TRUSTEES OF LIQUOR & ALLIED WORKER LOCAL NO 3 HEALTH & WELFARE has sponsored the creation of one or more 401k plans.
Submission information for form 5500 for 401k plan LOCAL 3 LIQUOR & ALLIED WORKERS HEALTH & WELFARE
401k plan membership statisitcs for LOCAL 3 LIQUOR & ALLIED WORKERS HEALTH & WELFARE
| Measure | Date | Value |
|---|
| 2014 : LOCAL 3 LIQUOR & ALLIED WORKERS HEALTH & WELFARE 2014 401k financial data |
|---|
| Total transfer of assets from this plan | 2014-09-30 | $922,832 |
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-09-30 | $0 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2014-09-30 | $1,762,475 |
| Total income from all sources (including contributions) | 2014-09-30 | $5,057,429 |
| Total of all expenses incurred | 2014-09-30 | $5,081,414 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2014-09-30 | $5,001,134 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2014-09-30 | $5,056,295 |
| Value of total assets at end of year | 2014-09-30 | $0 |
| Value of total assets at beginning of year | 2014-09-30 | $2,709,292 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2014-09-30 | $80,280 |
| Total interest from all sources | 2014-09-30 | $1,134 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2014-09-30 | No |
| Administrative expenses professional fees incurred | 2014-09-30 | $17,900 |
| Was this plan covered by a fidelity bond | 2014-09-30 | Yes |
| Value of fidelity bond cover | 2014-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2014-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2014-09-30 | No |
| Contributions received from participants | 2014-09-30 | $7,650 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2014-09-30 | $354,517 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2014-09-30 | $1,161,538 |
| Administrative expenses (other) incurred | 2014-09-30 | $62,380 |
| Liabilities. Value of operating payables at end of year | 2014-09-30 | $0 |
| Liabilities. Value of operating payables at beginning of year | 2014-09-30 | $84,975 |
| Total non interest bearing cash at end of year | 2014-09-30 | $0 |
| Total non interest bearing cash at beginning of year | 2014-09-30 | $229,223 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2014-09-30 | No |
| Value of net income/loss | 2014-09-30 | $-23,985 |
| Value of net assets at end of year (total assets less liabilities) | 2014-09-30 | $0 |
| Value of net assets at beginning of year (total assets less liabilities) | 2014-09-30 | $946,817 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2014-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2014-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2014-09-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2014-09-30 | $0 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2014-09-30 | $1,315,891 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2014-09-30 | $1,315,891 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2014-09-30 | $1,134 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2014-09-30 | $734,177 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2014-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2014-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2014-09-30 | No |
| Contributions received in cash from employer | 2014-09-30 | $5,048,645 |
| Employer contributions (assets) at end of year | 2014-09-30 | $0 |
| Employer contributions (assets) at beginning of year | 2014-09-30 | $2,640 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2014-09-30 | $3,912,440 |
| 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 | 2014-09-30 | No |
| Liabilities. Value of benefit claims payable at end of year | 2014-09-30 | $0 |
| Liabilities. Value of benefit claims payable at beginning of year | 2014-09-30 | $1,677,500 |
| Did the plan have assets held for investment | 2014-09-30 | No |
| 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 | 2014-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2014-09-30 | Yes |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2014-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2014-09-30 | Unqualified |
| Accountancy firm name | 2014-09-30 | CALIBRE CPA GROUP PLLC |
| Accountancy firm EIN | 2014-09-30 | 470900880 |
| 2013 : LOCAL 3 LIQUOR & ALLIED WORKERS HEALTH & WELFARE 2013 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-09-30 | $1,762,475 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2013-09-30 | $2,191,170 |
| Total income from all sources (including contributions) | 2013-09-30 | $7,986,902 |
| Total of all expenses incurred | 2013-09-30 | $8,918,945 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2013-09-30 | $8,838,468 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2013-09-30 | $7,984,166 |
| Value of total assets at end of year | 2013-09-30 | $2,709,292 |
| Value of total assets at beginning of year | 2013-09-30 | $4,070,030 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2013-09-30 | $80,477 |
