is the final filing	No
2012-07-01	This return/report is a short plan year return/report (less than 12 months)	No
2012-07-01	Plan is a collectively bargained plan	No
2012-07-01	Plan funding arrangement – Insurance	Yes
2012-07-01	Plan funding arrangement – Trust	Yes
2012-07-01	Plan benefit arrangement – Insurance	Yes
2012-07-01	Plan benefit arrangement - Trust	Yes

Insurance Providers Used on plan

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

999099

Policy instance

Insurance contract or identification number	999099
Number of Individuals Covered	88
Insurance policy start date	2019-07-01
Insurance policy end date	2020-06-30
Total amount of commissions paid to insurance broker	USD $6,794
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,465
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

999099

Policy instance

Insurance contract or identification number	999099
Number of Individuals Covered	92
Insurance policy start date	2018-07-01
Insurance policy end date	2019-06-30
Total amount of commissions paid to insurance broker	USD $8,357
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,262
Insurance broker organization code?	3

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

999099

Policy instance

Insurance contract or identification number	999099
Number of Individuals Covered	93
Insurance policy start date	2017-07-01
Insurance policy end date	2018-06-30
Total amount of commissions paid to insurance broker	USD $8,925
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $4,552
Insurance broker organization code?	3
Insurance broker name	RBC CAPITAL MARKETS LLC

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

999099-000

Policy instance

Insurance contract or identification number	999099-000
Number of Individuals Covered	93
Insurance policy start date	2015-07-01
Insurance policy end date	2016-07-30
Total amount of commissions paid to insurance broker	USD $7,453
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,801
Insurance broker organization code?	3
Insurance broker name	RBC CAPITAL MARKETS LLC

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

999099-000

Policy instance

Insurance contract or identification number	999099-000
Insurance policy start date	2014-07-01
Insurance policy end date	2015-07-30
Total amount of commissions paid to insurance broker	USD $7,584
Commission paid to Insurance Broker	USD $3,868
Insurance broker organization code?	3
Insurance broker name	MATTHEW M MONTALBANO

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

999099-000

Policy instance

Insurance contract or identification number	999099-000
Insurance policy start date	2013-07-01
Insurance policy end date	2014-07-30
Total amount of commissions paid to insurance broker	USD $6,868
Are there contracts with unallocated funds for contract types other than deposit administration, immediate participation guarantee or guaranteed investment?	Yes
Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500?	No
Commission paid to Insurance Broker	USD $3,503
Insurance broker organization code?	3
Insurance broker name	MATTHEW M MONTALBANO

TRANSAMERICA LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 86231 )

Policy contract number

999099

Policy instance

Insurance contract or identification number	999099
Number of Individuals Covered	112
Insurance policy start date	2012-07-01
Insurance policy end date	2013-06-30
Total amount of commissions paid to insurance broker	USD $6,128
Total amount of fees paid to insurance company	USD $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 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?	Yes
Health Insurance Welfare Benefit	No
Dental Insurance Welfare Benefit	No
Vision Insurance Welfare Benefit	No
Life Insurance Welfare Benefit	No
Temporary Disability Insurance Welfare Benefit	No
Long Term Disability Insurance Welfare Benefit	No
Unemployment Insurance Welfare Benefit	No
Were dividends or retroactive rate refunds paid in cash?	No
Were dividends or retroactive rate refunds paid as a credit?	No
Commission paid to Insurance Broker	USD $3,125
Insurance broker organization code?	3
Insurance broker name	MATTHEW M MONTALBANO

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Company Name:	NORTHERN ILLINOIS BLOOD BANK, INC. D/B/A ROCK RIVER VALLEY BLOOD CTR
Employer identification number (EIN):	362334632
NAIC Classification:	621900