| Total interest from all sources | 2013-09-30 | $2,736 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2013-09-30 | No |
| Administrative expenses professional fees incurred | 2013-09-30 | $15,750 |
| Was this plan covered by a fidelity bond | 2013-09-30 | Yes |
| Value of fidelity bond cover | 2013-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2013-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2013-09-30 | No |
| Contributions received from participants | 2013-09-30 | $19,193 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2013-09-30 | $460,468 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2013-09-30 | $1,161,538 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2013-09-30 | $1,380,967 |
| Administrative expenses (other) incurred | 2013-09-30 | $64,727 |
| Liabilities. Value of operating payables at end of year | 2013-09-30 | $84,975 |
| Liabilities. Value of operating payables at beginning of year | 2013-09-30 | $73,670 |
| Total non interest bearing cash at end of year | 2013-09-30 | $229,223 |
| Total non interest bearing cash at beginning of year | 2013-09-30 | $198,543 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2013-09-30 | No |
| Value of net income/loss | 2013-09-30 | $-932,043 |
| Value of net assets at end of year (total assets less liabilities) | 2013-09-30 | $946,817 |
| Value of net assets at beginning of year (total assets less liabilities) | 2013-09-30 | $1,878,860 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2013-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2013-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2013-09-30 | No |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2013-09-30 | $1,315,891 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2013-09-30 | $1,897,938 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2013-09-30 | $1,897,938 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2013-09-30 | $2,736 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2013-09-30 | $1,049,487 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2013-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2013-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2013-09-30 | No |
| Contributions received in cash from employer | 2013-09-30 | $7,964,973 |
| Employer contributions (assets) at end of year | 2013-09-30 | $2,640 |
| Employer contributions (assets) at beginning of year | 2013-09-30 | $592,582 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2013-09-30 | $7,328,513 |
| Liabilities. Value of benefit claims payable at end of year | 2013-09-30 | $1,677,500 |
| Liabilities. Value of benefit claims payable at beginning of year | 2013-09-30 | $2,117,500 |
| Did the plan have assets held for investment | 2013-09-30 | 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 | 2013-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2013-09-30 | No |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2013-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2013-09-30 | Unqualified |
| Accountancy firm name | 2013-09-30 | CALIBRE CPA GROUP PLLC |
| Accountancy firm EIN | 2013-09-30 | 470900880 |
| 2012 : LOCAL 3 LIQUOR & ALLIED WORKERS HEALTH & WELFARE 2012 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-09-30 | $2,191,170 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2012-09-30 | $1,044,789 |
| Total income from all sources (including contributions) | 2012-09-30 | $7,195,682 |
| Total of all expenses incurred | 2012-09-30 | $8,131,278 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2012-09-30 | $8,050,713 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2012-09-30 | $7,193,119 |
| Value of total assets at end of year | 2012-09-30 | $4,070,030 |
| Value of total assets at beginning of year | 2012-09-30 | $3,859,245 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2012-09-30 | $80,565 |
| Total interest from all sources | 2012-09-30 | $2,563 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2012-09-30 | No |
| Administrative expenses professional fees incurred | 2012-09-30 | $16,208 |
| Was this plan covered by a fidelity bond | 2012-09-30 | Yes |
| Value of fidelity bond cover | 2012-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2012-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2012-09-30 | No |
| Contributions received from participants | 2012-09-30 | $36,471 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2012-09-30 | $449,374 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2012-09-30 | $1,380,967 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2012-09-30 | $455,681 |
| Administrative expenses (other) incurred | 2012-09-30 | $64,357 |
| Liabilities. Value of operating payables at end of year | 2012-09-30 | $73,670 |
| Liabilities. Value of operating payables at beginning of year | 2012-09-30 | $62,789 |
| Total non interest bearing cash at end of year | 2012-09-30 | $198,543 |
| Total non interest bearing cash at beginning of year | 2012-09-30 | $191,307 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2012-09-30 | No |
| Value of net income/loss | 2012-09-30 | $-935,596 |
| Value of net assets at end of year (total assets less liabilities) | 2012-09-30 | $1,878,860 |
| Value of net assets at beginning of year (total assets less liabilities) | 2012-09-30 | $2,814,456 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2012-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2012-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2012-09-30 | No |
| Income. Interest from US Government securities | 2012-09-30 | $1,414 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2012-09-30 | $1,897,938 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2012-09-30 | $1,282,938 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2012-09-30 | $1,282,938 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2012-09-30 | $1,149 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2012-09-30 | $864,165 |
| Asset value of US Government securities at beginning of year | 2012-09-30 | $1,499,924 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2012-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2012-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2012-09-30 | No |
| Contributions received in cash from employer | 2012-09-30 | $7,156,648 |
| Employer contributions (assets) at end of year | 2012-09-30 | $592,582 |
| Employer contributions (assets) at beginning of year | 2012-09-30 | $429,395 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2012-09-30 | $6,737,174 |
| Liabilities. Value of benefit claims payable at end of year | 2012-09-30 | $2,117,500 |
| Liabilities. Value of benefit claims payable at beginning of year | 2012-09-30 | $982,000 |
| Did the plan have assets held for investment | 2012-09-30 | 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 | 2012-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2012-09-30 | No |
| Aggregate proceeds on sale of assets | 2012-09-30 | $6,699,419 |
| Aggregate carrying amount (costs) on sale of assets | 2012-09-30 | $6,699,419 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2012-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2012-09-30 | Unqualified |
| Accountancy firm name | 2012-09-30 | DI GIOVANNI, MCLAREN & ASSOC. PC |
| Accountancy firm EIN | 2012-09-30 | 364173708 |
| 2011 : LOCAL 3 LIQUOR & ALLIED WORKERS HEALTH & WELFARE 2011 401k financial data |
|---|
| Total liabilities at end of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-09-30 | $1,044,789 |
| Total liabilities at beginning of year (benefit claims payable, operating payabales, acquisition indebtedness and other liabilities) | 2011-09-30 | $846,528 |
| Total income from all sources (including contributions) | 2011-09-30 | $6,746,854 |
| Total of all expenses incurred | 2011-09-30 | $7,259,888 |
| Benefit payments and payments to participlants,beneficiaries,insurance carriers and others | 2011-09-30 | $7,176,848 |
| Total contributions o plan (from employers,participants, others, non cash contrinutions) | 2011-09-30 | $6,741,415 |
| Value of total assets at end of year | 2011-09-30 | $3,859,245 |
| Value of total assets at beginning of year | 2011-09-30 | $4,174,018 |
| Total of administrative expenses incurred including professional, contract, advisory and management fees | 2011-09-30 | $83,040 |
| Total interest from all sources | 2011-09-30 | $5,439 |
| Has a resolution to terminate the plan been adopted during the plan year or any prior plan year | 2011-09-30 | No |
| Administrative expenses professional fees incurred | 2011-09-30 | $15,500 |
| Was this plan covered by a fidelity bond | 2011-09-30 | Yes |
| Value of fidelity bond cover | 2011-09-30 | $500,000 |
| If this is an individual account plan, was there a blackout period | 2011-09-30 | No |
| Were there any nonexempt tranactions with any party-in-interest | 2011-09-30 | No |
| Contributions received from participants | 2011-09-30 | $61,760 |
| Expenses. Other payments made (not to insurance carriers or or participants/beneficiaries) | 2011-09-30 | $400,266 |
| Value of other receiveables (less allowance for doubtful accounts) at end of year | 2011-09-30 | $455,681 |
| Value of other receiveables (less allowance for doubtful accounts) at beginning of year | 2011-09-30 | $230,709 |
| Administrative expenses (other) incurred | 2011-09-30 | $67,540 |
| Liabilities. Value of operating payables at end of year | 2011-09-30 | $62,789 |
| Liabilities. Value of operating payables at beginning of year | 2011-09-30 | $51,528 |
| Total non interest bearing cash at end of year | 2011-09-30 | $191,307 |
| Total non interest bearing cash at beginning of year | 2011-09-30 | $229,113 |
| Did the receive any noncash contributions whose value was neither redily determinable on an established market nor set by an independent third party appraiser | 2011-09-30 | No |
| Value of net income/loss | 2011-09-30 | $-513,034 |
| Value of net assets at end of year (total assets less liabilities) | 2011-09-30 | $2,814,456 |
| Value of net assets at beginning of year (total assets less liabilities) | 2011-09-30 | $3,327,490 |
| Did the plan have a loss casued by fraud or dishonesty (regardless whether reimbursed by fidelity bond) | 2011-09-30 | No |
| Were any loans by the plan or fixed income obligations due to the plan in default | 2011-09-30 | No |
| Were any leases to which the plan was party in default or uncollectible | 2011-09-30 | No |
| Income. Interest from US Government securities | 2011-09-30 | $1,820 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at end of year | 2011-09-30 | $1,282,938 |
| Interest-bearing cash (include money market accounts & certificates of deposit) at beginning of the Year | 2011-09-30 | $1,961,587 |
| Value of interest bearing cash (including money market accounts and certificates of deposits) at beginning of year | 2011-09-30 | $1,961,587 |
| Interest earned from interest bearing cash (including money market accounts and certificates of deposit) | 2011-09-30 | $3,619 |
| Expenses. Payments to insurance carriers foe the provision of benefits | 2011-09-30 | $764,329 |
| Asset value of US Government securities at end of year | 2011-09-30 | $1,499,924 |
| Asset value of US Government securities at beginning of year | 2011-09-30 | $1,498,938 |
| Were any plan transactions or series of transactions in excess of 5% of the current value of the plan assets | 2011-09-30 | Yes |
| Was there a failure to transmit to the plan any participant contributions | 2011-09-30 | No |
| Has the plan failed to provide any benefit when due under the plan | 2011-09-30 | No |
| Contributions received in cash from employer | 2011-09-30 | $6,679,655 |
| Employer contributions (assets) at end of year | 2011-09-30 | $429,395 |
| Employer contributions (assets) at beginning of year | 2011-09-30 | $253,671 |
| Benefit payments and payments to provide benefits directly to participlants or beneficiaries including direct rollovers | 2011-09-30 | $6,012,253 |
| Liabilities. Value of benefit claims payable at end of year | 2011-09-30 | $982,000 |
| Liabilities. Value of benefit claims payable at beginning of year | 2011-09-30 | $795,000 |
| Did the plan have assets held for investment | 2011-09-30 | 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 | 2011-09-30 | No |
| Were all the plan assets eitehr distributed to particpants/beneficiaries, transferred to another plan or brought under the control of the PBGC | 2011-09-30 | No |
| Aggregate proceeds on sale of assets | 2011-09-30 | $7,200,000 |
| Aggregate carrying amount (costs) on sale of assets | 2011-09-30 | $7,200,000 |
| Accountant perfomed limited scope audit pursuant to 29 CFR 2520.103-8 and/or 103-12(d) | 2011-09-30 | No |
| Opinion of an independent qualified public accountant for this plan | 2011-09-30 | Unqualified |
| Accountancy firm name | 2011-09-30 | DI GIOVANNI, MCLAREN & ASSOC. PC |
| Accountancy firm EIN | 2011-09-30 | 364173708 |
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F007874 |
| Policy instance | 1 |
| Insurance contract or identification number | F007874 | | Number of Individuals Covered | 421 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2014-09-30 | | Total amount of commissions paid to insurance broker | USD $1,970 | | Total amount of fees paid to insurance company | USD $1,001 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $19,697 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $1,970 | | Amount paid for insurance broker fees | 1001 | | Additional information about fees paid to insurance broker | ADDITONAL COMPENSATION | | Insurance broker name | ELITE ADMINISTRATION & INS GROUP IN |
|
| TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
| Policy contract number | JG704 |
| Policy instance | 3 |
| Insurance contract or identification number | JG704 | | Number of Individuals Covered | 1173 | | Insurance policy start date | 2013-10-01 | | Insurance policy end date | 2013-11-01 | | Total amount of commissions paid to insurance broker | USD $11,562 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $96,350 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $11,562 | | Insurance broker name | ELITE ADMINISTRATION & INS GROUP IN |
|
| GERBER LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 70939 ) |
| Policy contract number | GB00218IL-01 |
| Policy instance | 2 |
| Insurance contract or identification number | GB00218IL-01 | | Number of Individuals Covered | 386 | | Insurance policy start date | 2013-11-01 | | Insurance policy end date | 2014-10-31 | | Total amount of commissions paid to insurance broker | USD $75,241 | | Total amount of fees paid to insurance company | USD $0 | | Contract purchased, in whole or in part, to distribute benefits from a terminating plan | No | | Contracts With Unallocated Funds Deposit Administration | 0 | | Welfare Benefit Premiums Paid to Carrier | USD $686,006 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $75,241 | | Insurance broker name | ELITE ADMINISTRATION & INS GROUP IN |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 30 033609 |
| Policy instance | 1 |
| Insurance contract or identification number | 30 033609 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2012-10-01 | | Insurance policy end date | 2013-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $35,565 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F007874 |
| Policy instance | 2 |
| Insurance contract or identification number | F007874 | | Number of Individuals Covered | 620 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $2,255 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,553 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $2,255 | | Insurance broker organization code? | 3 | | Insurance broker name | ELITE ADMINISTRATION & INSURANCE |
|
| TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
| Policy contract number | JG703 |
| Policy instance | 3 |
| Insurance contract or identification number | JG703 | | Number of Individuals Covered | 619 | | Insurance policy start date | 2011-11-01 | | Insurance policy end date | 2012-10-31 | | Total amount of commissions paid to insurance broker | USD $111,099 | | Welfare Benefit Premiums Paid to Carrier | USD $822,952 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No | | Commission paid to Insurance Broker | USD $111,099 | | Insurance broker organization code? | 3 | | Insurance broker name | ELITE ADMINISTRATION |
|
| TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
| Policy contract number | JG703 |
| Policy instance | 3 |
| Insurance contract or identification number | JG703 | | Number of Individuals Covered | 611 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $90,160 | | Welfare Benefit Premiums Paid to Carrier | USD $698,302 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F007874 |
| Policy instance | 2 |
| Insurance contract or identification number | F007874 | | Number of Individuals Covered | 607 | | Insurance policy start date | 2010-11-01 | | Insurance policy end date | 2011-10-31 | | Total amount of commissions paid to insurance broker | USD $2,178 | | Total amount of fees paid to insurance company | USD $132 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $21,775 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MID AMERICA BENEFITS INC (National Association of Insurance Commissioners NAIC id number: 70793 ) |
| Policy contract number | 3010-300 |
| Policy instance | 1 |
| Insurance contract or identification number | 3010-300 | | Number of Individuals Covered | 290 | | Insurance policy start date | 2011-10-01 | | Insurance policy end date | 2012-05-31 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $18,616 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | Yes |
|
| VISION SERVICE PLAN (National Association of Insurance Commissioners NAIC id number: 12516 ) |
| Policy contract number | 30 033609 |
| Policy instance | 4 |
| Insurance contract or identification number | 30 033609 | | Number of Individuals Covered | 284 | | Insurance policy start date | 2012-06-01 | | Insurance policy end date | 2012-10-31 | | Welfare Benefit Premiums Paid to Carrier | USD $11,924 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| TRUSTMARK INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 61425 ) |
| Policy contract number | JG703 |
| Policy instance | 3 |
| Insurance contract or identification number | JG703 | | Number of Individuals Covered | 621 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $77,189 | | Welfare Benefit Premiums Paid to Carrier | USD $617,515 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| DEARBORN NATIONAL LIFE INSURANCE COMPANY (National Association of Insurance Commissioners NAIC id number: 71129 ) |
| Policy contract number | F007874 |
| Policy instance | 2 |
| Insurance contract or identification number | F007874 | | Number of Individuals Covered | 612 | | Insurance policy start date | 2009-11-01 | | Insurance policy end date | 2010-10-31 | | Total amount of commissions paid to insurance broker | USD $2,205 | | Life Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $22,047 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
|
| MID AMERICA BENEFITS INC (National Association of Insurance Commissioners NAIC id number: 70793 ) |
| Policy contract number | 3010-300 |
| Policy instance | 1 |
| Insurance contract or identification number | 3010-300 | | Number of Individuals Covered | 281 | | Insurance policy start date | 2010-10-01 | | Insurance policy end date | 2011-09-30 | | Vision Insurance Welfare Benefit | Yes | | Welfare Benefit Premiums Paid to Carrier | USD $28,232 | | Did the insurance company fail to provide any information necessary to complete Schedule A of form 5500? | No |
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